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. Out-of-network providers set their own fees, so you may be responsible for charges above the Reasonable and Customary (R&C) limits. 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 HSA $5,000
Benefit Highlights
In-Network
Deductible (Individual/Family)
$5,000/$10,000
Out-of-Pocket Max (Individual/Family)
$7,500/$15,000
Preventive Care
$0
Primary Care Visit
20%*
Specialist Visit
20%*
Urgent Care
20%*
Emergency Room
20%*
Retail Rx (Up to 30-Day Supply)
Generic
20%*
Preferred Brand
20%*
Non-Preferred Brand
20%*
Specialty
20%*
Mail-Order Rx (Up to 90-Day Supply)
Generic
20%*
Preferred Brand
20%*
Non-Preferred Brand
Not Covered
*After Deductible
Out-of-Network
Deductible (Individual/Family)
$10,000/$20,000
Out-of-Pocket Max (Individual/Family)
$20,000/$40,000
Preventive Care
50%*
Primary Care Visit
50%*
Specialist Visit
50%*
Urgent Care
50%*
Emergency Room
20%*
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)
Generic
Not Covered
Preferred Brand
Not Covered
Non-Preferred Brand
Not Covered
Plan Cost
Wellness
Employee Only: $24.31
Employee and Spouse: $93.14
Employee and Child(ren): $74.99
Employee and Family: $125.94
Non-Wellness
Employee Only: $43.54
Employee and Spouse: $131.60
Employee and Child(ren): $94.22
Employee and Family: $164.40
UMR HSA $3,000
Benefit Highlights
In-Network
Deductible (Individual/Family)
$3,000/$6,000
Out-of-Pocket Max (Individual/Family)
$5,000/$10,000
Preventive Care
$0
Primary Care Visit
20%*
Specialist Visit
20%*
Urgent Care
20%*
Emergency Room
20%*
Retail Rx (Up to 30-Day Supply)
Generic
$15*
Preferred Brand
$40*
Non-Preferred Brand
$80*
Specialty
10% up to a $200 copay max*
Mail-Order Rx (Up to 90-Day Supply)
Generic
$37.50*
Preferred Brand
$100*
Non-Preferred Brand
$200*
*After Deductible
Out-of-Network
Deductible (Individual/Family)
$8,000/$16,000
Out-of-Pocket Max (Individual/Family)
$16,000/$32,000
Preventive Care
50%*
Primary Care Visit
50%*
Specialist Visit
50%*
Urgent Care
50%*
Emergency Room
20%*
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)
Generic
Not Covered
Preferred Brand
Not Covered
Non-Preferred Brand
Not Covered
Plan Cost
Wellness
Employee Only: $59.27
Employee and Spouse: $224.39
Employee and Child(ren): $149.15
Employee and Family: $260.60
Non-Wellness
Employee Only: $78.50
Employee and Spouse: $262.85
Employee and Child(ren): $168.38
Employee and Family: $299.06
Surest $0
Benefit Highlights
In-Network
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$5,000/$10,000
Preventive Care
$0
Primary Care Visit
$20-$105
Specialist Visit
$20-$105
Urgent Care
$60
Emergency Room
$600
Retail Rx (Up to 30-Day Supply)
Generic
$10
Preferred Brand
$60
Non-Preferred Brand
$90
Specialty
$270
Mail-Order Rx (Up to 90-Day Supply)
Generic
$25
Preferred Brand
$150
Non-Preferred Brand
$225
Plan Cost
See Benefits Guide