Medical Benefits

Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family.

Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit https://www.umr.com/find-a-provider.

	In-Network	Out-of-Network
Deductible (Individual/Family)	$2,500/$5,000	$2,500/$5,000
Out-of-Pocket Max (Individual/Family)	$6,350/$12,700	$6,350/$12,700
Member Coinsurance	20%	20%
Preventive Care	100%	Deductible, then Coinsurance
Primary Care Visit	$35 Copay	$35 Copay
Telemedicine	$35 Copay	$35 Copay
Specialist Visit	$70 Copay	$70 Copay
Inpatient Surgery	Deductible, then Coinsurance	Deductible, then Coinsurance
Outpatient Surgery	Deductible, then Coinsurance	Deductible, then Coinsurance
Urgent Care	$35 Copay	$35 Copay
Emergency Room	$250 Copay, then Deductible & Coinsurance	$250 Copay, then Deductible & Coinsurance

Retail Prescriptions (with Optum Rx Card)	In-Network	Out-of-Network
Tier 1	$15 Copay	$15 Copay
Tier 2	$50 Copay	$50 Copay
Tier 3	$75 Copay	$75 Copay
Tier 4	$150 Copay	Not Covered
Specialty	20% up to $250	Not Covered
Mail Order Prescriptions
90 Day Supply	2.5 x Retail Copay	2.5 x Retail Copay

	Monthly Cost
Employee Only	$94.98
Employee + Spouse	$414.96
Employee + Child(ren)	$414.96
Employee + Family	$573.30

Downloads

Summary of Benefits

Member Portal Registration

Member Health Language

Member Cost Control

	In-Network	Out-of-Network
Deductible (Individual/Family)	$1,000/$2,000	$1,000/$2,000
Out-of-Pocket Max (Individual/Family)	$5,000/$10,000	$5,000/$10,000
Member Coinsurance	20%	20%
Preventive Care	100%	Deductible, then Coinsurance
Primary Care Visit	$35 Copay	$35 Copay
Telemedicine	$35 Copay	$35 Copay
Specialist Visit	$35 Copay	$35 Copay
Inpatient Surgery	Deductible, then Coinsurance	Deductible, then Coinsurance
Outpatient Surgery	Deductible, then Coinsurance	Deductible, then Coinsurance
Urgent Care	$35 Copay	$35 Copay
Emergency Room	$250 Copay, then Deductible & Coinsurance	$250 Copay, then Deductible & Coinsurance

Retail Prescriptions (with Optum Rx Card)	In-Network	Out-of-Network
Tier 1	$15 Copay	$15 Copay
Tier 2	$50 Copay	$50 Copay
Tier 3	$75 Copay	$75 Copay
Tier 4	$150 Copay	Not Covered
Speciality	20% up to $250	Not Covered
Mail Order Prescriptions
90 Day Supply	2.5 x Retail Copay	2.5 x Retail Copay

	Monthly Cost
Employee Only	$217.61
Employee + Spouse	$556.92
Employee + Child(ren)	$556.92
Employee + Family	$764.40