2021 Open Enrollment

Medical Coverage

Here’s an overview of the 2021 plan changes for each University medical plan:

Classic Plan

 

SmartCare

Non-SmartCare

Disposable Medical Supplies (test strips, oxygen filters, lancets)

Plan covers $800 of disposable medical equipment and supply charges at 100%; then you pay deductible and 25% coinsurance

Emergency Room

Emergency: $250 copay

Non-emergency: $350 copay

Therapy Services (speech, physical, and occupational)

$40 evaluation copay; then you pay deductible and 20% coinsurance

$55 evaluation copay; then you pay deductible and 25% coinsurance

Premier Plan

 

SmartCare

Non-SmartCare

Disposable Medical Supplies (test strips, oxygen filters, lancets)

Plan covers $800 of disposable medical equipment and supply charges at 100%; then, you pay deductible and 20% coinsurance

Hospital Inpatient Services

 

$150 copay; then you pay deductible and 15% coinsurance

$300 copay; then you pay deductible and 20% coinsurance

Emergency Room

 

Emergency: $250 copay

Non-emergency: $350 copay

Therapy Services (speech, physical, and occupational)

$30 evaluation copay; then you pay deductible and 15% coinsurance

$45 evaluation copay; then you pay deductible and 20% coinsurance

Outpatient Diagnostic Lab Services

You pay 15% coinsurance

You pay 20% coinsurance

Outpatient Diagnostic Testing and Surgical Services

You pay deductible and 15% coinsurance

$75 copay; then you pay deductible and 20% coinsurance

Advanced Imaging (CT, PET, MRI)

Prior authorization required

$25 copay; then you pay deductible and 15% coinsurance

$50 copay; then you pay deductible and 20% coinsurance

Health Savings Plan

 

SmartCare

Non-SmartCare

Therapy Services (speech, physical, and occupational)

You pay deductible and 5% coinsurance

You pay deductible and 10% coinsurance

Prescription Drug Coverage

Prescription drug copays are changing for two of the health plans:

 

Classic Plan

Premier Plan

 

2020

2021

2020

2021

Tier 1

$17

$18

$12

$14

Tier II

$60

$62

$55

$57

Tier III

$95

$97

$90

$92

Diabetes Management and Healthy Heart Programs

The Diabetes Management Program and the Healthy Heart Program through UMR will not offer $0 medical and supply incentives in 2021, but you may still be eligible for up to $800 in no-cost disposable medical supplies through the health plan.

Starting January 1, 2021, prescriptions previously covered under the incentive programs will require a standard pharmacy copay. Most medications covered under the incentive programs are Tier I medications. Note: If the cost of your medication is lower than the copay, you’ll pay the lower amount. 

Here’s an idea of the average you will pay in 2021 for some of the most common medications currently covered under the incentive programs:*

  • Glimepiride: $6.12
  • Humalog: $62.00
  • Lantus Solostar: $62.00
  • Metformin: $4.99
  • Amlodipine Besylate: $4.34
  • Metoprolol: $12.52
  • Diltiazem: $17.84
  • Lisinopril: $3.77

*Examples are based on a 30-day supply of a medication for a participant covered under the Classic Plan (Tier I: $18, Tier II: $62, Tier III: $97). Actual copays will vary based on your plan enrollment and the retail pharmacy you use and by the dosing level and quantity prescribed by your doctor.

Work with a Health Coach

In 2021, continue to 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 Savings Account

2021 contribution limits will increase:

  • Individual: $3,600
  • Family: $7,200

Remember that an additional $1,000 catch-up contribution is allowed if you are 55 or older by December 31, 2021.

Flexible Spending Account

  • Flexible Spending Account 2020 contribution limits (set by the IRS):
  • Healthcare FSA: $2,750*
  • Dependent Care FSA: $5,000*
  • The annual rollover limit for Healthcare Flexible Spending Accounts (FSAs) will increase to $550 in 2021—a $50 increase from 2020.

*As of October 1, 2020, the IRS has not issued updated limits for 2021. Given campus-level coding and publication deadlines, the University will use 2020 maximums for 2021.

Enrolling for Coverage