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UHC Dual Complete HI-S001 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UHC Dual Complete HI-S001 (PPO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on UHC Dual Complete HI-S001 (PPO D-SNP) in 2025, please refer to our full plan details page.
UHC Dual Complete HI-S001 (PPO D-SNP) is a PPO D-SNP plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in State of Hawaii. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that UHC Dual Complete HI-S001 (PPO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
UHC Dual Complete HI-S001 (PPO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about UHC Dual Complete HI-S001 (PPO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For UHC Dual Complete HI-S001 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $47.70. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $14000.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $14000.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The UHC Dual Complete HI-S001 (PPO D-SNP) plan has a $590 deductible for prescription drugs. Once you meet your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000. If you qualify for the low-income subsidy (LIS), also known as "Extra Help," the plan's premium is $47.70. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The UHC Dual Complete HI-S001 (PPO D-SNP) plan provides coverage for a wide range of services with varying costs. Inpatient hospital stays require prior authorization and have a $1835 copay per admission. Outpatient services, primary care, preventive services, vision services, and dental services are covered, with some services having no copay. The plan also covers ambulance and transportation services, emergency services, and home health services, with varying cost-sharing. Additional benefits include hearing services, home infusion services, dialysis services, medical equipment, and diagnostic and radiological services. Other services, such as acupuncture and over-the-counter items, are covered with no copay, up to a certain limit.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization. For Inpatient Hospital-Acute, you will pay a copay of $1835 per admission or stay, and for additional days (91-999), there is no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including all Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services. Outpatient Hospital Services have a coinsurance between 0% and 20%, Observation Services have a 20% coinsurance, Ambulatory Surgical Center (ASC) Services have a coinsurance between 0% and 20%, Individual Sessions for Outpatient Substance Abuse have a coinsurance between 0% and 20%, Group Sessions for Outpatient Substance Abuse have a 20% coinsurance, and Outpatient Blood Services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the UHC Dual Complete HI-S001 (PPO D-SNP) plan, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including ground and air ambulance services, are covered. Ground and air ambulance services have a 20% coinsurance, while transportation services to plan-approved health-related locations have no copay, with up to 24 one-way trips per year via taxi or medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the UHC Dual Complete HI-S001 (PPO D-SNP) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a copay between $0 and $45. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
Primary Care includes coverage for Primary Care Physician Services with a coinsurance of 0% - 20%, Chiropractic Services with a 20% coinsurance, Occupational Therapy Services with a 0% - 20% coinsurance, Physician Specialist Services with a coinsurance of 0% - 20%, Mental Health Specialty Services with a coinsurance of 0% - 20% for individual sessions and 20% for group sessions, Podiatry Services with a 20% coinsurance, Other Health Care Professional with a 0% - 20% coinsurance, Psychiatric Services with a 0% - 20% coinsurance for individual sessions and 20% for group sessions, Physical Therapy and Speech-Language Pathology Services with a 0% - 20% coinsurance, Additional Telehealth Benefits with no copay, and Opioid Treatment Program Services with no copay. Routine Chiropractic Care has no copay, but is limited to 20 visits per year.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional preventive services, including fitness benefits, and home and bathroom safety devices and modifications, with no copay. Additional preventive services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefit, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, and counseling services are not covered. Other preventive services include glaucoma screening, diabetes self-management training, and barium enemas with no copay, and digital rectal exams and EKG following Welcome Visit with 20% coinsurance.
Hearing Services See details
Hearing Services are partially covered under the UHC Dual Complete HI-S001 (PPO D-SNP) plan, with hearing exams requiring prior authorization and a coinsurance of at most 20%, but routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids are not covered. OTC hearing aids are also not covered.
Vision Services See details
The UHC Dual Complete HI-S001 (PPO D-SNP) plan covers vision services, including eye exams with no copay. Eyewear benefits are also covered with no copay, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services. Other Dental Services, Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Oral and Maxillofacial Surgery all have no copay. The plan does not cover Implant Services or Orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay with a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the UHC Dual Complete HI-S001 (PPO D-SNP) plan, but require prior authorization. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetic devices, and medical supplies, is covered. Durable medical equipment has a 19% coinsurance, while prosthetic devices and medical supplies have a 19% coinsurance, and diabetic supplies have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. For Diagnostic Procedures/Tests and Diagnostic Radiological Services, you may pay up to 20% coinsurance, while Lab Services have no copay. Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of up to 20%.
Home Health Services See details
Home Health Services are covered by the UHC Dual Complete HI-S001 (PPO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the UHC Dual Complete HI-S001 (PPO D-SNP) plan, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required, and the copay is defined by Medicare.
Other Services See details
Under "Other Services", acupuncture is covered with no copay, up to 20 treatments per year. Over-the-counter (OTC) items are covered with no copay, including nicotine replacement therapy and naloxone, but not all drugs on the CMS OTC list. Other services such as meal benefits, EPSDT, and others are not covered.
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