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Your UMP CDHP deductible for a single person on an account is $1,400. For more than one person on an account, the deductible is $2,800. For most covered services, you pay your providers until you meet your deductible for the year, then the plan begins to pay benefits for your care.
Prescription drugs count toward your deductible. You pay the entire cost of your drugs, even those covered by the plan, until you have met your entire deductible. See “Products covered under the preventive care benefit” for exceptions.
The following out-of-pocket expenses do not count toward your deductible:
- Services you pay for that aren't covered by the plan.
- Services that are exempt from the deductible, even if you had out-of-pocket costs. For example, preventive care received from an out-of-network provider.
- Charges for services exceeding benefit maximums. For example, the maximum for adult vision hardware is $150 every two calendar years. Charges over this amount do not count toward your deductible.
- Charges for services beyond benefit limits. For example, the annual benefit limit for acupuncture is 16 visits. Costs for more than 16 visits are not covered by the plan and do not count toward your deductible.
- Out-of-network provider charges that exceed the allowed amount, including non-network pharmacies.
You do not have to pay the deductible before the plan pays for these services:
- Preventive care and immunizations.
- Routine vision care: exams, glasses, and contacts.
- Select contraceptive supplies and services.
- Certain products available from network pharmacies.
- Tobacco cessation services.
- Required second opinions.
Tip: The plan pays the services and drugs (subject to cost share) listed above even if you have not met your deductible. This means that you do not have to pay the first $1,400 or $2,800 of covered services before the plan begins to pay.
- If you cover only yourself, your deductible is $1,400. You must pay this amount for covered services not exempt from the deductible (including covered drugs) before the plan begins to pay for your care.
- If you cover yourself and at least one other person, your deductible is $2,800. You must pay this amount for covered services for all covered persons combined before the plan pays for any services, including drugs (other than those exempt from the deductible).
Alert: If you receive services with a benefit limit (such as massage therapy or physical therapy) before meeting your deductible, those visits will count toward the benefit limit. For more information read about limited benefits.
Note: If a dependent has other primary coverage, visits paid by the primary plan also count toward UMP CDHP benefit limits.