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:

  1. Use your HealthJoy app
  2. Contact your provider and ask:
    “Do you participate in the UHC Choice Plus POS network”
  3. Contact UMR at the number provided on your ID card
  4. Find a Provider – Online Instructions 
  5. Download the UMR “on the go” Mobile app

UMR Answers Quick & Easy!!

UMR Health Cost Estimator

UMR Preventive Care

Preventive Adult Screenings

Explanation of Benefits (EOB) – What does it mean?

www.umr.com

UMR.com Answers to Your Questions

How Does the HDHP Work?

Prior Authorization of Care

Tier 1 Premium Designation Program

Medical Plan Document

Basic Plan Summary of Coverage 10-01-2023 thru 12-31-2023

HDHP Plan Summary of Coverage 10-01-2023 thru 9-30-2024

Premium Plan Summary of Coverage 10-01-2023 thru 12-31-2023

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