Medical – High Deductible Health Plan (HDHP)/Health Savings Account (H.S.A.)
Washington County offers a High Deductible Health Plan/Health Savings Account medical plan to all eligible employees and their eligible dependents. The medical plan is administered by UMR. For prior authorization call UMR at 1-866-494-4502. United Healthcare NexusACO is the network provider.
For complete details, please refer to this document - Summary Plan Description
HDHP Medical Plan Benefit Summary
The purpose of this benefits summary is to highlight the major aspects of your medical benefits and to provide you with a quick reference tool. A full description of the benefit plan can be found in the Summary Plan Descriptions (SPD), which takes precedence over this benefits summary. SPDs are also posted on the County’s intranet. Please take time to review the SPD to understand your benefit choices and options.
|Medical Plan Coverage||Tier 1 |
|Annual Deductible||$2,000 Single / $5,500 Family||$2,500 Single / $6,875 Family||$5,000 Single / $13,750 Family|
|Maximum Out of Pocket |
(includes deductible and medical copays)
See Pharmacy / Rx page for Prescription Out of Pocket Limit
|$4,000 Single / $11,000 Family||$5,000 Single / $13,750 Family||$10,000 Single / $27,500 Family|
|Primary Care Provider or Specialist Visit||80% after deductible||60% after deductible||50% after deductible|
|Preventive Care Visits||Covered at 100%||Covered at 100%||50% after deductible|
|Maternity||80% after deductible||60% after deductible||50% after deductible|
|Inpatient Hospitalization||80% after deductible||60% after deductible||50% after deductible|
|Outpatient / Ambulatory Surgery||80% after deductible||60% after deductible||50% after deductible|
|Emergency Room||80% after deductible||80% after deductible||80% after deductible|
|Ambulance||80% after deductible||80% after deductible||80% after deductible|
|Urgent Care||80% after deductible||80% after deductible||50% after deductible|
|Inpatient Mental Health, Alcohol and Substance Abuse||80% after deductible||60% after deductible||50% after deductible|
|All Therapies (PT, OT, Speech)||80% after deductible||60% after deductible||50% after deductible|
|Chiropractic Services||80% after deductible||60% after deductible||50% after deductible|
|Labs and X-rays||80% after deductible||60% after deductible||50% after deductible|
|MRI (Nuclear Medicine, Other High Tech)||80% after deductible||60% after deductible||50% after deductible|
Eligibility for Medical Plan
- All regular employees of the County who are regularly scheduled to work a minimum of 30 hours per week are eligible.
- Employees are eligible for coverage under the plan the first day of the month after 30 consecutive days of regular employment.
If you are an Eligible Employee, you may elect to cover your eligible Dependents. An eligible “Dependent” is defined to mean:
- A covered employee’s legal spouse
- A covered employee’s married or unmarried: natural born, blood related child; stepchild; legally adopted child; child placed in the employee’s legal guardianship by court order; or a child placed with the employee for the purpose of adoption and for which the employee has a legal obligation to provide full or partial support.
The limiting age for each dependent child is the last day of the month in which such child reaches age 26.
This is a general outline of the Eligibility Coverage. A full description of Eligibility Coverage can be found in the Summary Plan Descriptions (SPD), which takes precedence over this Eligibility Summary.
UMR Member Benefits Portal
The UMR member benefit portal website has an easy to navigate home page that provides quick access to claims data, eligibility information, and paperless EOB elections.
- Check your benefits to see what’s covered
- Find a doctor in your network
- Learn about medical conditions and treatment options
- Access tools and trusted resources to help you live a healthier life
- Print or order an ID card
- Search treatments or procedures in the Health Cost Estimator
To create a UMR online member account, follow the steps below.
Go to www.umr.com, click Login/Register in the upper right corner to open an account
Make sure you have your ID card handy and follow the steps to get started
Click here for a quick tour.
NEW! UMR Mobile Member App
The UMR mobile app is available for download through the Google Play and Apple Store. It appears in the app store as: UMR I Health.
Members enrolled in the medical plan have on-demand access to important plan information such as:
- Digital ID card display
- Claim details
- Health account balances
- Provider search
For more information, click here.
Finding a Tier 1 Network Provider
Click here for step by step instructions to find In-Network providers and here to learn about and identify a Tier 1 provider. Tier 1 providers meet criteria for providing quality and cost-efficient care, look for the Tier 1 physician designation symbol.
If you are not yet registered with UMR, click on “Login/Register” or call 1-800-826-9781.
UMR Health Cost Estimator
Click here to learn how to use the UMR Health Cost Estimator. The Health Care Estimator gives provider information, patient ratings and costs for different kinds of care.
What are Deductible, Coinsurance, Copay, Out of Pocket Maximum?
Deductible means a specified dollar amount of covered expenses which must be incurred during a calendar year (unless otherwise stated in a benefit schedule) before any other covered expenses can be considered for payment according to the applicable benefit percentage. The participant is responsible for the amount of the deductible.
Coinsurance means that portion of eligible expenses to be paid by the plan and the participant in accordance with the coverage provisions stated in the plan. It is the basis used to determine the amount of covered expenses which are to be paid by the participant.
Copay means that amount shown in any benefit schedule which is the participants responsibility for charges incurred for the doctor’s office visits, prescription drugs or other services.
Out of Pocket Maximum is the maximum participant expense per calendar year. The out of pocket expense is the total of deductible, coinsurance and copays paid during a calendar year.