UMP Classic covers most medical services based on a percentage of the allowed amount that preferred providers agree to accept as payment in full. (The allowed amount is the most the plan will pay for a specific covered service or supply.)
Coinsurance is the percentage of the allowed amount you pay when the plan pays less than 100 percent of the allowed amount.
You pay 15 percent of the allowed amount.
You pay 40 percent of the allowed amount, plus any amount billed by the out-of-network provider that is above the allowed amount.*
* See Preferred vs. out-of-network costs for an example of how this works.
Coinsurance also applies to prescription drugs. How much you pay depends on whether the prescription drug is generic, preferred, or nonpreferred.
You also pay a copayment (“copay”) when you receive certain services. Copayments are set dollar amounts.
The only copayments under UMP Classic are for:
- Emergency care.
- Inpatient services at a hospital, mental health, chemical dependency, or skilled nursing facility.
See your UMP Classic Summary of benefits for details.