Sound Health Insurance by UniCare Life & Health Insurance Company—UniCare is a WellPoint company. WellPoint Inc.
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Here’s a list of FAQs about Sound Health by UniCare - Texas

Q1: What is different about Sound?

A1: Everything!

No paperwork – just a quick and easy online application that only takes about 15 minutes

Easy-to-understand health insurance designed for your lifestyle

Premium payments that you can actually afford

Includes medical, dental, vision and generic prescription drug benefits in one package

Instant approval if you qualify

There’s a dedicated customer service team just for Sound members

Q2: What Sound plans are available?

A2: There are three plans to choose from:

The Cruiser PPO Plan ($40 office visit copay/$1,500 deductible)

Curb Jumper PPO Plan ($40 office visit copay/$3,000 deductible)

Gravity Bender PPO Plan ($40 office visit copay/$5,000 deductible)

Q3: What do Sound plans cover?

A3: Covered benefits include preventive care, office visits, hospitalization, emergency services, dental, vision,

generic prescription drugs and more. For specific details regarding what is covered, go to

soundhealth.com and check out the plan summaries posted for each plan.

Q4: What is covered when I visit my doctor?

A4: If your doctor is in-network, your office visit copay will cover the cost for in-network, covered professional

services related to your office visit. This includes lab work and x-rays that you receive in your doctor’s

office during the office visit.

Q5: Can I see a specialist?

A5: Yes. If he or she is in the UniCare network. You’ll pay the same copay as you would

for regular doctor visits.

Q6: Are emergency services covered?

A6: Emergency services are covered. You’ll pay the $150 copay which will include all covered services

received in the Emergency Room. This copay will be waived if the Emergency Room visit results in an

inpatient admission.

Q7: Am I covered when I’m away from home?

A7: If you need to see a doctor when you are away from home and you are in the United States, you’re

covered under the UniCare Travel Access program. The toll-free UniCare phone number will be on the

back of your Member ID card. If you’re traveling outside of the United States, you’ll be covered for

medical emergencies only.

Q8: What’s the deal with generic drugs?

A8: Your plan has benefits for generic prescription drugs. You can still get a brand-name drug, but it’ll cost

you more. Generic drugs are identical to their brand-name equivalents in active ingredient, dosage form,

strength and quality – and they’re cheaper.

Q9: Can you explain the dental benefits?

A9: When you go to a dentist, the Sound dental benefits are:

$25 annual deductible and $500 annual maximum benefit

You’ll pay $0 for cleanings, exams and x-rays. After you pay your $25 deductible, the Sound plan

will cover 80% of the costs for fillings and other minor restorative procedures, up to the annual

maximum.

Q10: What are the vision benefits?

A10: Vision services are a covered benefit on all Sound plans. The plan will pay $50 per year toward the cost

of your eyeglasses, contacts or a routine eye exam.

Q11: How do I sign up?

A11: Just go to my Web site or soundhealth.com and click Apply Now. When asked, type in my name and

Agent ID number. Be sure you have your Social Security number, previous health insurance information,

medical history and prescription drug information handy.

Q12: What if I want to cover my spouse or kids?

A12: Separate Sound applications will need to be completed online for your spouse and each dependent.

 

Copay – The amount you pay for a doctor visit or other medical services such as an EmergencyRoom 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 beingtreated 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 andover 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 bygetting 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, labwork, 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 fromprofessional services covered under your office visit.
Out-of-Pocket Maximum (OOP) – Your annual OOP in-network is the most you’ll have to pay forin-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 havethem 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 mailedto 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 upof 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 preservice and utilization review.