UACES Facebook C.E.S.P. 8-2: UMR Health Insurance

Employee Benefits - Fringe Benefits

C.E.S.P. 8-2: Health Insurance

Date Revised: 1-1-2016
Supersedes: 1-1-2015

Summary: Establishes policies for participation in the University of Arkansas Group Health Insurance Program.

 The University of Arkansas Health Plan is self-insured and self-funded. UMR is the third party administrator and processes all medical claims. MedImpact is the pharmacy benefit manager and processes all prescription claims.

There are two plans to choose from: Classic or Point of Service. Both cover a wide range of traditional expenses such as doctor visits, surgical services, pregnancy, emergency room services, hospital stays, mental health services and diagnostic testing. With a goal of assisting employees in being healthy, most preventive care performed in-network are covered in full (such as annual physicals, flu shots, cancer screenings and well-baby care).

The Classic Plan has a lower monthly premium because all health care is handled through in- network physicians and specialists. The employee and each family member covered by the plan may choose to receive services from any Primary Care Physician (PCP) within the UMR Network. There are no benefits if services are received outside the network, except for emergencies that arise while traveling. The network is nationwide.

The Point of Service Plan is for those who need the flexibility of choosing one of two benefits options each time a health care need develops, in other words at the “point of service.” When you choose In-Network, your health care is provided by an in-network physician or specialists. In-Network is much like the Classic Plan. If you choose to go to a physician who is not in the UMR Network, you will be choosing the Out-Of-Network option and incurring the most out-of- pocket expense. Your Benefit payments for covered services will be based on the Maximum Allowable Payment as determined by UMR. Charges in excess of the Maximum Allowable Payments do not count toward meeting the deductible or meeting the limitation of your Out of Pocket maximum. Non-UMR Providers may bill the patient for amounts in excess of the Maximum Allowable Payment.

 If you have questions about the medical plans, you may call UMR (1-888-438-6105) or the Extension Human Resources Office (501-671-2219).

Prescription Drug coverage is a part of both the Classic and Point of Service Plans. The 3-tier prescription drug program requires a $15 copayment for generic drugs, $50 copayment for formulary preferred brand-name drugs, and $80 copayment for formulary non-preferred drugs.

Additionally, there is an out-of-pocket maximum of $1,600 per individual, $3,200 per family. Drugs that are reference based pricing, 100% member paid, or non-covered will not count toward this maximum.

 If you have questions about the prescription drug coverage, call MedImpact (1-800-788-2949), UMR (1-888-438-6105) or the Extension Human Resources Office (501-671-2219).

Onlife Health is a free health and wellness program for employees and their spouses who are insured under the UA health insurance plan. If you have questions about the UA Wellness program, you may call (1-877-369-0285) or log in to the Onlife Health site for education, motivation and fun. If you are a returning user, enter your username and password. If you are a new user, click GET STARTED and type in “UAS” as the key code. Follow the online instructions to create your username and password.

 Exclusions and Limitations - The following is a partial listing of procedures that are not covered under the University of Arkansas medical insurance plan:

  • Operations or treatment of the teeth or the supporting tissues of the teeth, other than for tumors, dental services in connection with an accidental injury, treatment of diseases of the jaw, or extraction of impacted teeth
  • Elective cosmetic surgery (certain reconstructive surgeries are covered)
  • Eyeglasses or hearing aids
  • Treatment of weak, strained, flat, or unstable feet and corns, calluses, or toenails
  • Organ donation services
  • Non-prescription drugs and supplies
  • Infertility treatment
  • Services or supplies as a result of on-the-job injuries covered under Workers’ Compensation
  • Services or supplies as a result of an act of war

 You can cover your spouse, as legally recognized by the State of Arkansas. You can also cover your children until they reach their 26th birthday, regardless of their marital, employment or student status.

Your premium cost is based on which plan you elect, the percent of time you work and the family members you are covering.

Coordination of Benefits - This plan coordinates with other group plans under which an individual is covered so that the total benefits available will not exceed 100% of the allowable expenses.

Resignation - Under the federal regulation called COBRA (Consolidated Omnibus Budget Reconciliation Act), you have the option of continuing your current group health insurance coverage for up to 18 months after termination (or 36 months under certain conditions). To keep this coverage, you must pay the total premium (employee and employer share of the cost) plus 2%.
Retirement - You may continue the UA health insurance by paying both the employee and employer share of premiums if you have been insured under the plan for at least 10 continuous years prior to retirement and your age plus length of service equals at least 70.

Medical Resources:

Other resources:

Forms:

 Legal Notices: 

Consult your Summary Plan Description or contact the Human Resources Office for more information.