Medical Coverage

This plan has mid-range monthly premiums and mid-range coverage. Participants are eligible for a Healthcare Flexible Spending Account (FSA).

Here’s how the plan works:

• You pay co-payments for doctor and specialist visits, certain other expenses and prescription drugs.
• You will pay all other expenses in full until you meet your plan deductible.
• Once you meet your deductible, you and the University share in the cost of covered services.
• If you reach the medical out-of-pocket maximum, the plan pays 100% of all eligible expenses for the rest of the calendar year.
• Benefits are not paid for services outside the network, except in emergencies.
• Classic Plan Summary

This qualified high-deductible plan has the lowest monthly premiums of all the medical plans but will have the highest out of pocket costs. It includes a Health Savings Account (HSA) – a tax-advantaged account with contributions made by the University as well as voluntary contributions by the employee.

Here’s how the plan works:

• Until you meet your deductible, you pay for all medical expenses, including prescription drugs, yourself or with money from your HSA. There are no co-payments.
• Once you meet the deductible, you and the plan share in the cost of covered medical and prescription drug expenses through coinsurance.
• If you reach the medical out-of-pocket maximum, the plan plans 100% of all eligible expenses for the rest of the calendar year.
• You have the option to see an out-of-network provider, but you will pay more for your care.
• Health Savings Plan

This plan has the highest monthly premiums but you’ll pay the least out-of-pocket of all the medical options when you receive care from in-network providers. Participants are eligible for a Healthcare Flexible Spending Account (FSA).

Here’s how the plan works:

• You pay co-payments for doctor and specialist visits, certain other expenses and prescription drugs.
• You will pay all other expenses in full until you meet your plan deductible.
• Once you meet your deductible, you and the University share in the cost of covered services.
• If you reach the medical out-of-pocket maximum, the plan pays 100% of all eligible expenses for the rest of the calendar year.
• You will have the option to see an out-of-network provider, but you will pay more for your care.
• Premier Plan Summary

UA System Intranet for SmartCare

The Health Savings Plan and Premier Plan offer coverage for out-of-network providers but your out-of-pocket expenses will be higher. When you obtain care through a non-UA-UMR provider, your benefit payments for covered services will be based on the maximum allowable payment for out-of-network services, as determined by UMR. Charges in excess of the maximum allowable payments do not count toward meeting the deductible or meeting the limitation on your coinsurance maximum. Non-UA-UMR providers may bill you for amounts in excess of the maximum allowable payment.

You pay additional amounts for certain out-of-network services. The amounts you pay for out-of-network deductibles and out-of-pocket maximums are in addition to what you pay for in-network providers. Your in-network deductibles and maximums do not count toward your out-of-network deductibles and maximums and vise versa.

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.

Most providers will file claims for you. If a claim is denied, contact UMR or learn more about filing an appeal.

The university's medical coverage plan promotes wellness. Annual physicals or OB/GYN exams and well-baby visits are covered at 100%. If employees on the medical plan take advantage of their free annual wellness exam and don’t use tobacco or commit to tobacco cessation, they are eligible for the plan’s wellness discounts – which include reduction of their out-of-pocket maximums for the Classic and Premier plans. Additionally, employees can participate in a weight loss program called Real Appeal . This program is free to participants of our Health Plans and uses small doable steps to help participants lose weight and reduce their risk of developing diabetes and cardiovascular disease.

• Wellness Classic Plan Summary
• Wellness Premium Plan Summary
• U of A System’s Wellness 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.

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.