Our Medical and Prescription Plan – The United Health Plan (UMR)
Contact information
- Phone (plan advisor): 800-207-3172
- Website: www.umr.com
- Create your account on their website to find providers, view SPD, claims, print and request an ID card
- To find a provider, go to “find a provider”, type “UnitedHealthcare Choice Plus Network” and select “search”. For behavioral health providers, click on “view directory” after you followed the previous steps. Click here for a guide.
- Click here to view details on how to use the UMR website on your phone
Eligibility
Any employee who works 30 or more hours per week during a school year or calendar year is eligible for this insurance coverage. However, participation in a Health Savings Account has some restrictions. You may not participate in the Health Savings Account if you are covered by other insurance that provides “first dollar” coverage (plans that include copays for doctor’s visits or prescription drugs) and has an annual deductible less than the amount established by the IRS. You also cannot participate in a Health Savings Account, if you are enrolled in Medicare, receive Veteran’s Administration benefits, or if you are listed as a dependent on someone else’s tax return.
2024 High Deductible Plan
* The in-network and out-of-pocket deductibles and OOP maximums do not cross-reduce.
| Plan Feature |
Your Responsibility In-Network |
Your Responsibility Out-of-Network |
| Annual Deductible* |
Individual $2,500
Family $5,000 |
Individual $5,000
Family $10,000 |
| Co-insurance |
30% of expense for service (paid after deductible is satisfied) |
50% of expense for service (paid after deductible is satisfied) |
Out-of-Pocket (OOP) Maximum*
OOP maximum is the combined costs of your deductible and co-insurance |
Individual $5,000
Family $10,000 |
Individual $10,000
Family $20,000 |
| Preventive Care Services |
$0 – No copayments or co-insurance, not subject to deductible and does not count toward your OOP maximum |
see plan document |
| Urgent Care and Emergency Services |
30% after your deductible is satisfied |
30% after your deductible is satisfied |
| In-patient, Outpatient, Laboratory, Diagnostic, Maternity and Physician Office Visits and Services |
30% after your deductible is satisfied |
50% after your deductible is satisfied |
| Prescription Drugs |
30% after your deductible is satisfied |
50% after your deductible is satisfied |
2024 Payroll Deductions
Medical and Prescription Drug Plan
Coverage Per Pay Period Deductions
Individual $41.29/pay period
Family $222.53/pay period
Find an In-Network provider
To find a provider, go to umr.com and select “find a provider”, type or search for “UnitedHealthcare Choice Plus Network” and select “search”.
Important: For behavioral health providers, click on “view directory of behavioral health providers” as shown in here.
Click here for a guide.
Your Out-of-Pocket Costs
Under our plan, you will be responsible for paying the deductible and your co-insurance. If your expenses reach the out of pocket maximum the plan begins to cover the cost of your care at 100%.
Prescription Drug Benefit
Using in-network pharmacies assures that you will benefit from the lowest negotiated rates for prescription drugs. You should also request generic drugs whenever possible (about half the drugs on the market are also available in generic form).
Our current prescription drug coverage is through Epiphany RX. You can use Costco mail order for convenient refills of routine medications for ongoing medical conditions such as arthritis, asthma, diabetes and high blood pressure. Before using the mail order pharmacy, be sure to compare the costs of your prescriptions through the mail order pharmacy and your local pharmacy. We encourage you to purchase your prescriptions where you find the “best deal.”
Under our medical plan, you will pay the cost of the prescription until your deductible is satisfied. (Remember, all non-preventive care is subject to the deductible.) Once your deductible is satisfied, you will pay 30% of the cost of your prescription, and the plan will cover the remaining 70%.
If your medical expenses for the year reach the out-of-pocket maximum, the plan then covers your medical expenses at 100% including your prescription drugs. The Health Savings Account is available to help pay for your medical expenses, including prescription drugs.
Natural Family Planning
The Natural Family Planning benefit and associated supplies will be covered at 100% (before deductible) through The United Health Plan effective. For more information about this benefit click here. Please present your health insurance ID card at the time of your NFP visit.
Managing Your Expenses: 10 ways to control health care costs
Click here for details on the following 10 items:
- see preferred doctors (to find physicians, go to the “contact” section of this site)
- go generic on prescriptions
- practice prevention
- get online
- choose the right care
- think long-term
- eat right
- exercise
- take care of yourself
- review your EOB (explanation of benefits)
NOTE: If you choose an out-of-network provider, precertification is required for any procedures you elect. Contact your plan advisor at 800-207-3172 for more information.
Preventive Services: FREE to Plan Participants
If you elect our plan, you and your covered family members are eligible for many free preventive services from UMR providers. The following preventive care is not subject to any copayments, deductibles or co-insurance:
- Routine physical exams
- Immunization
- Routine diagnostic test, lab and x-rays
- Routine mammograms
- Routine pap test and pelvic exams
- Routine PSA test and prostate exam
- Routine colonoscopy and similar routine procedures done for preventive reasons
- Routine hearing exam
- Routine eye exam (click here for further details)
- Well baby care
- Prescription drugs for smoking cessation
up to $1,000 per year
- Prescription drugs for weight loss up
to $1,000 per year
Preventive services do not apply toward your deductible, co-insurance or out-of-pocket maximum.
