Cost for providers by type

The table below describes how much you'll pay for services.

Unless otherwise noted, all payment is based on the allowed amount, and services are subject to the medical deductible.

Type of service How much I pay
Primary care services

Primary care providers in the core network: You pay $0; the plan pays in full. Services performed during a primary care office visit, like x-rays or labs, may be covered under the standard benefit (described below).

If you receive primary care office visits from the following providers, services are subject to the medical deductible and the following coinsurance:

Standard

Subject to the medical deductible and coinsurance.

Most ancillary providers and services are paid at the standard rate.

You must pay your medical deductible, the first $125 in covered services, before the plan begins to pay. How much you pay (your coinsurance) depends on the provider’s network status:
Preventive

Not subject to the medical deductible or coinsurance.

How much you pay depends on the provider’s network status:
Outpatient

Subject to the medical deductible and coinsurance.

If you receive services at a facility that offers inpatient services but are not admitted, the services are covered as outpatient. See the specific benefit (e.g., emergency room or diagnostic tests) for how much you will pay. You may be billed separately for facility fees in addition to the provider fees.
Inpatient

Subject to the medical deductible, copay, and coinsurance.

You pay the inpatient copay: $200 per day at network facilities, $600 maximum per calendar year. The inpatient copay counts toward your medical out-of-pocket limit.

When you are admitted to a network facility, you will pay:

  • Any remaining medical deductible,
  • The inpatient copay, and
  • Your coinsurance for professional services, such as doctor consultations or lab tests, which depends on the provider’s network status.

See the "Standard" row above for provider status information. See the specific benefit (like diagnostic tests) for how the plan covers these services.

Professional providers may contract separately from a facility. Even if a facility is network, a provider may not be.

If you go to an out-of-network facility for non-emergency inpatient care, you will pay 50 percent of the allowed amount and may be balance billed.

Services are considered inpatient only when you are admitted to a facility.

Most inpatient services require both preauthorization and notification, which means your provider must notify the plan upon admission to a facility.

Facility fees

Facility fees may be charged in addition to provider fees when accessing hospitals or clinics.

Facility fees associated with primary care office visits will be paid at 100 percent.

How much you pay for facility fees not related to a primary care office visit depends on the provider’s* network status:

*A facility, such as a hospital, may be referred to as a “provider.”

Special

(for example, ambulance)

Subject to the medical deductible.

These services have unique payment rules. See the summary of benefits page for details.

Contact

UMP Customer Service
Phone: 1-888-849-3681
TRS: 711
Business hours: Monday–Friday 5 a.m. to 8 p.m. and Saturday 8 a.m. to 4:30 p.m. Pacific Time