Sound Health in Texas by Unicare

And remember, if you're covered and stay in our network, the most you'll pay is $1,500, $3,000 or $5,000, depending on the plan you select, plus your monthly payment. *Figures based on third quarter 2005 averages from UniCare ™s claims database.

You have to spend a day in the hospital.
Average day in hospital
$5,858
You need to be flown to the hospital.
Air ambulance
$6,919
You need to be driven to the hospital.
Ambulance ride
$667
Your appendix burst.
Care and surgery for appendicitis (5 days in hospital)
$22,215
Your knee just popped.
Knee surgery
$28,863
You landed wrong. Really wrong.
Fractured ankle, compound fracture of tibia and fibula (7 days in hospital, surgery)
$52,156

Copay – The amount you pay for a doctor visit or other medical services such as an Emergency
Room visit or generic prescription drug.
Deductible – Depending on the Sound plan you choose, your deductible each year will be
$1,500, $3,000 or $5,000 – that’s how much you have to pay before UniCare starts paying for
certain services outlined in your policy booklet. Your monthly premium payments do not count
toward your deductible. You also have a separate $25 deductible for dental benefits. In some
cases, like when you go to the doctor’s office, your deductible is waived.
Emergency – The sudden onset of a medical condition with symptoms so severe that not being
treated immediately could result in one or more of the following:
Placing your health in serious jeopardy
Causing serious disfigurement
Serious impairment to bodily functions
Serious and permanent dysfunction of any organ or any other part of you
In-Network/Out-of-Network – UniCare has negotiated with more than 25,000 PPO doctors and
over 500 hospitals to provide you with quality care and services at a much lower,
in-network cost to you. Services from providers who have not contracted with UniCare will cost
you more because they charge out-of-network rates. In other words, staying in-network saves you
money.
Mail Order Service – If you take a prescription medication regularly, you can save a lot of time by
getting it through the mail. No more waiting in line at the pharmacy every month. Just check out
PrecisionRX at precisionrx.com for more information or call them at (866) 274-6826.
Office Visit – Routine physical exams, preventive care and covered professional services, lab
work, X-ray, etc. that you receive in your doctor’s office during your office visit.
Other Professional Services – X-rays, blood tests, anesthesia, etc. received separately from
professional services covered under your office visit.
Out-of-Pocket Maximum (OOP) – Your annual OOP in-network is the most you’ll have to pay for
in-network covered services within a calendar year, then UniCare pays the rest. This amount
varies depending on the plan you choose ($1,500, $3,000 or $5,000). Basically, meet your
deductible – and you’ve reached your in-network OOP. If you go out-of-network, your annual OOP
is $15,000 plus deductibles.
Participating Pharmacy – To pay the lowest possible costs for your prescriptions you should have
them filled at a participating pharmacy. In addition to all those doctors and hospitals, UniCare
has a network of over 4,000 participating pharmacies in Texas and access to over 63,000
nationwide.
Policy Booklet – A booklet with detailed information about your plan benefits that will be mailed
to you after you enroll in a Sound plan.
Premium – The payments you pay each month for Sound coverage.
PPO – PPO stands for “Preferred Provider Organization.” The UniCare PPO network is made up
of more than 25,000 doctors and over 500 hospitals that they’ve negotiated with to provide you
with services at a much lower cost to you.

*Refer to the policy booklet for a complete list of definitions, benefits, exclusions and limitations, and pre service and utilization review.

(1) the rates are illustrative only;
(2) a person should not send money to the issuer of the health benefit
plan in response to the advertisement;
(3) a person cannot obtain coverage under the health benefit plan until
the person completes an application for coverage; and
(4) benefit exclusions and limitations may apply to the health benefit plan