IN-NETWORKBENEFITS |
UMR - Choice Plus Network |
Preventive Care*Preventive Care is defined by the Affordable Care Act (ACA) Visit HealthCare.gov to access a list of covered preventive services by gender and age. |
100% Covered |
Office Visit Copay |
$25 PCP $50 Specialist $0 Teladoc $35 Urgent Care |
Emergency Room |
$250 copay |
Prescription DrugCost Per Tier |
Tier 1: $10 Tier 2: $50 Tier 3: $100 Tier 4: $250
Specialty $250 |
Deductible |
$2,000 Single $4,000 Family |
Coinsurance |
You pay 20% Plan pays 80% |
Out-of-Pocket Maximum |
$4,000 Single $8,000 Family |





















