The University of Arkansas Medical Coverage Plan is self-funded and offers employees a choice between two health plans that cover a wide range of medical services. Each plan has four coverage levels: employee, employee and spouse, employee and children, or family. The medical coverage plan promotes wellness, and the university pays at least 72% of the total premium for full-time employees.
Medical Plan Choice
University benefits-eligible employees have a choice of two health plans that cover a wide range of traditional expenses such as doctor visits, surgical services, pregnancy, emergency room services, hospital stays and diagnostic testing. Claims are administered by UMR, a division of United Healthcare, and UMR providers serve as in-network providers for participants. The prescription portion of the university's Medical Coverage Plan is administered by MedImpact. Both UMR and MedImpact offer a nationwide network of providers.
Classic Plan premiums are lower than the Point of Service Plan. However, benefits are only provided if you access care through in-network providers. There are no benefits for out-of-network providers other than emergency or urgent care while traveling.
Point of Service Plan
The Point of Service Plan is dual option, and out-of-pocket expenses are determined by whether you seek care from an in-network or out-of-network provider. You get the most benefit by seeing in-network providers. Seeing a doctor or other provider outside of the network requires that you pay a higher share of the cost, but your payment is based on the allowable amount for the services provided, not on billed charges.
For help choosing between the plans, see Medical Plans Comparison and Medical Benefit Summary Plan Description or contact an HR Expert. New employees can learn more about the benefit enrollment process at New Employee Orientation.
When you enroll in UMR medical coverage, you are automatically enrolled in prescription coverage from MedImpact. MedImpact has a nationwide network of pharmacies that includes most chains.
The prescription plan has three levels, or tiers, of coverage:
- Tier 1: Generic
- $15 for up to a 30-day supply
- $45 for a 31 to 90-day supply
- Tier 2: Preferred name brand
- $50 for up to a 30-day supply
- $150 for a 31 to 90-day supply
- Tier 3: Non-preferred
- $80 for up to a 30-day supply
- $120 for a 31 to 90-day supply
As a generic incentive plan, MedImpact prescription coverage requires a 100% co-pay on all brand-name drugs that have a generic equivalent regardless of Dispense As Written (DAW) logic used by the prescriber. Multi-source brands considered Narrow Therapeutic Index (NTI) drugs will continue at the applicable Tier co-payment.
The out-of-pocket maximum on prescription co-pay is $1,600 per person or $3,200 per family. To satisfy the family maximum, two people must meet their out-of-pocket maximums. Reference-based pricing and 100% co-pay drugs do not apply to the out-of-pocket maximum.
The university prescription drug formulary is maintained by the University of Arkansas System Pharmacy Advisory Committee, which is composed of faculty, clinical pharmacists, physicians and nurse practitioners who advise the committee on the most recent medical research results. The committee’s recommendations are based on the latest available evidence-based studies.
Premium conversion allows you to pay your medical insurance premiums on a tax-exempt basis. Your premiums are deducted from your pay before federal, state and social security taxes are calculated. Once you elect to pre-tax your premiums, you cannot change or cancel your premiums during the calendar year unless you are within 31 days of a qualifying event as defined by the IRS. If eligible, complete the Premium Conversion Change form to change your premium status.
Managing Your Plan
For both plans, see UMR's website to view your claims and eligibility, order new ID cards, view your flexible spending account information (if enrolled), check on providers and more.
You can add or remove dependents from your health plan during an open enrollment period or if you are within 31 days of an eligible qualifying event such as marriage, birth, placement in the home for adoption, etc.
The university's medical coverage plan promotes wellness. Annual physicals or OB/GYN exams and well-baby visits are covered at 100%. Additionally, employees and their covered spouses can participate in a wellness program through Onlife Health. Use the key code UAS to log in as a new user. The wellness program offers a wellness assessment and access to a health coach to work toward improvement and better health in areas such as physical activity, nutrition, stress reduction and tobacco cessation. Employees can qualify for participation incentives by working with health coaches on achieving wellness goals.
The Smoking Cessation Program offers free PCP visits and zero co-pays for Chantix, a medication for nicotine addiction. The Diabetes Management Initiative and the Healthy Heart Program provide the opportunity for zero co-pays on many generic medications. The Pregnancy Management Program offers a $300 discount on your hospital expense if you enroll in the first trimester or $150 if you enroll in your second trimester. For more information, call UMR at 888-438-6105.
Nutritional Counseling and Weight Management Program
The university's medical coverage plan provides coverage for nutritional counseling and weight management.
Level I: All covered members are eligible to receive one visit per calendar year for nutritional counseling with a registered dietitian at an in-network facility.
Level II: Members who have a BMI of 27 or greater are eligible to enroll in a nutritional counseling weight loss program. This program provides up to four total annual visits with a registered dietitian at an in-network facility. The member must be under the direction of a physician with documentation through a Physician Attestation Form.
Level III: Members who have a BMI of 30 or greater are eligible for reimbursement for the cost of non-surgical weight loss programs for up to $1,000 lifetime maximum. The member must be under the direction of a physician with documentation through a Physician Attestation Form. Coverage includes instruction, education, weight monitoring, counseling and support. Initial and routine lab work is covered as provided within the benefit, but weight loss products and meal replacement shakes are not covered. File a Reimbursement Request Form with UMR.
Coverage after Leaving the University
If you have university health insurance when you retire, you may be eligible to continue your coverage as an eligible retiree. When a retiree and/or their spouse turns 65, university medical coverage automatically becomes secondary to Medicare.
You may also have the right to continue group health coverage on a self-paid basis when you are no longer eligible for employer-sponsored coverage for a reason other than retirement under COBRA.