Physical health

Medical

Quality care, flexibility and support for your whole health journey.

Medical plan options

UMR High Deductible medical plan

With the UMR high deductible medical plan option you pay a lower premium out of your paycheck, but have a greater cost sharing for both medical and pharmacy expenses until you meet the medical plan annual deductible. Once the deductible is met, the plan covers 80% of medical services and you are responsible for 20%. Copays will apply to your prescriptions.

UMR Traditional PPO medical plan

The UMR Traditional PPO plan has a set copay for doctor’s office visits and prescription expenses. Services subject to deductible and coinsurance process at 80% plan responsibility and 20% your responsibility after the deductible is met. Both plans have an out-of-pocket maximum, which is the maximum you will pay in the calendar year.

UHC Surest medical plan

UHC Surest medical plan members can see up-front prices in advance of seeking care. There are copays but no deductibles or coinsurance with the UHC Surest medical plan. Members will use the Surest app to find the highest quality, lowest cost provider. The copay you pay will be dependent upon the provider you choose and where you seek health care.

UHC Surest and UMR Medical plans prescription drugs

Your pharmacy benefit allows you to get maintenance medications filled for a 90-day supply at any in-network retail pharmacy. Your prescription drug benefits are through OptumRX. Maintenance medications are those you take routinely, often to treat chronic conditions. Visit www.optumrx.com to find the most recent drug lists and program details.

Network

Plan comparison

UHC Surest medical plan
in-network coverage		 UMR High Deductible medical plan
in-network coverage		 UMR Traditional PPO medical plan
in-network coverage
Annual deductible Deductible applies to out-of-pocket maximum
Individual None $1,700 $750
Family None $3,400 $1,500
Out-of-pocket maximum
Individual $6,000 $4,000 $6,000
Family $12,000 $8,000 $12,000
Cost of care
Preventive care 100% covered 100% covered 100% covered
Primary office visit $15 to $100 You pay 20% $20 copay
Specialist office visit $15 to $100 You pay 20% $40 copay
Urgent care visit $50 You pay 20% $40 copay
Inpatient/outpatient hospital $200 to $3,000 You pay 20% You pay 20%
Emergency room $500 You pay 20% You pay 20%
Telemedicine Doctor on Demand Teladoc
Medical visit Primary $0 /
Specialty $15 to $60		 You pay 20% $20 copay
Behavioral health $15 You pay 20% $40 copay
Dermatology visit Care through Surest app You pay 20% $40 copay
Prescription drugs
Generic $10 $15 after deductible $15 copay
Formulary $60 $50 after deductible $50 copay
Non-formulary $90 $100 after deductible $100 copay
Specialty drugs $270 20% up to $500
(after deductible)		 20% up to $500
Preventive drugs Only applicable for the HDHP $5 copay Only applicable for the HDHP

NOTE: If you are enrolled in coverage other than employee only, you must meet the family deductible on the High Deductible medical plan.

NEW First Stop Health - FREE
When enrolled in a Refresco medical plan, visits include preventive care, primary care and urgent care services (prescription drug copays apply).

California - Kaiser HMO plan

In addition to the UHC Surest medical plan, UMR High Deductible medical plan and Traditional PPO medical plan, Refresco employees located in California also have the option to choose the Kaiser HMO medical plan. Information about the Kaiser HMO medical plan is provided below. Visit www.kp.org/registernow or call (800) 954-8000 for Kaiser Telemedicine services.

Kaiser HMO medical plan
in-network coverage
Annual deductible
Individual $0
Family $0
Out-of-pocket maximum
Individual $1,500
Family $3,000
Cost of care
Preventive care 100%
Primary/specialist office visit $15 per visit
Inpatient hospital $250 per admit
Outpatient surgery $15 per procedure
Emergency room $100 per visit
Urgent care center $15 per visit
Prescription drugs Retail pharmacy (30-day supply) / Mail order (100-day supply)
Generic $10 copay / $20 copay
Brand $20 copay / $40 copay
Telemedicine*
Examples of visits Scheduled routine care, preventive care, specialty care services, maintenance prescription refills, health questions or advice on treatment
Costs No cost

Medical plan documents

NOTE: Only care received from a Kaiser facility or a Kaiser physician is covered under the Kaiser HMO medical plan.

*See contacts page of your benefits guide for a link to your mental health resource guide, which contains telemedicine resources.