Medical Carrier: UMR
As an eligible employee of IncredibleBank, you may choose benefit coverage that fits you and your family’s needs.
For 24/7 support: +1 (800) 826-9781
Eligibility: 1st of the month following 30 days of employment, must be a Full-Time employee with an FTE of .75/30 hours per week or more.
Network:
- United Healthcare Choice Plus
Provider Search: Go to www.umr.com. Click “Find a Provider” and choose United Healthcare Choice Plus network (also found on your insurance card).
Medical Plan Summary
| PPO Plan | HDHP 1 | HDHP 2 | ||||
|---|---|---|---|---|---|---|
| General Plan Information | In-Network | Out-of-Network | In-Network | Out-of-Network | In-Network | Out-of-Network |
| Deductible | $0 Single $0 Employee + Spouse, Employee + Child(ren), Family | $1,000 Single $2,000 Employee + Spouse, Employee + Child(ren), Family | $1,650 Single $3,300 Employee + Spouse, Employee + Child(ren), Family | $3,300 Single $6,600 Employee + Spouse, Employee + Child(ren), Family | $3,300 Single $6,600 Employee + Spouse, Employee + Child(ren), Family | $6,600 Single $13,200 Employee + Spouse, Employee + Child(ren), Family |
| Embedded Deductible - the maximum amount that any one individual can satisfy toward the annual family deductible | N/A | $1,000 | N/A | N/A | $3,300 | $6,600 |
| Coinsurance | 80% | 60% | 80% | 60% | 80% | 60% |
| Out-of-Pocket Maximum (including Employees Deductible and Co-Insurance) | $4,000 Single $8,000 Employee + Spouse, Employee + Child(ren), Family | $8,000 Single $16,000 Employee + Spouse, Employee + Child(ren), Family | $3,300 Single $6,600 Employee + Spouse, Employee + Child(ren), Family | $6,600 Single $13,200 Employee + Spouse, Employee + Child(ren), Family | $6,600 Single $13,200 Employee + Spouse, Employee + Child(ren), Family | $13,200 Single $26,400 Employee + Spouse, Employee + Child(ren), Family |
| Embedded Out-of-Pocket Maximum - the maximum amount that any one individual can satisfy toward the annual family out-of-pocket maximum | $4,000 | $8,000 | N/A | N/A | $6,600 | $13,200 |
| Dependent Eligibility | 26 | 26 | 26 | |||
| Services: | ||||||
| Preventive Care | 100% | Not Covered | 100% | Not Covered | 100% | Not Covered |
| Chiropractic | $10 Copay | 60% after ded. | 80% after ded. | 60% after ded. | 80% after ded. | 60% after ded. |
| PCP | $25 Copay | 60% after ded. | 80% after ded. | 60% after ded. | 80% after ded. | 60% after ded. |
| Specialist | $50 Copay | 60% after ded. | 80% after ded. | 60% after ded. | 80% after ded. | 60% after ded. |
| Urgent Care | $100 Copay | 60% after ded. | 80% after ded. | 60% after ded. | 80% after ded. | 60% after ded. |
| Emergency Room | $300 Copay | $300 Copay | 80% after ded. | 80% after ded. | 80% after ded. | 80% after ded. |
| Hospital Services | ||||||
| Inpatient | 80% | 60% after ded. | 80% after ded. | 60% after ded. | 80% after ded. | 60% after ded. |
| Outpatient | 80% | 60% after ded. | 80% after ded. | 60% after ded. | 80% after ded. | 60% after ded. |
| Teladoc | ||||||
| Acute Care, Behavioral Health & Dermatology | $0 Copay | 60% after ded. | 80% after ded. | 60% after ded. | 80% after ded. | 60% after ded. |
An attachment of this summary and rate information can be found here.
See the SPD (Summary Plan Description) for all covered and excluded benefits.
Prior Authorizations: It’s important to make sure that you’re covered with the provider and services that you are receiving. You or your health care provider can call the number on the back of your medical ID card to verify the level of benefits available.
- Here’s a list of services that will require prior authorization before receiving care: Bariatric Surgery, Reconstructive Surgery, and Cosmetic Procedures, Chemotherapy and Radiation, Dialysis, MRI, Partial Hospitalization, Specialty Injectables, PET, High Dollar Injectable Therapy (except Insulin), CTA, CT, Nuclear Cardiology, Genetic Testing, Non-Urgent Air Ambulance.
Preventive Care:
- In-network preventive services
- Preventive services are based on a calendar year not date of last service; this provides more flexibility with appointments
- Providers may charge you for a full doctor’s appointment when you incorporate other conditions into your wellness checkup.
- If you fill a prescription that is considered preventive medication it will be covered at 100% (drugs that help protect against or manage a medical condition). Drugs not on this list will apply towards the deductible first then the co-insurance will apply if you’re on a HDHP or a copay charge if you’re on the PPO plan.
Explanation of Benefits (EOB):
- As medical claims are processed – you will receive Explanation of Benefits from UMR; this is not a bill. It simply tells you everything you need to know about the claim(s) such as type of service, if the claim was denied, how much the service cost, what was paid, plan maximums, and what the provider may bill you. If you suspect an error or incorrect charge, please feel free to reach out to UMR Customer Service or the People Team for further assistance.
UMR Medical Claim Form
- In the event you need to manually submit a claim (For example, paying cash at a provider), to streamline the process, please use the attached form. Claims can be submitted dated back 12 months from date of service. Follow the claim filing instructions on the bottom of the form and submit as soon as possible.
Medical Bi-Weekly Contributions
| Health Insurance Bi-Weekly Employee Contributions | PPO Plan | HDHP 1 | HDHP 2 |
|---|---|---|---|
| Coverage Type | Standard Deductions | Standard Deductions | Standard Deductions |
| Single | $63.80 | $58.02 | $41.14 |
| Employee + Child(ren) | $127.60 | $116.04 | $79.20 |
| Employee + Spouse | $153.12 | $139.25 | $95.04 |
| Family | $216.92 | $197.28 | $134.64 |
Transparency in Coverage
Through UnitedHealthcare, UMR creates and publishes the Machine-Readable Files on behalf of IncredibleBank.
To link to the Machine-Readable Files, please click on the URL provided: transparency-in-coverage.uhc.com.
Health Care Cost Estimator
The next time you’re in the market for a new doctor or are wondering how much you’ll pay
for a possible medical procedure, visit www.umr.com first. Your online services make it easy to look up UnitedHealthcare network providers and health care facilities and find cost estimates for different services – all in one place.
Please see this flyer for further information.
UMR Mobile App & Website
The UMR app has a smart fresh look, simple navigation, and faster access to your health care benefits information. View your plan details on demand – anytime, anywhere. Please see this flyer for information on how to download the app.
More information on the tools available for you on www.umr.com and the UMR app can be found here.
Cobra Services
If you are losing your group health coverage, Get Covered powered by HealthMarkets can help answer questions about COBRA, the Affordable Care Act (ACA), Medicare, state Medicaid, and even short-term health insurance plans. Get connected with an agent who can help you find the right plan for you and your loved ones.
Get started by calling (844)-686-1054 or visit www.getcovered.com/umr.
More information can be found here.
Information about COBRA rates can be found here.
2nd.MD – Second Opinion Services
WE SPECIALIZE IN MEDICAL CERTAINTY
IncredibleBank employees and their family members enrolled in our medical plan have access to 2nd.MD, a virtual expert medical consultation and 2nd opinion navigation service. We connect you with a board-certified, elite specialist for a virtual expert medical consultation via phone or video from the comfort of home.
WHEN TO USE 2nd MD
- Do I have the right diagnosis?
- Am I on the best treatment path and medications?
- Is this surgery or procedure the best option for me?
2nd.MD specializes in medical certainty by providing access to elite specialists for questions about:
- Disease, cancer, or chronic conditions
- Surgery or procedure
- Medications and treatment plans
- A New or Existing Diagnosis
2nd.MD Health Advocates may reach out to members as new diagnostic claim data is processed with UMR or you can call 2nd.MD and request a consult.
WHO IS ELIGIBLE?
2nd.MD offers confidential, fast, and free services for you and your family members covered by the UnitedHealthcare medical plan. Please note that any family member or dependent over 18 years old will need to register and create their own login within the 2nd.MD app to access these services.
HOW IT WORKS: 3 Simple Steps
- ACTIVATE YOUR ACCOUNT AND REQUEST A CONSULT
Visit www.2nd.md/incrediblebank, download our app or call us at 1.866.269.3534
- SPEAK WITH A NURSE
Just explain your medical issues and an experienced nurse will handle the rest, including collecting medical records and connecting you with a leading specialist who is an expert in your condition.
- CONSULT WITH A LEADING SPECIALIST
Get information about your diagnosis, treatment plan, and next steps in care from a nationally recognized specialist. Consult via video or phone at a time that works best for you, including evenings and weekends!
AFTER YOUR CONSULTATION
You’ll receive a written summary of your consultation, so you’re prepared for a conversation with your treating doctor, or we can refer you to another in-network doctor in your area.
GET STARTED TODAY
Call at 1.866.269.3534
Visit www.2nd.md/incrediblebank or download our 2nd.MD app
Please see attached flyer for further information.
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Smartscan $250 MRI Bonus
IncredibleBank is introducing an MRI bonus of $250 paid through payroll when utilizing Smart Scan Medical Imaging (SSMI) for MRI’s or MRA’s.
To receive your $250 MRI bonus please provide proof of your MRI scan from Smart Scan to your People Team.
Smart Scan utilizes fellowship trained radiologists and will share your report with your provider within hours of the scan. The average cost for an MRI with contrast at a traditional providers office based on IncredibleBank’s medical claims is almost $3,000, compared to the cost at Smart Scan of $850. Not only is Smart Scan over $2,000 less in claim cost, but this is also an Incredible deal to our members and hope anyone needing an MRI located near a Smart Scan location utilizes this benefit.
There are Smart Scan locations in Eau Claire, Wausau, and Madison. Please see attached quick contact card for location addresses, phone number, and fax.
Hours of Operations for all locations: Monday-Friday, 8:00a-5:00p.
To get started, call: 855-694-3300 or visit www.myssmi.com.
For an overview of the Referral Process to use Smart Scan, please see attached flyer.
Please see attached flyer for further information.
Additional Information
Use this link to review recommended preventive screenings. *Please note that age requirements have been removed from our plan for both mammograms and colonoscopies.
Go to www.umr.com to search for a provider, to review your EOB, and view medical & RX claims or download UMRs Mobile App (Using your desktop credentials).
Please contact the People Team for assistance with this program.