Visit UMR.com or Download the UMR app to:
- Access your digital insurance card
- View benefits and claims
- Search for an in-network provider
- Request costs of care estimates
- and more!
To register, use group number: 76-414892
Medical Coverage
Manage Your Medical Benefits
How to find your plan or switch plans: Your plan is listed on your ID card (digital cards are available at UMR.com) and the THT member portal. You can switch your plan during the annual open enrollment period (typically in August) or any time during the year after experiencing a Qualifying Life Event (requests must be submitted within 31 days of the Qualifying Life Event).
Plan Comparison
| Signature Plan | Advantage Plan | |
|---|---|---|
| Official Plan Documents including full medical benefit details. | Benefit Summary (SBC) Full Plan Document (SPD) |
Benefit Summary (SBC) Full Plan Document (SPD) |
| Offers Local Coverage for all members residing in the United States | Yes | |
| FSA / HSA eligibility | Eligible for FSA only (Flexible Spending Account) | |
| Coverage outside local area | Emergency and Urgent Care only (subject to member responsibility as listed below) | |
| International Coverage | Emergency Care only (subject to member responsibility). Member must submit bills/receipts to UMR for direct reimbursement. | |
| Referrals required? | No, THT never requires a referral. However, some practices may require one before scheduling an appointment. | |
| Plan Year Deductible (Individual/Family) Copays do not apply to the deductible |
$500 / $1,500 | $1,650 / $3,300 |
| Out-of-Pocket Maximum Medical and Pharmacy combined. Includes deductible, copays, and coinsurance. |
$7,500 / $15,000 | $10,600 / $21,200 |
| Preventive Care | THT pays 100% | |
| Access to Health Investment Providers | Full Access. Reduced copays, quicker appointment availability, and no deductibles or coinsurance. | |
| • Primary Care | $0 copay | |
| • Pediatric | $0 copay | |
| • Physical Therapy | $0 copay | |
| • Endocrinology | $0 copay | |
| • Oncology | $0 copay | |
| • Hematology | $0 copay | |
| • Talk Therapy | $0 copay | |
| • MDLive (Virtual Care: Primary care, urgent care, therapy, psychiatry, dermatology) | $0 copay | |
| • In-home Urgent Care (Doctoroo / IncrediCare) | $0 copay | |
| • Dermatology | $30 copay | |
| • Cardiology | $30 copay | |
| • Neuropsych Assessments (Autism Spectrum Disorder – ASD) | $100 copay | |
| • Applied Behavioral Analysis (ABA) Therapy | Depends on number of monthly hours. See rates. | |
| All Other In-Network Physician Office Visits | ||
| • Primary Care Physician | $15 copay | 20% after deductible |
| • Behavioral Health Office visits | $10 copay | 20% after deductible |
| • Physical Therapy | $10 copay | 20% after deductible |
| • Specialist | $30 copay | 20% after deductible |
| • Urgent Care / CVS Minute Clinic | $30 copay | |
| Labwork | ||
| • Quest Diagnostics | $0 copay for all services1 | |
| • Hospital Lab | 20% after deductible | |
| • Other freestanding labs | Covered 100% after deductible, only if service not available at Quest. Otherwise, not covered. | |
| Diagnostic Imaging | ||
| • Steinberg Diagnostic Medical Imaging | $0 copay for all services2 | |
| • Hospital/ER Imaging | 20% after deductible | |
| • Diagnostic X-Ray Imaging at Urgent Care | Included in urgent care copay | |
| • Other imaging facilities | Covered 80% after deductible, only if service not available at SDMI. Otherwise, not covered. | |
| Hospital Services (Inpatient & Outpatient) | 20% after deductible | |
| Emergency room Copay waived if admitted |
$300 copay (after deductible) for first visit + 20% doctor bills. $750 copay (after deductible) for subsequent visits + 20% doctor bills. | |
- Signature Plan members residing in Clark County must utilize Quest Diagnostics to receive the $0 copay. Any costs incurred by lab work performed by providers other than Quest will be the member’s full responsibility.
- Services not available at Quest Diagnostics will have a $0 copay.
- Signature Plan members residing in Clark County must utilize Steinberg Diagnostic Medical Imaging to receive the $0 copay. Any costs incurred by imaging services performed by providers other than SDMI will be the member’s full responsibility, except in cases where Steinberg Diagnostic cannot perform the service or out of extreme medical necessity.
- Services not available at Steinberg Diagnostics will be 20% after deductible.
- Copay is waived if admitted to the hospital. Out-of-Network emergency room care is covered as in-area network. Professional provider services (emergency-related or non-emergency) are 20% after deductible.
Flexible Savings Account (FSA)
Active employees on this plan are eligible for a Flexible Savings Account (FSA) through American Fidelity. Contact American Fidelity for more information and to open your Flexible Spending Account. Retirees on this plan are eligible for an FSA but must use an institution of their choice that is not American Fidelity.
Quest - Lab Work
Quest Diagnostics became our exclusive partner for lab services on September 1, 2022. Members will no longer have a deductible or copay for lab services by Quest Diagnostics.
Please ensure your provider only sends your labs to Quest. Any costs incurred by lab work performed by providers other than Quest will be the member’s full responsibility.
As the world’s leading provider of diagnostic information services, Quest Diagnostics has numerous locations around the Las Vegas Valley to serve you. Have your provider send your in-office lab draws to Quest or schedule an appointment directly with Quest.
Which Tests Are Covered?
The following laboratory tests are allowed one time per year and covered at 100% when ordered by your provider.
- CBC (Complete Blood Count with Differential)
- CMP (Comprehensive Metabolic Panel)
- Lipid panel (Cholesterol/LDL/HDL/Triglycerides)
- TSH (Highly Sensitive Thyroid -Stimulating. Hormone)
The following screenings are allowed one time per year for high-risk individuals:
- Hepatitis B screening
- Hepatitis C screening
- HIV screening
- Syphilis screening
SDMI (Steinberg Diagnostic Medical Imaging)
Steinberg Diagnostic Medical Imaging (SDMI) became our exclusive partner for imaging services on April 1, 2021. Members will no longer have a deductible or copay for the imaging services listed below performed by SDMI (with a referral from your provider).
Any costs incurred by imaging services performed by providers other than SDMI will be the member’s full responsibility, except in cases where Steinberg Diagnostic cannot perform the service or out of extreme medical necessity.
Members with out-of-area benefits are not eligible. Out-of-area members (e.g. college students) can utilize diagnostic imaging providers on the UHC Choice network.
Steinberg Diagnostic Medical Imaging has 10 Locations around the Las Vegas Valley. You can schedule online, or by calling Monday-Saturday.
Covered Services (with a referral from your provider):
- Mammogram: 3D Mammography, Breast Biopsy (including Stereotactic Breast Bx), Breast MRI, Breast Ultrasound
- Fetal MRI, OB Ultrasound
- Dexa Scan
- Fluoroscopy
- LDCT: Screenings for high-risk seniors for lung cancer
- MRI
- CT
- PET Scan
- Nuclear Medicine
- X-Ray
- Ultrasounds
- Interventional Radiology:
- Includes placing chest & arm ports, drainage catheters, needle biopsy/bone biopsy
- Vertebroplasty & Kyphoplasty (treats compression fractures)
- IVC Filter placements & removals (prevents blood clots from traveling to heart and lungs)
- Nephrology image guided procedures
Preventive Care
Preventive care is covered at 100% for Advantage and Signature plan members when performed by an in-network provider. Preventive care services vary by age and gender. We recommend speaking with your provider to determine which are recommended for you and your family.
Note on exclusive providers: Signature Plan members must utilize Quest Diagnostics and Steinberg Diagnostic Medical Imaging for labwork and imaging, respectively, to receive the $0 copay benefit. Any costs incurred by lab work or imaging services performed by providers other than these partners will be the member’s full responsibility.
Annual Preventive Services Covered at 100%
- Physical examinations
- Pelvic examinations and pap smears
- Hearing and vision screenings
- Mammograms
- Cardiovascular screening blood tests
- Colorectal cancer screening tests (Cologuard is currently excluded for Signature and Advantage members. Quest offers an at-home colorectal cancer screening test called “InsureONE”. If opting for a non-invasive screening, use Quest to receive the $0 benefit.)
- Vaccinations and immunizations recommended by your physician
- BRCA1 and BRCA2 when medically indicated
- Prostate cancer screening (digital rectal examination)
- Nutritional Counseling
