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Your medical deductible is $250 per person each calendar year (with a maximum of $750 for a family of three or more). When you first get services, you pay the first $250 in charges. After that, the plan begins to pay benefits for your care. This applies to each covered member, up to the $750 maximum.
See additional information about your separate prescription drug deductible.
When you see a preferred or participating provider, you don’t have to pay your medical deductible before the plan pays for these services.
- Covered preventive care and covered immunizations (including well-baby care and screening mammograms).
- Routine vision care (exams, glasses, and contacts).
- Routine hearing care (exams and hearing aids).
- Contraceptive supplies and services.
- Tobacco cessation services.
- Diabetes Control Program.
- Diabetes Prevention Program.
- Second opinions required by the plan.
The following out-of-pocket expenses do not count toward your $250 medical deductible:
- Services you pay for that aren't covered by the plan.
- Services that are exempt from the medical deductible, even if you had out-of-pocket costs. For example, covered 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 medical 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 medical deductible.
- Out-of-network provider charges that exceed the allowed amount (see an example).
- Your inpatient hospital copayment.
- Your emergency room copayment ($75 per visit).
- Prescription drug costs.
If you have three or fewer members in your family enrolled in the plan, each member must pay the $250 medical deductible for a family maximum of $750. Once any one person spends $250 that applies toward the deductible, the plan will begin paying benefits for that person only. Because the plan is now paying for this person’s covered services, they are no longer contributing toward the family deductible.
If your family has four or more members, each person has a medical deductible of $250. The maximum the family pays towards medical deductibles is $750. Once an individual pays his or her $250 deductible, the plan begins paying for covered services for that person. Because the plan is now paying for this person’s covered services, they are no longer contributing toward the family deductible. If the combined amount paid toward the deductible for everyone in the family reaches $750—even if no one reached $250 on their own—the plan begins paying for covered services for everyone in the family. No more medical deductible is owed.
Note: Only services that are covered and are subject to the medical deductible count.
You only pay a prescription drug deductible when you purchase Tier 2 and Tier 3 drugs. You don’t pay any deductible for Preventive, Value Tier, or Tier 1 drugs. So, if you get only Preventive, Value Tier, and Tier 1 drugs during the year, you won’t need to pay the prescription drug deductible.
The prescription drug deductible is $100 per person, with a maximum of $300 for a family of three or more people covered under the same account. You pay this deductible to the pharmacy when you purchase a drug to which it applies.
Visit What you pay for drugs to learn more.
Use your UMP member ID card: Show your ID card each time you see a provider or fill a prescription. Pharmacies and providers need this information to charge you the right amount and bill your plan correctly.