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Your medical deductible is $250 per person every calendar year (with a maximum of $750 for a family of three or more). When you first get medical services, you pay the first $250 in charges. After that, the plan begins to pay benefits for your care. This applies to each covered family member, up to the $750 maximum.
The subscriber is the only family member who can earn the SmartHealth wellness incentive. If you (the subscriber) earned this incentive for 2018, 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. Learn about UMP Classic and Medicare.
For these services, you don’t have to pay your medical deductible before the plan begins to pay:
- Preventive care and immunizations (including 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.
- Prescription drugs. However, a prescription drug deductible applies to Tier 2 and Tier 3 drugs.
- Tobacco cessation services.
- Diabetes Control Program.
- 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 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.
- Your inpatient hospital copayment.
- Your emergency room copayment ($75 per visit).
- 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. 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, 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 medical deductible is owed.
You only pay a prescription drug deductible when you purchase Tier 2 and Tier 3 drugs. The prescription drug deductible is $100 per person every calendar year, with a maximum of $300 for a family of three or more people. This deductible does not apply to Preventive Tier, 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.