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 health 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.
Limited Benefits for Out-of-Network Coverage
| Classic Plan | Health Savings Plan | Premier Plan | |
|---|---|---|---|
| Deductibles | |||
| Individual | No coverage out-of-network except for emergency room visits | $2,700 | $2,000 |
| Family | $5,400 | $4,000 | |
| Coinsurance | 50% | 50% | |
| Annual Out-of-Pocket Maximums | |||
| Individual | No coverage out-of-network except for emergency room visits | $9,700 | $9,000 |
| Family | $19,400 | $18,000 | |
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 vice versa.