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Uniform Medical Plan

A premium is the amount a member pays for health insurance coverage.

2012 monthly premiums subscriber only subscriber & spouse/
registered domestic partner		 subscriber & child full family
Classic* $82 $174 $144 $236
CDHP* $27 $64 $47 $84
2012 monthly premiums retiree only retiree & spouse/
registered domestic partner		 retiree & child full family
Classic
for non-Medicare retirees		 $531.11 $1,056.69 $925.30 $1,450.88
CDHP
for non-Medicare retirees		 $485.22 $961.45 $856.97 $1,274.87
2012 monthly premiums retiree only retiree & spouse/
registered domestic partner, one on Medicare		 retiree & spouse/
registered domestic partner, both on Medicare
Classic
for Medicare retirees		 $213.87 $739.45 $422.21
CDHP
for Medicare retirees		 Note: The UMP CDHP is not available to PEBB retirees who are covered by Medicare.

*The premiums apply to employees in state agencies, higher-education institutions, and community and technical colleges. School district employees and employees who work for a city, county, port, water district, hospital, etc. need to contact their personnel, payroll, or benefits office for their monthly premiums for 2012.

A deductible is what you pay before the plan begins paying toward covered services. For the UMP Classic Plan and CDHP, 2012 plan deductibles are:

UMP Classic UMP CDHP
  • $250 per person
  • $750 for families of three or more
Please note that the Classic plan has a $100 per person/up to $300 per family pharmacy deductible that is counted separately from the plan's annual deductible.
  • $1,400 for individuals
  • $2,800 for families of two or more
Please note that the entire $2,800 deductible must be met before the plan begins paying benefits, except for services that are exempt from the deductible like preventive care and routine vision exams.

Coinsurance is the percentage of the cost of visits and procedures that members pay after they've met their deductible.

For both the UMP Classic and CDHP, members pay:

  • 15% for network providers for most services
  • 40% for non-network providers for most services
  • Preventive care services are covered 100% with no deductible when you see a network provider

A copay is a fixed dollar amount the member pays the provider when they receive a medical service.

For the UMP Classic, members pay:

  • $75 for emergency room visits (this copay is waived if the visit results in a doctor admitting the patient to the hospital). Members also pay 15% of facility and professional fees.
  • $200 per day for inpatient stays, up to $600 per calendar year. Medicare retirees pay $200 per day, up to $600 per admission. In addition to the inpatient copay, members pay 15% for network provider professional services.

For the UMP CDHP, members pay:

  • The UMP CDHP does not have emergency room or inpatient copays.
  • Members generally pay 15% for network providers for emergency room visits and inpatient hospital stays.

The out-of-pocket limit is the maximum amount you will be liable to pay in any year. Both plans have out-of-pocket limits, but they are calculated differently.

The UMP Classic out-of-pocket limit is $2,000 for individuals, $4,000 for families. What you pay toward the medical deductible, copays for ER visits and inpatient hospitalization, and prescription drug costs do not count toward your out-of-pocket limit. Payments to non-network providers are never paid at the 100% level, even if you reach the out-of-pocket limit.

The UMP CDHP out-of-pocket limit, which is the maximum amount you pay to network providers for covered services and prescription drugs during a calendar year, is $4,200 for one person on an account or $8,400 for a family of two or more. Unlike UMP Classic, the deductible and prescription drugs cost do count toward the out-of-pocket limit. Similar to UMP Classic, payments to non-network providers don't count toward the out-of-pocket limit and are never paid at the 100% level, even if you reach the out-of-pocket limit.

A health savings account (HSA) is a tax-free savings account used to pay for health expenses.

The PEBB Program contributes $700 for individuals, or $1,400 for families of two or more, per year into your account. Deposits are prorated and paid on a monthly basis throughout the year. Individuals can contribute up to $2,400 more, or families can contribute up to $4,850 more, to their HSAs per year. Individuals age 55 or older can contribute an additional $1,000 per year.

To open or contribute to an HSA, you must be enrolled in a qualifying health plan, like the UMP Consumer-Directed Health Plan (CDHP). Medicare enrollees are not eligible to open HSAs.