Medical Insurance
The City of Woodstock offers employees three medical plan options through UMR. The rising cost of health care continues to make it harder to find affordable medical benefits. Our goal is to offer affordable benefit options that also ensure you have access to high-quality services.
You have three deductible plans to choose from:
- The first option has a deductible expense of $500 for employee only coverage, $1,000 for employee plus spouse coverage or employee plus child coverage, and $1,500 for family coverage.
- The second option has a deductible expense of $1,500 for employee only coverage, $3,000 for employee plus spouse coverage or employee plus child coverage, and $4,500 for family coverage.
- The third option has a deductible expense of $1,500 for employee only coverage, $3,000 for employee plus spouse coverage or employee plus child coverage, and $3,000 for family coverage.
Once you have incurred an out-of-pocket of either $500 or $1,500 (per covered member) the City of Woodstock will cover all remaining eligible in-network medical expenses.
PLEASE NOTE that the medical plan that you choose during benefits open enrollment, will be the medical plan that you’re enrolled in through September 30, 2024. The Basic and Premium medical plans have plan design changes that will take effect on January 1, 2024 however you will be unable to change your plan in January based on these changes. For additional details regarding plan design changes, please reference the Medical Insurance Effective January 1, 2024 tab.
The UMR Choice Plus POS is a traditional health plan. Employees pay a $25 – $35 office visit copay for in-network doctor visits participating in the UHC Choice Plus POS Network. Employees can also access care from a UMR/UHC Premium Designated Provider. This program recognizes doctors who meet standards for quality and cost efficiency. By utilizing these premium doctors, you will also receive a $10 discount on your PCP and Specialist office visit copays. Certain other services are covered after the deductible is reached. This plan allows you to visit any in-network provider without a referral.
If you use out-of-network providers, you may have to file your benefit claims yourself or pay for services and wait to be reimbursed by UMR.
The information contained in this presentation is an overview of your benefits. If you have specific questions regarding a provider or procedure, please call UMR Customer Service at the number listed on the back of your ID Card. If you do not have an ID card, please call (800) 826-9781 or refer to the Medical & Rx SPD.
Premium – $500 POS Plan Benefits
In-Network | Out-of-Network | |
Deductible (Calendar Year) | ||
Single | $500 | $6,000 |
Family | $1,500 | $18,000 |
Lifetime Maximum | Unlimited | Unlimited |
Coinsurance (Plan/Member) | 100% / 0% | 60% / 40% |
Max Out-of-Pocket (Including Deductible) | ||
Single | $500 | $14,000 |
Family | $1,500 | $42,000 |
Hospital Facility Services | ||
Inpatient | Deductible and $250 Copay | Plan Pays 40% after Deductible |
Outpatient | Deductible and $250 Copay | Plan Pays 40% after Deductible |
Emergency Room | $150 Copay | $150 Copay |
Physician Office Visits | ||
Primary Care | $15 Copay | Plan Pays 40% after Deductible |
Specialist | $25 Copay | Plan Pays 40% after Deductible |
First-Choice Pharmacy* | ||
Tier 1 Drugs | $15 Copay | Plan Pays 40% after Deductible |
Tier 2 Drugs | $30 Copay | Plan Pays 40% after Deductible |
Tier 3 Drugs | $60 Copay | Plan Pays 40% after Deductible |
Mail Order | $25/$60/$120 | Not Covered |
Non-First-Choice Pharmacy* | ||
Tier 1 Drugs | $25 Copay | Plan Pays 40% after Deductible |
Tier 2 Drugs | $40 Copay | Plan Pays 40% after Deductible |
Tier 3 Drugs | $70 Copay | Plan Pays 40% after Deductible |
Mail Order | $25/$60/$120 | Not Covered |
* Please refer to the benefit summary for Rx Tier descriptions
Basic – $1,500 POS Plan Benefits
In-Network | Out-of-Network | |
Deductible (Calendar Year) | ||
Single | $1,500 | $6,000 |
Family | $4,500 | $18,000 |
Lifetime Maximum | Unlimited | Unlimited |
Coinsurance (Plan/Member) | 100% / 0% | 60% / 40% |
Max Out-of-Pocket (Including Deductible) | ||
Single | $1,500 | $14,000 |
Family | $4,500 | $42,000 |
Hospital Facility Services | ||
Inpatient | Deductible and $250 Copay | Plan Pays 40% after Deductible |
Outpatient | Deductible and $250 Copay | Plan Pays 40% after Deductible |
Emergency Room | $150 Copay | $150 Copay |
Physician Office Visits | ||
Primary Care | $25 Copay | Plan Pays 40% after Deductible |
Specialist | $35 Copay | Plan Pays 40% after Deductible |
First-Choice Pharmacy* | ||
Tier 1 Drugs | $15 Copay | Plan Pays 40% after Deductible |
Tier 2 Drugs | $30 Copay | Plan Pays 40% after Deductible |
Tier 3 Drugs | $60 Copay | Plan Pays 40% after Deductible |
Mail Order | $15/$60/$120 | Plan Pays 40% after Deductible |
Non-First-Choice Pharmacy* | ||
Tier 1 Drugs | $25 Copay | Plan Pays 40% after Deductible |
Tier 2 Drugs | $40 Copay | Plan Pays 40% after Deductible |
Tier 3 Drugs | $70 Copay | Plan Pays 40% after Deductible |
Mail Order | $15/$60/$120 | Plan Pays 40% after Deductible |
* Please refer to the benefit summary for Rx Tier descriptions
High Deductible Health Plan – $1,500 HDHP Plan Benefits
In-Network | Out-of-Network | |
Deductible (Calendar Year) | ||
Single | $1,500 | $6,000 |
Family | $3,000 | $18,000 |
Lifetime Maximum | Unlimited | Unlimited |
Coinsurance (Plan/Member) | 90% / 10% | 60% / 40% |
Max Out-of-Pocket (Including Deductible) | ||
Single | $2,250 | $14,000 |
Family | $4,500 | $42,000 |
Hospital Facility Services | ||
Inpatient | Plan Pays 90% after Deductible | Plan Pays 40% after Deductible |
Outpatient | Plan Pays 90% after Deductible | Plan Pays 40% after Deductible |
Emergency Room | Plan Pays 90% after Deductible | Plan Pays 90% after Deductible |
Physician Office Visits | ||
Primary Care | Plan Pays 90% after Deductible | Plan Pays 40% after Deductible |
Specialist | Plan Pays 90% after Deductible | Plan Pays 40% after Deductible |
First-Choice Pharmacy* | ||
Tier 1 Drugs | Plan Pays 90% after Deductible | Plan Pays 40% after Deductible |
Tier 2 Drugs | Plan Pays 90% after Deductible | Plan Pays 40% after Deductible |
Tier 3 Drugs | Plan Pays 90% after Deductible | Plan Pays 40% after Deductible |
Mail Order | Plan Pays 90% after Deductible | Plan Pays 40% after Deductible |
Non-First-Choice Pharmacy* | ||
Tier 1 Drugs | Plan Pays 90% after Deductible | Plan Pays 40% after Deductible |
Tier 2 Drugs | Plan Pays 90% after Deductible | Plan Pays 40% after Deductible |
Tier 3 Drugs | Plan Pays 90% after Deductible | Plan Pays 40% after Deductible |
Mail Order | Plan Pays 90% after Deductible | Not Covered |
* Please refer to the benefit summary for Rx Tier descriptions
Medical Payroll Deductions
Tier of Coverage | Rates Per Pay Period (26) Basic Plan | Rates Per Pay Period (26) Premium Plan | Rates Per Pay Period (26) Premium Plan |
Medical | Basic Plan – POS – $1500 Deductible | Premium Plan – POS – $500 Deductible | HDHP Plan – $1,500 Deductible |
Employee Only | $28.83 | $39.96 | $6.96 |
Employee + Spouse | $106.42 | $118.02 | $82.23 |
Employee + Children | $80.95 | $97.25 | $65.15 |
Family | $164.02 | $181.90 | $126.74 |
Medical Non-Participating in Wellness | Basic Plan – POS – $1500 Deductible | Premium Plan – POS – $500 Deductible | HDHP Plan – $1,500 Deductible |
Employee Only | $63.45 | $74.58 | $41.58 |
Employee + Spouse | $141.04 | $152.64 | $116.85 |
Employee + Children | $115.57 | $131.87 | $99.77 |
Family | $198.64 | $216.52 | $161.36 |
Medical Tobacco User | Basic Plan – POS – $1500 Deductible | Premium Plan – POS – $500 Deductible | HDHP Plan – $1,500 Deductible |
Employee Only | $63.45 | $74.58 | $41.58 |
Employee + Spouse | $141.04 | $152.64 | $116.85 |
Employee + Children | $115.57 | $131.87 | $99.77 |
Family | $198.64 | $216.52 | $161.36 |
Medical Non-Participating in Wellness/ Tobacco User | Basic Plan – POS – $1500 Deductible | Premium Plan – POS – $500 Deductible | HDHP Plan – $1,500 Deductible |
Employee Only | $98.06 | $109.19 | $76.19 |
Employee + Spouse | $175.65 | $187.25 | $151.46 |
Employee + Children | $150.18 | $166.48 | $134.38 |
Family | $233.25 | $251.13 | $195.97 |
Finding Providers
How do you find a Choice Plus POS in-network provider?
It’s easy! There are several ways:
- Use your HealthJoy app
- Contact your provider and ask:
“Do you participate in the UHC Choice Plus POS network” - Contact UMR at the number provided on your ID card
- Find a Provider – Online Instructions
- Download the UMR “on the go” Mobile app
Explanation of Benefits (EOB) – What does it mean?
UMR.com Answers to Your Questions
Tier 1 Premium Designation Program
Basic Plan Summary of Coverage 10-01-2023 thru 12-31-2023