• Frequently Asked Questions

      Q.  Who is UMR?

     A.  UMR is a third-party administrator that the District has hired to process and pay your medical claims.

     

     Q.  How can I contact UMR?

     A.  You can contact member services at 800-826-9781 or via UMR’s secure site at myumr.com.  You will need to create a login and password.

     

     Q.  Who is our Provider Network?

     A.  The Districts’s provider network is UHC Choice Plus.  This is a national network that will allow you to access providers both locally and out of state.  When you utilize a participating          provider / facility, you will receive the highest level of benefits.

     

     Q.  How can I find a Network Provider?

     A.  You can access a provider by calling 800-826-9781 or via the website at www.umr.com; click on locate a provider; network - UHC Choice Plus.

     

     Q.  Who is RxBenefits/OptumRX?

     A.  OptumRx is the District’s pharmacy benefit manager.  This is the vendor that your prescription drugs process through. 

     

     Q.  How can I contact OptumRx?

     A.  You can contact customer service at 800-334-8134 or via the website at www.optumrx.com/myCatamaranRx.  You can check the prescription formulary to find what tier your medicine falls into or login to a secure site to access your pharmacy claims.

     

    Q.  When can I change medical / dental plans?

     A.  You can switch medical / dental plans each annual enrollment which is in May for an effective date of July 1.  You will remain in the selected plan for 12 months. 

     

     Q.  When does my deductible start?

     A.  Your medical deductible runs plan year, which is July 1 – June 30.  Your dental deductible runs calendar year which is January 1 – December 31.

     

    Q.  What are the monthly health insurance rates?

     A. 

    HSA with Wellness

    HSA without Wellness

    Emp

    $0

    Emp

    $5

    Emp + Spouse

    $420

    Emp + Spouse

    $450

    Emp + Children

    $285

    Emp + Children

    $315

    Emp + Family

    $725

    Emp + Family

    $755

    Base Plan with Wellness

    Base Plan without Wellness

    Emp

    $25

    Emp

    $55

    Emp + Spouse

    $510

    Emp + Spouse

    $540

    Emp + Children

    $360

    Emp + Children

    $390

    Emp + Family

    $845

    Emp + Family

    $875

    Buy- Up Plan with Wellness

    Buy-Up without Wellness

    Emp

    $70

    Emp

    $100

    Emp + Spouse

    $600

    Emp + Spouse

    $630

    Emp + Children

    $430

    Emp + Children

    $460

    Emp + Family

    $960

    Emp + Family

    $990

     

    Q.  What is a health savings account?

     A.  Otherwise known as an HSA, a health savings account can be funded with your tax-exempt dollars, by your employer, or both, to help pay for eligible medical expenses not covered by an insurance plan, including the deductible, coinsurance, and even in some cases, health insurance premiums.

     

    Q.  Who is eligible for an HSA?

     A.  Anyone who is:

    • Covered by a High Deductible Health Plan (HDHP); 
    • Not covered under another medical plan that is not an HDHP

     

    Q.  What are the steps in a HSA?

     A.  1.  Employee and/or employer funds HSA account.

    2.   Employee seeks medical services.

    3.   Medical services are paid by HDHP, subject to deductible and coinsurance.

    4.   Employee may seek reimbursement from HSA account for amounts paid toward deductible and coinsurance.

    5.   Deductible and out-of-pocket maximum fulfilled.

    6.   Employee may be covered for all remaining eligible expenses.*  Preventive care may be covered at 100%

     

    Q.  When do I use my HSA?

     A.  After visiting a physician, facility or pharmacy, your medical claim will be submitted to your HDHP for payment. Your HSA dollars can be used to pay your out-of-pocket expenses (deductibles and coinsurance) billed by the physician, facility or pharmacy, or you can choose to save your HSA dollars for a future medical expense.

     

    Q.  How much can I contribute to an HSA each calendar year?

     A.  As noted by federal law, the annual contribution limits are: 

    • $3,450 for individual coverage or $6,900 for family coverage.
    • Individuals age 55 or older may be eligible to make a catch-up contribution of $1,000

     Q.  What is the difference between an HSA and Flexible Spending Account (FSA)?

     A. .   An HSA is a savings account and can accumulate unused funds from year to year.

    •   An FSA is for the current plan year only, it cannot roll over unused funds from year to year unless there is a remaining balance of $500 or less.

     

    Q.  Why should I elect an HSA?

     A.  1.  Cost Savings

    -   Tax benefits

    o HSA contributions are excluded from federal income tax

    o Interest earnings are tax-deferred

    o Withdrawals for eligible expenses are exempt from federal income tax

    -   Reduction in medical plan contribution

    -   Unused money is held in an interest-bearing savings or investment account

    Note: Many states have not passed legislation to provide favorable state tax treatment for HSAs. Therefore, amounts contributed to HSAs and interest earned on HSA accounts may be included on the employee’s W-2 for state income tax purposes.

     

    2.  Long-Term Financial Benefits
    -   Save for future medical expenses
    -   Funds roll over from year to year

    -   This is your account – you take it with you

     

    3.  Choice

    -   You control and manage your health care expenses.

    -   You choose when to use your HSA dollars to pay your health care expenses.

    -   You choose when to save your HSA dollars and pay health care expenses out-of-pocket.

     

     Q.  Why participate in a Health Risk Assessment (HRA)?

     A.  A Health Risk Appraisal (or Assessment), also known as an HRA, is a technique for determining the presence of disease and estimating the risk that someone with certain characteristics will develop disease within a given time span. It can be used by both employers and employees to identify people at risk, and target specific strategies that will keep them well and also reduce health care costs.  

    Health Risk Appraisals are appealing for several reasons:

    • They are easy to complete and are popular with clients.
    • They may increase individual motivation and participation in health promotion programs because of risks that are identified.
    • They provide group data that can be used by the employer to identify major health problems and risk factors that can be addressed in wellness programming.

     

    Q.  Why contact the NurseLine with UMR?

     A.  Coping with health concerns can be time consuming and complex. It can be hard to know where to find trusted information among so many choices or what to do in a non-emergency situation. Ever experienced one of these scenarios?

    It’s midnight. Your child has a fever and now you notice a peculiar rash. What should you do?

    You wake up with severe stomach cramps. You wonder if you should phone your doctor, go to the emergency room or wait it out.

    You’re diagnosed with cancer and want to learn more about the disease and possible treatment options.

    A family member is scheduled for a surgical procedure. You read the pamphlets from the surgeon’s office, but you still have several unanswered questions.

     Instead of playing guessing games with health issues, give UMR’s NurseLine a ring. A simple phone call to NurseLine gets you in touch with a highly trained registered nurse who can answer your medical questions and provide advice—without an appointment.

    NurseLine is a 24 hour-a-day, 7 day-a-week nurse telephone line that is completely confidential. Our nurses speak English, Spanish and 140+ other languages and can accommodate those requiring hearing assistance. When you call, you may choose to speak with a registered nurse or access the audio health library containing over 1,100 topics, such as physical and emotional conditions, procedures, medications, men’s and women’s health, children’s health and much more. Call 1-866-494-4502 Pin: 197.

     

    Q.  What is a self-funding insurance plan?

     A.  An employer has a self-funded group health plan—or a self-insured plan—if the employer assumes the financial risk for providing health care benefits to its employees. Rather than paying fixed premiums to an insurance company who in turn assumes the financial risk, your employer pays for medical claims out-of-pocket, as they are incurred. Generally, employers who have self-funded plans will set up special funds to earmark corporate money to pay for employee medical claims.

     

    Q.  Why do employers choose self-funding?

     A. An employer may choose to offer a self-funded health insurance plan for a number of reasons.

    §  Instead of trying to purchase a “one size fits all” health plan, self-funded plans can be customized to fit the needs of an employer’s workforce.

    §  Employers with self-funded plans control the health plan cash reserves, allowing them to maximize interest income (insurance companies otherwise generate interest income for themselves by investing premium dollars).

    §  Self-funded coverage is not prepaid, as it is when the employer pays premiums to an insurance company. Therefore, companies who self-fund their health plans have improved cash flow.

    §  Self-funded plans are not subject to conflicting state health insurance regulations and benefits mandates. Instead, these plans are regulated by federal law.

    §  Employers with self-funded plans are not subject to state health insurance premium taxes.

    Employers can contract with the providers or a particular provider network that will best meet the needs of its employees

     

    Q.  How does self-funded benefits work?

     A.  Imagine you have made an appointment with your doctor when you are not feeling well. When you arrive at your doctor’s office, you will be asked to provide your insurance card to your physician’s office personnel. Your insurance card tells the doctor’s office what type of health plan you have and how it is administered, i.e. to whom your claim should be sent.

    After you have seen your doctor, a claim for payment for an office visit has been generated. Someone in your doctor’s office will prepare the claim and submit it to the administrator—the entity that will determine how your claim will be paid—listed on the insurance card you provided at the time of your visit. Your employer may administer employee health care claims in-house, or it may use a third party administrator (TPA).

    The administrator then adjudicates your claim. Adjudication is the process of paying health care claims according to your health plan’s contract. Your health plan’s administrator will determine how your health benefits work and what payment is required for your doctor. Your plan may require you to pay coinsurance or a deductible before your health plan pays its portion of your bill. Or, your doctor may participate in a Preferred Provider Organization (PPO) or another type of managed care plan and therefore will charge discounted fees to your plan. These and other factors determine how much of the claim the plan will pay, how much you will pay, and how much the doctor will eventually receive for services rendered.

    Once all of the payment issues are cleared up, your plan administrator contacts your employer for approval of your claim’s payment (and any other current claims). Your employer approves payment of the claim.

    After receiving payment approval from your employer, the administrator requests payment from your employer’s bank. The bank will wire the appropriate funds to the administrator, who will then send payment to your physician. Your claim is paid.

    This payment process generally takes two to four weeks.