Highlights of Your Medical Plan Options
You have three medical plan options, each of which is administered by UMR:
- Health Savings Plan
- Classic Plan
- Premier Plan.
All three medical plans:
- Offer a nationwide network of providers and facilities. The Health Savings Plan and Premier Plan offer coverage for out-of-network benefits.
- Cover preventive care in-network at no cost to you. This includes well-baby visits; routine physical exams, immunizations, mammograms, colorectal cancer screenings, Pap smears, nutritional counseling; and certain preventive care drugs. Some preventive care is subject to yearly limitations.
- Include prescription drug coverage through MedImpact, which has a nationwide network of pharmacies, including most national drug store chains and many independent pharmacies.
- Lowest monthly premiums
- Health plan with a Health Savings Account (HSA)—a tax-advantaged account with contributions made by the university and optional contributions made by you
- Before you meet the annual deductible: You pay for all medical expenses (except preventive care), including prescription drugs, yourself or with money from your HSA
- After you meet the annual deductible: You and the university share the cost of care
- After you meet the medical annual out-of-pocket maximum: Plan pays 100% of all covered expenses for the rest of the Plan Year
- You can see out-of-network providers but you will pay more for care
- Mid-range monthly premiums
- You pay copays for doctor and specialist office visits, certain other expenses and prescription drugs; all other expenses apply to the deductible—you pay the expense in full until you meet the deductible
- After you meet the annual deductible: You and the university share the cost of care through copays and coinsurance
- After you meet the medical annual out-of-pocket maximum: Plan pays 100% of all covered expenses for the rest of the Plan Year
- Benefits are not paid for services received from non-network providers, except in emergencies
- Highest monthly premium
- Pay the least out-of-pocket of all the medical options when you receive care from in-network providers
- You pay copays for doctor and specialist office visits, certain other expenses and prescription drugs; all other expenses apply to the deductible—you pay the expense in full until you meet the deductible
- After you meet the annual deductible: You and the university share the cost of care through copays and coinsurance
- After you meet the medical annual out-of-pocket maximum: Plan pays 100% of all eligible expenses for the rest of the Plan Year
- You can see an out-of-network providers but you will pay more for care
Medical Coverage Summary
The charts below compare the in-network coverage for all three medical plan options. The listed amounts are what you pay. See Out-of-Network Coverage, below, for coverage when you do not see a UMR network provider.
Annual Deductibles
| |
Health Savings Plan |
Classic Plan |
Premier Plan |
| Individual |
$3,300 |
$1,350 |
$800 |
| Family |
$6,000 |
$2,700 |
$1,600 |
Annual Out-of-Pocket Maximums
| |
Health Savings Plan |
Classic Plan |
Premier Plan |
| Individual |
$6,750 |
$5,250 |
$3,200 |
| Family |
$13,300 |
$10,500 |
$6,400 |
Medical Services
The below table shows an overview of how certain services are covered in-network. If there is a discrepancy between the website content and the official Plan Documents, the official Plan Documents will govern.
| |
Health Savings Plan |
Classic Plan |
Premier Plan |
|
Coinsurance
|
10% after deductible
|
25% after deductible
|
20% after deductible
|
|
PCP Visit
|
10% after deductible
|
$35 copay
|
$25 copay
|
|
Specialist Visit
|
10% after deductible
|
$55 copay
|
$45 copay
|
|
Preventive Care
|
$0
|
$0
|
$0
|
|
Diagnostic Lab
In Office
|
10% after deductible
|
25% after deductible
|
20% after deductible
|
|
Urgent Care
|
10% after deductible
|
$55 copay
|
$50 copay
|
|
Emergency Room
|
10% after deductible
|
25% after deductible is met and $350 copay (waived if admitted)
|
20% after deductible is met and $350 copay (waived if admitted)
|
|
Ambulance
|
10% after deductible
|
$100 copay (waived if admitted)
|
$100 copay (waived if admitted)
|
|
Advanced Imaging*
|
10% after deductible
|
25% after deductible is met and $150 copay
|
20% after deductible is met and $100 copay
|
|
Outpatient Surgery
|
10% after deductible
|
25% after deductible is met and $160 copay
|
20% after deductible is met and $80 copay
|
|
Inpatient Services**
|
10% after deductible
|
25% after deductible, and $300 copay
|
20% after deductible, and $300 copay
|
| Infertility Treatment and Services***
|
25% after deductible
|
20% after deductible
|
10% after deductible
|
|
Speech, Occupational
and Physical Therapy
(30-visit combined maximum)
|
10% after deductible
|
25% after deductible, and $55 evaluation copay
|
25% after deductible, and $45 evaluation copay
|
|
Routine Vision Exam
|
10% after deductible
|
$35 copay
|
$25 copay
|
|
Hearing Exam
|
10% after deductible
|
PCP: $35 copay
Specialist: $55 copay
|
PCP: $25 copay
Specialist: $45 copay
|
|
Hearing Aids (benefit is per ear every three years)
|
10% after deductible, up to Maximum Benefit of $3,000
|
$3,000 allowance
|
$3,000 allowance
|
*Prior authorization required.
**Includes semi-private room and board, intensive care room and board, ancillary charges and maternity inpatient charges.
***$20,000 medical services/$10,000 prescription drug lifetime maximums.
Find an In-Network Provider
To find an in-network provider, start by visiting umr.com.
- From the home page, click Search for a provider.
- Click Change Location to add your address or zip code. You can then search for a provider by name, specialty, location, service, cost, and more.
For step-by-step directions, check out the find a provider instructions. If you have any questions, please call UMR at 888-438-6105.
Out-of-Network Coverage
The Health Savings Plan and Premier Plan offer coverage for out-of-network providers, but your out-of-pocket expenses will be higher than for in-network care. The Classic Plan offers only in-network coverage (except in case of emergency).
Annual Deductibles
| |
Health Savings Plan |
Classic Plan |
Premier Plan |
| Individual |
$3,300 |
Emergency coverage only
|
$2,000 |
| Family |
$6,000 |
Emergency coverage only
|
$4,000 |
| Coinsurance |
50% |
Emergency coverage only
|
50% |
Annual Out-of-Pocket Maximums
| |
Health Savings Plan |
Classic Plan |
Premier Plan |
| Individual |
$9,800 |
Emergency coverage only
|
$9,000 |
| Family |
$19,800 |
Emergency coverage only
|
$18,000 |
In-network deductibles and maximums do not count toward your out-of-network deductibles and maximums, and vice versa.
UMR Programs
Work with a Health Coach
Program coaches help you create health care goals and adhere to your diabetes and healthy heart treatment plan. If you are identified as high-risk, you may be invited to work with a health coach to bring these and other health conditions under control. You can also self-enroll by calling UMR Care Management at 866-575-2540.
Disease Management
UMR—the medical plan administrator—offers disease management programs to help you and your family members deal with chronic conditions. If you or a covered family member has a chronic condition, like diabetes or hypertension, speak with a UMR representative about your options at 866-575-2540.
Maternity Management
Navigating infertility treatment can be overwhelming, but if you are enrolled in university medical coverage, you can contact the UMR Maternity Management Program for assistance. Speak with a dedicated nurse, who can guide you through pre-approvals and inform you of your options. Call 844-604-6244 to get started.
Explanation of Benefits (EOBs)
An explanation of benefits (EOB) is not a bill. It simply tells you everything you might want to know about how your recent medical service was covered by your benefits plan. You’ll receive a bill from your provider for any amount you may owe.
Your EOB shows:
- What providers charge for their services
- The network discount applied
- How much your plan has paid
- How much the patient owes, if anything
You will also see individual/family deductible and out-of-pocket amounts applied to your account.
For more information, review the Understanding your EOB flyer.
