Coinsurance/copayments

Coinsurance

UMP Plus covers most medical services based on a percentage of the allowed amount that network providers agree to accept as payment in full.

Coinsurance is the percentage of the allowed amount you pay when the plan pays less than 100 percent of the allowed amount. Your coinsurance depends on the provider's network status:

  • Primary care providers: Office visit charges covered in full when using a primary care network provider. You may pay 15 percent of the allowed amount for related services, such as lab or other tests.
  • Network providers: You pay 15 percent of the allowed amount.
  • Non-network providers: You pay 50 percent of the allowed amount.
  • Out-of-network providers: You pay 50 percent of the allowed amount and may be balance billed. (See Cost for providers by type for examples 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.

Copayment

You also pay a copayment (“copay”) when you receive certain services. Copayments are set dollar amounts.

The only copayments under UMP Plus are facility charges for inpatient services and emergency room care. See your UMP Plus Summary of benefits for details.