Employer and Employee Paid

Overview

Medical insurance (including prescriptions and vision care) is part of the university employee insurance package, which also includes dental, life and long-term disability insurances. The coverage is available from different insurance carriers depending on residence location and/or preference of medical/dental service delivery. During the first 31 days of eligibility and at the annual open enrollment, employees may choose among the plans available in their area. Insurance premiums are deducted from employee's paychecks. The premium amount depends on the plan they choose and the dependents they cover.

Choosing a Medical Plan

During the first 31 days of eligibility and at the annual open enrollment, employees may choose among the Managed Care Plans and the Preferred Provider Plan (Uniform Medical Plan). The Health Care Authority offers a Comparison of Managed and Preferred Provider Plans.

Managed Care Plans

Health care is managed for you by the Primary Care Physician you select. This physician must be in the plan's network of providers, and will coordinate all of your referrals for service beyond his or her care. Only emergency/urgent care is covered by Managed Care Plans when you are out of your plan's service area. There is no deductible, however, most services such as office visits, prescription drugs, emergency room visits, and hospitalization require a co-payment (amount you pay).

Benefits for the managed care plans are for the most part standardized to make plan selection easier. The main differences among the managed care plans are:

• the affiliated doctors and hospitals,
• the premium deduction from the employee's paycheck, for the coverage,
• where in the state the plan offers services,
• if the plan offers Extended Network Benefits, you can self-refer to any doctor within the extended network.

The State offers many Managed Care Plans, depending on your county residence. The plans available in Kittitas County are Group Health Classic and Group Health Value at 1-800-274-2140 (in Yakima); 1-888-901-4636 (All)

Preferred Provider: Uniform Medical Plan

The Uniform Medical Plan has an established Preferred Provider network with many doctors and hospitals within Washington, as well as a nation-wide network. If you utilize UMP preferred providers and participating pharmacies, the provider will submit claims on your behalf. However, if you receive services from a non-preferred provider or nonparticipating pharmacy, you are responsible for submitting a claim form.

Most medical expenses will be paid at 90% after a $200 per person or $600 per family deductible has been met during the calendar year. There is an additional deductible for prescription drugs of $100 per person or $300 per family. There is a maximum annual out-of-pocket amount, after which claims from preferred providers or out-of-area providers will be paid at 100% of the fee schedule, except as otherwise specified.

Contact Uniform Medical for forms and plans information, or call 1-800-762-6004 for employees and 1-800-352-3968 for retirees. Or see the
Uniform Medical Plan Book (PDF Format).