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 |
$3,000 |
$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 |
$3,000 |
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.
