The information on this page reflects changes to UMP effective Jan. 1, 2010.

A deductible is a fixed dollar amount you pay each year before the plan begins paying most benefits. The medical deductible amount is $250 per person, with a maximum of $750 for a family of three or more people. When you first get services, you pay your provider the first $250 in charges. After you pay that first $250, the plan begins to pay benefits for your care. This applies to each covered family member, up to the $750 maximum.

You also pay a separate deductible for prescription drugs when you purchase Tier 2 and Tier 3 (brand-name) drugs.

What Doesn't Count Toward My Medical Deductible?

The following out-of-pocket expenses do not count toward your $250 annual medical deductible:

• Services you pay for that aren't covered by the plan or that exceed benefit limits.
• Out-of-pocket costs for non-network provider charges exceeding the allowed amount.
• Your $200 per day inpatient hospital copayment.
• Your $75 per visit emergency room copayment.
• Prescription drug costs.

Which Services Are Exempt From the Medical Deductible?

TIP: All services not listed below are subject to the medical deductible. This means that you must pay the first $250 of covered services before the plan begins to pay.

You don't have to pay toward the medical deductible for these services before the plan pays:

• Preventive care.
• Routine vision care: exams and hardware.
• Routine hearing care: exams and hardware.
• Prescription drugs (however, there is a prescription drug deductible that applies to Tier 2 and Tier 3 drugs only).
• Quit For Life tobacco cessation program.
• Required second opinions.

How Does the Medical Deductible Work With Families?

For families of three or more covered people, the $250 per person deductible still applies, up to the $750 family maximum. If any one person spends $250, the plan will begin paying benefits for that person. Once three or more persons spend a combined total of $750 that counts toward the medical deductible, the plan will begin paying benefits for all family members.

ALERT! If you receive services with a benefit limit (such as chiropractic, massage therapy, or physical therapy) before meeting your deductible, those visits will count toward the benefit limit. For example, if you pay out of pocket for a chiropractor visit because you haven't met your deductible, that visit will count toward the maximum of 10 visits per calendar year. See definition of "Limited Benefit" for more information.