How Much Will I Pay?
Annual Medical Deductible
Use Your UMP ID Card
Whenever you see a provider or fill a prescription, make sure you show your UMP ID card. Pharmacies need this information to charge you the right amount. And it's a good idea to make sure that your provider has the right insurance information at each visit, to make sure it's billed correctly.
Important: This information is effective through Dec. 31, 2009. See the changes to coinsurance, medical deductible, and out-of-pocket limit for 2010.
Before UMP pays for most services, you must pay your $200 medical deductible every calendar year. Following is a list of services that UMP pays for even if you haven't paid your medical deductible:
- Services covered under the preventive care benefit (includes services such as well-baby care and screening mammograms)
- Routine vision care (eye exams and vision hardware, such as eyeglasses and contact lenses)
- Routine hearing care (hearing exams and hearing aids)
- The Free & Clear tobacco cessation program
- Required second opinions (for more information, see page 33 of the UMP 2009 Certificate of Coverage)
Prescription Drug Deductible
You do not have to pay toward the prescription drug deductible for generic (Tier 1) prescription drugs. You must pay an annual prescription drug deductible for brand-name (Tier 2 and Tier 3) prescription drugs before UMP pays benefits. This deductible is $100 per person, or a maximum of $300 for a family (three or more people covered under the same account). You must pay toward this deductible no matter where you get your prescriptions.
Coinsurance
Important: This information is effective through Dec. 31, 2009. See the changes to coinsurance, medical deductible, and out-of-pocket limit for 2010.
Most UMP medical services are paid based on a percentage of the UMP allowed amount. Coinsurance is the percentage you must pay when UMP pays less than 100% of the UMP allowed amount.
| For UMP network providers: | 10% of the UMP allowed amount. |
| For non-network providers: | 40% of the UMP allowed amount, plus any amount billed by the provider that is above the UMP allowed amount.* |
| * See table under "Avoid Using Non-Network Providers" for an example of how this works. | |
You also pay for prescription drugs purchased at a retail pharmacy based on coinsurance; how much you pay depends on whether the prescription drug is generic, preferred, or nonpreferred.
Copayment
A copayment (also called "copay") is a set dollar amount you pay when you receive specific services, treatments, or supplies, such as inpatient hospitalization, emergency room care, or a prescription filled through UMP's mail-order pharmacy. See the Summary of Benefits for specific dollar amounts.
