Make Your Elections

When you are ready to make your 2017 plan elections, go to umb.intratnet:

myData -> Employee Self Service -> Benefits -> Benefits Enrollment

Remember you can must enroll between November 2nd and November 16th

 

North Kansas City Hospital, Meritas Physician Clinics, Gashland, Creekwood & Briarcliff Surgery Centers

Preferred Care Blue In-Network Providers

Out of Network Providers

LIFETIME MAXIMUM
ANNUAL DEDUCTIBLE
    Individual
$0$2,000 $3,000
    Family
$0$5,000 $7,500
ANNUAL COINSURANCE10%20% Physician services
30% Facility services
75%
OUT OF POCKET MAXIMUUM
    Medical Plan
    Individual
$5,000 $5,000 No Out of Pocket Max for an Out of Network Provider
    Family
$10,000 $10,000
PHYSICIAN/OFFICE VISITS
      Physician Office Visit
$30 copayDeductible, $30 copay then 20% of the Allowable ChargeDeductible, $30 copay then 75% of the Allowable Charge
      Specialist
$40 copayDeductible, $40 copay then 20% of the Allowable Charge (including Quick Care/Minute Clinics)Deductible, $40 copay then 75% of the Allowable Charge
(applies to Gashland Urgent Care & Meritas Express Care)
    Physical Services in the Office
Deductible then 10% of the Allowable ChargeDeductible then 20% of the Allowable ChargeDeductible then 75% of the Allowable Charge
    Emergency Room Visits
Deductible, $200 copay then 25% of the Allowable ChargeDeductible, $200 copay then 25% of the Allowable ChargeDeductible, $200 Copay 25% of the allowable
The Blue Card Program National Network for out of area 1-800-810-2583
(copay waived if admitted)
    Emergency Room Physician Services
Deductible then 10% of PPO Allowable ChargeDeductible then 10% of PPO Allowable ChargeDeductible then 10% of the Allowable Charge
    Inpatient Services- Hospital charges for Room & Board related to Admissions
No Deductible, $250 copay per day up to out of pockeet max, then 10% coinsuranceDeductible then 30% of the Allowable Charges Pre-cert is requiredDeductible then 75% of the Allowable Charges Pre-cert is required
    Observation care (23+ hours)
No deductible. Pre-cert required. $250 copay per day up to out of pocket max. 10% coinsuranceDeductible then 30% of the Allowable Charges Pre-cert is requiredDeductible then 75% of the Allowable Charges Pre-cert is required
    Physician Hospital Visits
No Deductible, 10% of the Allowable ChargeDeductible, 20% of the Allowable ChargeDeductible, 75% of the Allowable Charge
No Deductible, $250 copay, then 10% of the Allowable ChargeDeductible, 30% of the Allowable ChargeDeductible, 75% of the Allowable Charge
    Ambulance Including air ambulance
No Deductible, 10% of the PPO Allowable ChargesDeductible, 20% of the PPO Allowable ChargePPO Benefit Year Deductible then 20% of the Billed Charges up to PPO out of pocket max
BI-WEEKLY PREMIUMS
    Employee (EE)
$24.76
    EE + Child(ren)
$54.48
    EE + Spouse
$74.29
    Family
$89.77