Medical Coverage

The University of Arkansas Medical Coverage Plan is self-funded and offers employees a choice between three 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 contribution varies depending on plan selection, coverage tier and salary level.  

Medical Plan Choice

University benefits-eligible employees have a choice of three 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.

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 Highlights

 

In-Network Benefits

Preventive Care

No Cost

Deductibles

$1,250 individual/ $2,500 family

Annual Out-of-Pocket Maximum

$5,250 individual/ $10,500 family

Office Visits

$35 PCP/ $55 Specialist

Coinsurance

25%

Prescription Drugs

Tier 1: $15/ Tier 2: $55/ Tier 3: $90

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.

Classic Plan Highlights

 

In-Network Benefits

University contributions to HSA

$420 individual/$840 family

Preventive Care

No Cost

Deductibles

$2,700 individual/ $5,400 family

Annual Out-of-Pocket Maximum

$6,650 individual/ $13,300 family

Office Visits, Other Medical Services & Prescription Drugs

10% after deductible is met

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 Highlights

 

In-Network Benefits

Preventive Care

No Cost

Deductibles

$650 individual/ $1,300 family

Annual Out-of-Pocket Maximum

$3,000 individual/ $6,000 family

Office Visits

$25 PCP/ $45 Specialist

Coinsurance

20%

Prescription Drugs

Tier 1: $10/ Tier 2: $50/ Tier 3: $80

Participants in all three medical plans may save on health care costs through the SmartCare program by visiting a provider at the University of Arkansas for Medical Sciences.  Additionally, employees of the University of Arkansas Fayetteville can access SmartCare discounts when they visit the Pat Walker Health Center.  If you are in the Classic Plan or Premier Plan, you may save money on certain expenses through lower deductibles, out-of-pocket maximums, co-payments and coinsurance.  If you are in the Health Savings Plan, you may save money through lower coinsurance.  You don’t have to sign up for SmartCare.  If you visit a UAMS facility or the Pat Walker Health Center (UAF faculty/staff only) for your care and are enrolled in one of the three health plans, UMR will automatically apply the SmartCare adjustments.

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.

 

Classic Plan

Health Savings Plan

Premier Plan

Deductibles

No coverage for out-of-network except for emergency room visits

$2,700 Individual

$5,400 Family

$2,000 Individual

$4,000 Family

Coinsurance

.

50%

50%

Annual Out-of-Pocket Maximum

No coverage for out-of-network except for emergency room visits

$9,700 Individual

$19,400 Family

$9,000 Individual

$18,000 Family

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 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.

 

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. 

 

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%. 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.
 

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.