Texas health plan · 2025

UHC Kelsey-Seybold Gold Copay Focus ($5 Tier 2 Rx) · 40220TX0080034

UnitedHealthcare of Texas, Inc. offers this marketplace health insurance plan (Plan ID 40220TX0080034) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Gold Plan type: HMO CSR: Standard Gold On Exchange Plan Issuer: UnitedHealthcare of Texas, Inc.
Telehealth Data pending HSA eligible No Dental Child Vision Child
Pay / Manage Plan View issuer site

Issuer actuarial value: 81.41%. Expect to pay roughly 18.59% of covered costs out of pocket, based on issuer reporting.

2025 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$282 – $1133

Before subsidies

Estimate after subsidies

Deductible

N/A

N/A

See deductible details

Max out-of-pocket

$7,000

$14000 per group

Review MOOP rules

Office visits

Primary care $10.00
Specialist $40.00
HSA Not eligible

Drug tiers

Generic $5.00
Preferred brand $50.00

View formulary tiers

$396 / mo before subsidies

≈ $4751 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$1225 / mo before subsidies

≈ $14702 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$1484 / mo before subsidies

≈ $17806 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$943 / mo before subsidies

≈ $11316 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

$1,000.00

Durable Medical Equipment

45.00%

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Enrollment guidance

Stay on top of 2025 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Texas). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • Standard Gold On Exchange Plan plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

$1,000.00

Durable Medical Equipment

45.00%

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 40220TX0080034
Coverage year 2025
State Texas
Issuer UnitedHealthcare of Texas, Inc.
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 40220TX0080034-01
Available variants

Standard Off Exchange Plan · 40220TX0080034-00

Standard On Exchange Plan · 40220TX0080034-01

Open to Indians below 300% FPL · 40220TX0080034-02

Open to Indians above 300% FPL · 40220TX0080034-03
Last plan update Fri, 16 Aug 2024 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Texas 78
PCPs in Texas 13
Telehealth support Data pending
Nationwide providers 90
78 doctors statewide 13 PCPs

Provider network(s)

Providers Texas All US states
All 78 90
PCP 13 16
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A

Drug coverage overview

3,749 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
NON-PREFERRED-BRAND 1,438
PREFERRED-GENERIC 1,402
ZERO-COST-SHARE-PREVENTIVE 477
SPECIALTY 432
Prior authorization Drugs
Required 681
Not Required 3,068
Step therapy Drugs
Required 51
Not Required 3,698
Quantity limits Drugs
Has Limit 1,739
No Limit 2,010

Customer highlights

What stands out for members

  • Issuer: UnitedHealthcare of Texas, Inc. · Plan ID 40220TX0080034 · 2025 filing.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 40220TX0080034-01 (Standard On Exchange Plan) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

45.00%
Tier 1 in-network 45.00%
Out-of-network 100.00%

Limit: 35.0 Visit(s) per Year

nan

Exclusions: nan

Diabetes Education

45.00%
Tier 1 in-network 45.00%
Out-of-network 100.00%

nan

Exclusions: nan

Home Health Care Services

45.00%
Tier 1 in-network 45.00%
Out-of-network 100.00%

Limit: 60.0 Visit(s) per Year

nan

Exclusions: nan

Laboratory Outpatient and Professional Services

$5.00
Tier 1 in-network $5.00
Out-of-network 100.00%

nan

Exclusions: nan

Other Practitioner Office Visit (Nurse, Physician Assistant)

45.00%
Tier 1 in-network 45.00%
Out-of-network 100.00%

nan

Exclusions: nan

Preventive Care/Screening/Immunization

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Primary Care Visit to Treat an Injury or Illness

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

Virtual visits may be assigned a reduced cost share. See your plan's Summary of Benefits and Coverage (SBC) for more information.

Exclusions: nan

Rehabilitative Occupational and Rehabilitative Physical Therapy

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Limit: 35.0 Visit(s) per Year

35 visits for any combination of physical therapy, occupational therapy, speech therapy and manipulative treatments.

Exclusions: nan

Rehabilitative Speech Therapy

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Limit: 35.0 Visit(s) per Year

35 visits for any combination of physical therapy, occupational therapy, speech therapy and manipulative treatments.

Exclusions: nan

Specialist Visit

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Virtual visits may be assigned a reduced cost share. See your plan's Summary of Benefits and Coverage (SBC) for more information.

Exclusions: nan

Urgent Care Centers or Facilities

$50.00
Tier 1 in-network $50.00
Out-of-network 100.00%

nan

Exclusions: nan

X-rays and Diagnostic Imaging

$65.00
Tier 1 in-network $65.00
Out-of-network 100.00%

nan

Exclusions: nan

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

$500.00
Tier 1 in-network $500.00
Out-of-network 100.00%

nan

Exclusions: nan

Delivery and All Inpatient Services for Maternity Care

$2,000.00
Tier 1 in-network $2,000.00
Out-of-network 100.00%

Childbirth/delivery professional services follow inpatient physician/surgeon fees.

Exclusions: nan

Dialysis

$500.00
Tier 1 in-network $500.00
Out-of-network 100.00%

nan

Exclusions: nan

Durable Medical Equipment

45.00%
Tier 1 in-network 45.00%
Out-of-network 100.00%

nan

Exclusions: nan

Emergency Room Services

$1,000.00
Tier 1 in-network $1,000.00
Out-of-network $1,000.00

nan

Exclusions: nan

Emergency Transportation/Ambulance

$1,000.00
Tier 1 in-network $1,000.00
Out-of-network $1,000.00

nan

Exclusions: nan

Hospice Services

45.00%
Tier 1 in-network 45.00%
Out-of-network 100.00%

nan

Exclusions: nan

Inpatient Hospital Services (e.g., Hospital Stay)

$2000.00 Copay per Day
Tier 1 in-network $2000.00 Copay per Day
Out-of-network 100.00%

nan

Exclusions: nan

Inpatient Physician and Surgical Services

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Mental/Behavioral Health Inpatient Services

$2000.00 Copay per Day
Tier 1 in-network $2000.00 Copay per Day
Out-of-network 100.00%

nan

Exclusions: nan

Mental/Behavioral Health Outpatient Services

$20.00
Tier 1 in-network $20.00
Out-of-network 100.00%

Cost share applies to office visits, please see SBC for Mental Health Outpatient Services.

Exclusions: nan

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

$300.00
Tier 1 in-network $300.00
Out-of-network 100.00%

nan

Exclusions: nan

Outpatient Rehabilitation Services

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Limit: 35.0 Visit(s) per Year

nan

Exclusions: nan

Outpatient Surgery Physician/Surgical Services

$300.00
Tier 1 in-network $300.00
Out-of-network 100.00%

nan

Exclusions: nan

Radiation

$75.00
Tier 1 in-network $75.00
Out-of-network 100.00%

nan

Exclusions: nan

Skilled Nursing Facility

$2000.00 Copay per Day
Tier 1 in-network $2000.00 Copay per Day
Out-of-network 100.00%

Limit: 25.0 Days per Year

nan

Exclusions: nan

Substance Abuse Disorder Inpatient Services

$2000.00 Copay per Day
Tier 1 in-network $2000.00 Copay per Day
Out-of-network 100.00%

nan

Exclusions: nan

Substance Abuse Disorder Outpatient Services

$20.00
Tier 1 in-network $20.00
Out-of-network 100.00%

nan

Exclusions: nan

Transplant

$2,000.00
Tier 1 in-network $2,000.00
Out-of-network 100.00%

nan

Exclusions: nan

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

45.00%
Tier 1 in-network 45.00%
Out-of-network 100.00%

Benefit limitations may apply to individual services.

Exclusions: nan

Hearing Aids

45.00%
Tier 1 in-network 45.00%
Out-of-network 100.00%

Limit: 1.0 Item(s) per 3 Years

Benefits are limited to a single purchase per hearing impaired ear every 36 months.

Exclusions: nan

Major Dental Care - Child

45.00%
Tier 1 in-network 45.00%
Out-of-network 100.00%

Benefit limitations may apply to individual services.

Exclusions: nan

Prenatal and Postnatal Care

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Routine Eye Exam for Children

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Limit: 1.0 Visit(s) per Year

nan

Exclusions: nan

Well Baby Visits and Care

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$5.00
Tier 1 in-network $5.00
Out-of-network 100.00%

Limit: 30.0 Days per Month

Members can obtain a 1 month supply through network pharmacies or home delivery. Members also have the option to receive a 3 month supply through network pharmacy or home delivery. Other quantity limits may apply. Check the plan's Summary of Benefits or Prescription Drug List for more information.

Exclusions: nan

Non-Preferred Brand Drugs

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 30.0 Days per Month

Members can obtain a 1 month supply through network pharmacies or home delivery. Members also have the option to receive a 3 month supply through network pharmacy or home delivery. Other quantity limits may apply. Check the plan's Summary of Benefits or Prescription Drug List for more information.

Exclusions: nan

Preferred Brand Drugs

$50.00
Tier 1 in-network $50.00
Out-of-network 100.00%

Limit: 30.0 Days per Month

Members can obtain a 1 month supply through network pharmacies or home delivery. Members also have the option to receive a 3 month supply through network pharmacy or home delivery. Other quantity limits may apply. Check the plan's Summary of Benefits or Prescription Drug List for more information.

Exclusions: nan

Specialty Drugs

45.00% Coinsurance after deductible
Tier 1 in-network 45.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 30.0 Days per Month

Specialty medications are limited to a 1-month supply. Other quantity limits may apply. Check the plan's Summary of Benefits or Prescription Drug List for more information.

Exclusions: nan

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

45.00%
Tier 1 in-network 45.00%
Out-of-network 100.00%

nan

Exclusions: nan

Basic Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Dental Check-Up for Children

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Limit: 1.0 Visit(s) per 6 Months

nan

Exclusions: nan

Infusion Therapy

$75.00
Tier 1 in-network $75.00
Out-of-network 100.00%

nan

Exclusions: nan

Major Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Nutritional Counseling

Coverage details pending

Medical or behavioral/mental health related nutritional education services that are provided as part of treatment for a disease are covered

Exclusions: nan

Orthodontia - Adult

Coverage details pending

nan

Exclusions: nan

Orthodontia - Child

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Coverage is for medically necessary orthodontia only.

Exclusions: nan

Prosthetic Devices

45.00%
Tier 1 in-network 45.00%
Out-of-network 100.00%

nan

Exclusions: nan

Routine Dental Services (Adult)

Coverage details pending

nan

Exclusions: nan

Weight Loss Programs

Coverage details pending

nan

Exclusions: nan

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

nan

Exclusions: nan

Acupuncture

Coverage details pending

nan

Exclusions: nan

Allergy Testing

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

nan

Exclusions: nan

Bariatric Surgery

Coverage details pending

nan

Exclusions: nan

Cosmetic Surgery

Coverage details pending

nan

Exclusions: nan

Eye Glasses for Children

45.00%
Tier 1 in-network 45.00%
Out-of-network 100.00%

Limit: 1.0 Item(s) per Year

nan

Exclusions: nan

Gender Affirming Care

$300.00
Tier 1 in-network $300.00
Out-of-network 100.00%

Covered when medically necessary.

Exclusions: nan

Habilitation Services

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Limit: 35.0 Visit(s) per Year

35 visits per year for any combination of physical therapy, occupational therapy, speech therapy, and manipulative treatment. Visit limits do not apply if the primary diagnosis code for the outpatient habilitative services being provided is a covered mental health or substance use disorder.

Exclusions: nan

Imaging (CT/PET Scans, MRIs)

$300.00
Tier 1 in-network $300.00
Out-of-network 100.00%

nan

Exclusions: nan

Infertility Treatment

Coverage details pending

nan

Exclusions: nan

Long-Term/Custodial Nursing Home Care

Coverage details pending

nan

Exclusions: nan

Private-Duty Nursing

45.00%
Tier 1 in-network 45.00%
Out-of-network 100.00%

Covered inpatient only when medically necessary.

Exclusions: nan

Reconstructive Surgery

$300.00
Tier 1 in-network $300.00
Out-of-network 100.00%

Reconstructive procedures are covered when the primary purpose of the procedure is either treatment of a medical condition or required to improve or restore physiologic function.

Exclusions: nan

Routine Eye Exam (Adult)

Coverage details pending

nan

Exclusions: nan

Routine Foot Care

Coverage details pending

Covered when done for the prevention of complications associated with metabolic, neurologic, or peripheral vascular disease

Exclusions: nan

Treatment for Temporomandibular Joint Disorders

45.00%
Tier 1 in-network 45.00%
Out-of-network 100.00%

nan

Exclusions: nan

Variant attributes

UHC Kelsey-Seybold Gold Copay Focus ($5 Tier 2 Rx) · Variant 40220TX0080034-01

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

Standard Gold On Exchange Plan

HIOS Product ID

40220TX008

Metal Level

Gold

Plan ID (Standard Component ID with Variant)

40220TX0080034-01

Plan Marketing Name

UHC Kelsey-Seybold Gold Copay Focus ($5 Tier 2 Rx)

Plan Variant Marketing Name

UHC Kelsey-Seybold Gold Copay Focus ($5 Tier 2 Rx)

Issuer & service area

Issuer-provided metadata for this variant.

Issuer Actuarial Value

81.41%

Issuer ID

40220

Issuer Marketplace Marketing Name

UnitedHealthcare

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

TXN012

Out of Country Coverage

No

Out of Service Area Coverage

Yes

Out of Service Area Coverage Description

Plan covers eligible expenses provided by a Network Physician or other provider or facility within the Network Area. The plan also covers emergency health care services received outside the service area.

Service Area ID

TXS012

State Code

TX

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

0.00%

Inpatient Copayment Maximum Days

3

Medical Drug Deductibles Integrated

No

Medical Drug Maximum Out of Pocket Integrated

Yes

Medical EHB Deductible, In Network (Tier 1), Default Coinsurance

45.00%

SBC Scenario, Having a Baby, Coinsurance

$0

SBC Scenario, Having a Baby, Copayment

$2,400

SBC Scenario, Having a Baby, Deductible

$0

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$300

SBC Scenario, Having Diabetes, Deductible

$0

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$20

SBC Scenario, Treatment of a Simple Fracture, Copayment

$2,300

SBC Scenario, Treatment of a Simple Fracture, Deductible

$0

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

Not Applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$14000 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$7000 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$7,000

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

Not Applicable

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

TXF040

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$0

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Drug EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Drug EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Drug EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Drug EHB Deductible, In Network (Tier 1), Family Per Group

$1000 per group

Drug EHB Deductible, In Network (Tier 1), Family Per Person

$500 per person

Drug EHB Deductible, In Network (Tier 1), Individual

$500

Drug EHB Deductible, Out of Network, Family Per Group

per group not applicable

Drug EHB Deductible, Out of Network, Family Per Person

per person not applicable

Drug EHB Deductible, Out of Network, Individual

Not Applicable

Dental Only Plan

No

Design Type

Not Applicable

EHB Percent of Total Premium

1.0

First Tier Utilization

100%

Import Date

2024-08-16 01:01:20

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

Yes

Medical EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Medical EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Medical EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Medical EHB Deductible, In Network (Tier 1), Family Per Group

$0 per group

Medical EHB Deductible, In Network (Tier 1), Family Per Person

$0 per person

Medical EHB Deductible, In Network (Tier 1), Individual

$0

Medical EHB Deductible, Out of Network, Family Per Group

per group not applicable

Medical EHB Deductible, Out of Network, Family Per Person

per person not applicable

Medical EHB Deductible, Out of Network, Individual

Not Applicable

Plan Effective Date

2025-01-01

Plan Level Exclusions

Some exclusions may apply. See the applicable Certificate of Coverage for details.

Plan Type

HMO

QHP/Non QHP

Both

Source Name

HIOS

Specialist Requiring a Referral

All, except OBGYN and as state mandated.

Plan ID

40220TX0080034

Unique Plan Design

Yes

Wellness Program Offered

No

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Texas?

UHC Kelsey-Seybold Gold Copay Focus ($5 Tier 2 Rx) (40220TX0080034) is a Gold HMO from UnitedHealthcare of Texas, Inc. in Texas for the 2025 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does UHC Kelsey-Seybold Gold Copay Focus ($5 Tier 2 Rx) support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is UHC Kelsey-Seybold Gold Copay Focus ($5 Tier 2 Rx) HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental add-ons: Child.

Vision add-ons: Child.

Does UHC Kelsey-Seybold Gold Copay Focus ($5 Tier 2 Rx) support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Is there out-of-country coverage for UHC Kelsey-Seybold Gold Copay Focus ($5 Tier 2 Rx)?

No, out-of-country services are not covered for this plan.

Does UHC Kelsey-Seybold Gold Copay Focus ($5 Tier 2 Rx) cover care outside the service area?

Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: Plan covers eligible expenses provided by a Network Physician or other provider or facility within the Network Area. The plan also covers emergency health care services received outside the service area.

How do I enroll in or manage payments for UHC Kelsey-Seybold Gold Copay Focus ($5 Tier 2 Rx)?

Use the issuer portal https://sso.uhc.com/ext/sp/ACS.saml2 to pay premiums or start enrollment, then return to HealthPorta for benefit comparisons.

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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