On this page
A deductible is a fixed dollar amount you pay each calendar year before the plan begins paying most covered medical services. Your UMP Plus medical deductible is $125 per person every calendar year (with a maximum of $375 for a family of three or more).
You do not pay a deductible for prescription drugs, and prescription drug costs don’t count toward your medical deductible.
If you are a subscriber who earned the SmartHealth wellness incentive, your medical deductible is reduced to $0. The subscriber is the only family member eligible to earn the SmartHealth wellness incentive.
You don’t have to pay your medical deductible before the plan begins to pay for the following:
- Office visit charges by Primary Care Network providers.
- Preventive care and immunizations.
- 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.
- Tobacco cessation services.
- Diabetes Prevention Program.
- Required second opinions.
The following out-of-pocket expenses do not count toward your deductible:
- Services you pay for that aren’t covered by the plan.
- Services exempt from the medical deductible, even if you had out-of-pocket costs. For example, preventive care received from a non-network or out-of-network provider.
- Charges for services exceeding benefit maximums. For example, the maximum for adult vision hardware is $150 every two calendar years. The charges over $150 do not count toward your medical deductible. (See note below for more information.)
- 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.
- Prescription drug costs.
Note: If you receive services with a benefit limit before you have met your deductible, for which you pay out of pocket, count toward your benefit limit. If you have other primary coverage, visits paid by your primary plan also count toward UMP Plus benefit limits.
If you have three members in your family enrolled in UMP Plus, each family member must meet the $125 medical deductible, for a family maximum of $375. Once any one person spends $125 that applies toward the medical 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 $125 and the maximum the family pays towards medical deductibles is $375. Once a particular individual meets his or her $125 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 $375—even if no one reached $125 on their own—the plan begins paying for covered services for everyone in the family; no more deductible is owed.