Important:  This information is effective through Dec. 31, 2009. See the changes to coinsurance, medical deductible, and out-of-pocket limit for 2010.

A deductible is a fixed dollar amount you pay each year before UMP begins paying most benefits. The annual medical deductible amount is $200 per person, with a maximum of $600 for a family of three or more people. When you first get services, you pay your provider the first $200 in charges. After you pay that first $200, UMP begins to pay benefits for your care. This applies to each covered family member, up to the $600 maximum.

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

The following out-of-pocket expenses do not count toward your $200 annual medical deductible:

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

You don’t have to pay toward the medical deductible for these services before UMP 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).
• Free & Clear tobacco cessation program.
• Required second opinions.

For families of three or more covered people, the $200 per person deductible still applies, up to the $600 family maximum. If any one person spends $200, UMP will begin paying benefits for that person. Once three or more persons spend a combined total of $600, UMP 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.