Medical
Medical coverage provides healthcare protection for you and your family. You can visit any provider, but in-network doctors offer the highest level of benefits and lower out-of-pocket costs by charging reduced, contracted rates. Preventive care—such as physical exams, flu shots, and screenings—is covered at 100% when you use in-network providers. The main differences between plan options are how much you pay per paycheck and what you pay when you receive care.
Each plan has different:
- Annual deductible amounts – the amount you pay each year for eligible in-network and out-of-network charges before the plan begins to pay.
- Out-of-pocket maximums– the most you will pay each year for eligible network services and/or prescriptions. After you reach your out-of-pocket maximum, the plan picks up the full cost of covered medical care for the remainder of the year.
- Copays – A copay is a fixed amount you pay for a health care service. Copays do not count toward your deductible but do count toward your annual out-of-pocket maximum.
- Coinsurance – Once you’ve met your deductible, you and the plan share the cost of care, which is called coinsurance. For example, you pay 20% for services and the plan will pay 80% of the cost until you have reached your out-of-pocket maximum.
UMR PPO $1,000
Benefit Highlights
In-Network
Deductible (Individual/Family)
$1,000/$2,000
Out-of-Pocket Max (Individual/Family)
$3,000/$6,000
Preventive Care
$0
Primary Care Visit
$25
Specialist Visit
$45
Urgent Care
$50
Emergency Room
$100 per visit*
Retail Rx (Up to 30-Day Supply)
Generic
$10
Preferred Brand
$25
Non-Preferred Brand
$45
Specialty
$100
Mail-Order Rx (Up to 90-Day Supply)
Generic
$10
Preferred Brand
$50
Non-Preferred Brand
$135
Specialty
Not covered
*After deductible
Out-of-Network
Deductible (Individual/Family)
$2,000/$4,000
Out-of-Pocket Max (Individual/Family)
$6,000/$12,000
Preventive Care
40%*
Primary Care Visit
40%*
Specialist Visit
40%*
Urgent Care
40%*
Emergency Room
$100 per visit*
Retail Rx (Up to 30-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
If you use a non-network Pharmacy, you are responsible for payment upfront. You may be reimbursed based on the lowest contracted amount, minus any applicable deductible or copayment amount.
Monthly Plan Cost
Employee Only: $386.74
Employee and Spouse: $1,077.17
Employee and Child(ren): $815.66
Employee and Family: $1,749.84
UMR PPO $2,500
Benefit Highlights
In-Network
Deductible (Individual/Family)
$2,500/$5,000
Out-of-Pocket Max (Individual/Family)
$4,000/$8,000
Preventive Care
$0
Primary Care Visit
$25
Specialist Visit
$45
Urgent Care
$50
Emergency Room
$150 per visit*
Retail Rx (Up to 30-Day Supply)
Generic
$10
Preferred Brand
$25
Non-Preferred Brand
$45
Specialty
$100
Mail-Order Rx (Up to 90-Day Supply)
Generic
$10
Preferred Brand
$50
Non-Preferred Brand
$135
Specialty
Not covered
*After deductible
Out-of-Network
Deductible (Individual/Family)
$5,000/$10,000
Out-of-Pocket Max (Individual/Family)
$8,000/$16,000
Preventive Care
40%*
Primary Care Visit
40%*
Specialist Visit
40%*
Urgent Care
40%*
Emergency Room
$150 per visit*
Retail Rx (Up to 30-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
If you use a non-network Pharmacy, you are responsible for payment upfront. You may be reimbursed based on the lowest contracted amount, minus any applicable deductible or copayment amount.
Monthly Plan Cost
Employee Only: $262.10
Employee and Spouse: $890.22
Employee and Child(ren): $677.72
Employee and Family: $1,408.17
UMR HDHP
Benefit Highlights
In-Network
Deductible (Individual/Family)
$2,500/$5,000
Out-of-Pocket Max (Individual/Individual in a Family/Family)
$4,500/$4,500/$8,000
Preventive Care
$0
Primary Care Visit
You pay 20%* for everything
Specialist Visit
You pay 20%* for everything
Urgent Care
You pay 20%* for everything
Emergency Room
You pay 20%* for everything
Retail Rx (Up to 30-Day Supply)
Generic
$7*
Preferred Brand
$21*
Non-Preferred Brand
$42*
Specialty
$100*
Mail-Order Rx (Up to 90-Day Supply)
Generic
$7*
Preferred Brand
$42*
Non-Preferred Brand
$126*
Specialty
Not covered
*After deductible
Out-of-Network
Deductible (Individual/Family)
$3,750/$7,500
Out-of-Pocket Max (Individual/Individual in a Family/Family)
$6,000/$6,000/$12,000
Preventive Care
40%*
Primary Care Visit
40%*
Specialist Visit
40%*
Urgent Care
40%*
Emergency Room
You pay 20%* for everything
Retail Rx (Up to 30-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
If you use a non-network Pharmacy, you are responsible for payment upfront. You may be reimbursed based on the lowest contracted amount, minus any applicable deductible or copayment amount.
Monthly Plan Cost
Employee Only: $77.16
Employee and Spouse: $525.23
Employee and Child(ren): $402.31
Employee and Family: $593.92