Check out our premiums page for information on what you pay for coverage.
2021 Medical Plan SPD coming soon!
When the Medical Plan Summary Plan Description is available, you'll see it posted to the documents page.
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
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.
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
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
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
UMR Disease Management Programs
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.
2021 Medical Coverage Summary
The chart below compares the in-network coverage for all three medical plan options. See Out-of-Network Coverage, below, for coverage when you do not see a UMR network provider.
Health Savings Plan
Classic Plan
Premier Plan
Amounts are What YOU Pay
Annual Deductibles
Individual
$2,800
$1,250
$700
Family
$5,400
$2,500
$1,400
Annual Out-of-Pocket Maximums
Individual
$6,750
$5,250
$3,050
Family
$13,300
$10,500
$6,100
Medical Services
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
Emergency: $250 copay (waived if admitted)
Non-emergency: $350 copay (waived if admitted)
Emergency: $250 copay (waived if admitted)
Non-emergency: $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, and $100 copay
20% after deductible, and $50 copay
Outpatient Surgery
10% after deductible
25% after deductible, and $150 copay
20% after deductible, and $75 copay
Inpatient Services**
10% after deductible
25% after deductible, and $300 copay
20% after deductible, and $300 copay
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.
Telehealth Visits are Covered!
Telehealth visits (phone or video) with in-network providers are covered by the Plan at the same cost sharing amount as an in-person visit.
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).
Health Savings Plan
Classic Plan
Premier Plan
Out-of-Network Deductibles
Individual
$2,700
No coverage out-of-network, except for emergency
$2,000
Family
$5,400
$4,000
Coinsurance
50%
50%
Out-of-Network Annual Out-of-Pocket Maximums
Individual
$9,700
No coverage out-of-network except for emergency
$9,000
Family
$19,400
$18,000
In-network deductibles and maximums do not count toward your out-of-network deductibles and maximums, and vice versa.
Benefit payments for covered services received out of network will be based on the Maximum Allowable Payment, as determined by UMR. Charges in excess of the Maximum Allowable Payment do not count toward meeting the annual deductible or meeting the limitation on your coinsurance maximum. Out-of-network providers may bill you for amounts in excess of the Maximum Allowable Payment.
