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Your UMP Classic medical deductible is $250 per person every calendar year (with a maximum of $750 for a family of three or more). For most covered medical services, you pay toward the deductible before the plan begins to pay.
The subscriber is the only family member who can earn the SmartHealth wellness incentive. If you (the subscriber) earned this incentive for 2017, your medical deductible decreases by $125 for the year.
Note: If you have other primary coverage, including Medicare, visits paid by your primary plan also count toward UMP Classic benefit limits.
For these services, you don’t have to pay your medical deductible before the plan begins to pay:
- Preventive care and immunizations (includes well-baby care and screening mammograms).
- Routine vision care (exams, glasses, and contacts).
- Routine hearing care (exams and hearing aids).
- Select contraceptive supplies and services.
- Certain products available from network pharmacies.
- Tobacco cessation services.
- Diabetes Prevention Program.
- Required second opinions.
The following out-of-pocket expenses do not count toward your 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, 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 $150 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.
- Your inpatient hospital copayment.
- Your $75 per visit emergency room copayment.
- Prescription drug costs.
If you have three members in your family enrolled in UMP Classic, each family 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, he or she is no longer contributing toward the family deductible.
If your family has four or more members, each person has an individual medical deductible of $250, for a family maximum of $750. Once a particular 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, he or she is 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 deductible is owed.
Your UMP Classic prescription drug deductible is $100 per person every calendar year, with a maximum of $300 for a family of three or more people.
You don't pay any deductible for Value Tier or Tier 1 drugs. For Tier 2 and Tier 3 drugs, you must pay your prescription drug deductible before the plan begins to pay–no matter where you purchase your prescriptions. Learn more about your drug coverage.
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.