Starting July 1, 2021, health plan premiums will increase for the Classic, Health Savings and Premier Plan options. Check out our premiums page for more information.
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
When you enroll in a University medical plan, UMR sends you an ID card. If you need a replacement ID card, you can order one on the UMR website.
To view or print a copy of your ID card, log in to your UMR account. Or download the UMR app from the App Store or Google Play to access your card when you’re away from home.
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 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.
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).
Out-of-Network Deductibles
Health Savings Plan
Classic Plan
Premier Plan
Individual
$2,700
Emergency coverage only
$2000
Family
$5,400
Emergency coverage only
$4,000
Coinsurance
50%
Emergency coverage only
50%
Out-of-Network Annual Out-of-Pocket Maximums
Health Savings Plan
Classic Plan
Premier Plan
Individual
$9,700
Emergency coverage only
$9000
Family
$19,400
Emergency coverage only
$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.
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.
