There are plan changes taking effect 10/1/2024. These have been posted on the Open Enrollment page since August 1, 2024.
Medical Coverage
Notice: October 1, 2024 Plan Changes
Manage Your Medical Benefits
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
Plan Comparison
| Signature (FSA-Eligible) | Advantage (HSA-Eligible) | |
|---|---|---|
| Plan Year Deductible (Individual/Family) |
$500/$1,500 | $1,650/$3,300 |
| Out-of-Pocket Maximum Medical and Pharmacy combined. Includes deductible, copays, and coinsurance. |
$7,500/$15,000 | $7,500/$15,000 |
| Preventive Care | THT pays 100% | THT pays 100% |
| Physician Services | ||
| • Primary Care Physician | $15 Copay | 20% after deductible |
| • Behavioral Health Office visits | $10 Copay | 20% after deductible |
| • Physical Therapy | $10 Copay | 20% after deductible |
| • Telehealth | $0 Copay | 20% after deductible |
| • Specialist | $30 Copay | 20% after deductible |
| • Urgent Care / CVS Minute Clinic | $30 Copay | 20% after deductible |
| • In-Home Urgent Care (Dispatch Health / Doctoroo / IncrediCare) | $0 Copay | $0 Copay after deductible |
| Labwork | ||
| • Outpatient Clinical Lab | $0 copay1 | 20% after deductible |
| • Hospital Lab | 20% after deductible | 20% after deductible |
| • All other lab facilities | No benefit2 | 20% after deductible |
| Diagnostic Imaging | ||
| • Diagnostic X-Ray Imaging | $0 copay3 | 20% after deductible |
| • High Tech Services (CT, MRI, PET) | $0 copay3 | 20% after deductible |
| • All other imaging facilities | No benefit4 | 20% after deductible |
| Hospital Services (Inpatient & Outpatient) |
20% after deductible | 20% after deductible |
| Emergency room Copay is waived if admitted to the hospital. |
$300 copay (after deductible) for first visit5 + 20% of doctor bills. $750 copay (after deductible) for subsequent visits5 + 20% of doctor bills. |
20% after deductible |
| Pharmacy Benefits | Deductible DOES NOT apply to Pharmacy. | Deductible DOES apply to Pharmacy. |
| Non-Specialty Prescriptions6,7 | ||
| • Tier 1 – Generic8 | Max copay of $15 per 34-day supply or $40 per 35+ day supply | |
| • Tier 2 – Preferred Brand | 25% of the cost, max copay of $100 per 34-day supply or $300 per 35+ day supply | |
| • Tier 3 – Non-Preferred Brand | 40% of the cost | |
| • Formulary Diabetic Supplies | $0 copay for supplies, max copay of $20 per 30-day supply of insulin | |
| • Non-Formulary | No benefit | |
| Specialty Prescriptions6 | ||
| • Tier 1 – Generic | 25% of the cost, up to $500 max copay per 30-day supply | |
| • Tier 2 – Preferred Brand | 25% of the cost, up to $500 max copay per 30-day supply | |
| • Tier 3 – Non-Preferred Brand | 40% of the cost | |
| • Non-Formulary | No benefit | |
- 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.
- Select products are eligible for a coinsurance assistance program. There is no copay for these products, and they do not accumulate toward the out-of-pocket maximum. For more information contact THT at 702-794-0272, Option 1.
- Prescriptions filled at pharmacies other than THT’s Exclusive Network Retail Pharmacies will incur a $10 per prescription choice fee in addition to applicable copays. The pharmacy choice fee does not accumulate toward your out-of-pocket maximum.
- If the generic cost of the medication is less than the copay, the individual will be responsible for that lesser amount.
Signature Plan
The Signature Plan has set copays and deductibles. The Signature Plan also has one of the largest medical networks, meaning you have more flexibility when picking a doctor or hospital. Preventive services are covered at 100%.
THT does not require a referral to see a specialist, however, the specialist may require one.
Upcoming Benefit Changes
THT evaluated its benefit offerings and made adjustments to provide additional value, simplify specific coverages, and remain in compliance with new regulations. The changes will go into effect 10/01/2024. Review all upcoming benefit changes.
| In-Area Network | Out-of-Area Network | |
|---|---|---|
| Plan Year Deductible (Individual/Family) |
$500/$1,500 | $1,500/$4,500 |
| Out-of-Pocket Maximum Medical and Pharmacy combined. Includes deductible, copays, and coinsurance. |
$7,500/$15,000 | $7,500/$15,000 |
| Preventive Care | THT pays 100% | THT pays 100% |
| Telehealth / Telemedicine | THT pays 100% | 50% after deductible |
| Physician Services | ||
| • Primary Care Physician | $15 Copay | 50% after deductible |
| • Behavioral Health Office visits | $10 Copay | 50% after deductible |
| • Physical Therapy | $10 Copay | 50% after deductible |
| • Specialist | $30 Copay | 50% after deductible |
| • Urgent Care / CVS Minute Clinic | $30 Copay | 50% after deductible |
| • In-Home Urgent Care (Dispatch Health / Doctoroo) | $30 Copay | 50% after deductible |
| Labwork | ||
| • Quest Diagnostics Outpatient Clinical Lab | $0 copay | n/a |
| • Hospital Lab | 20% after deductible | 50% after deductible |
| • All other lab facilities | No benefit | 20% after deductible |
| Diagnostic Imaging | ||
| • Steinberg Diagnostic: X-Ray Imaging | $0 copay | n/a |
| • Steinberg Diagnostic: High Tech Services (CT, MRI, PET) | $0 copay | 50% after deductible |
| • All other imaging facilities | No benefit | 50% after deductible |
| Hospital Services (Inpatient & Outpatient) |
20% after deductible | 50% after deductible |
| Emergency room Copay is waived if admitted to the hospital. |
$300 copay (after deductible) for first visit + 20% of doctor bills. $750 copay (after deductible) for subsequent visits + 20% of doctor bills. |
$300 copay (after deductible) for first visit + 20% of doctor bills. $750 copay (after deductible) for subsequent visits + 20% of doctor bills. |
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.
Advantage Plan
The Advantage Plan is a High Deductible Health Plan (HDHP). An HDHP covers preventive services at 100%, while all other medical costs are your full responsibility until the yearly deductible is fulfilled. This means you will pay for the care services you need until you reach your deductible each year. We have negotiated rates with providers on the UMR/SHO that cost less than traditional cash-pay patients. Talk to your doctor about getting an estimate of costs for the services you need.
THT does not require a referral to see a specialist, however, the specialist may require one.
Upcoming Benefit Changes
THT evaluated its benefit offerings and made adjustments to provide additional value, simplify specific coverages, and remain in compliance with new regulations. The changes will go into effect 10/01/2024. Review all upcoming benefit changes.
| In-Area Network | Out-of-Area Network | |
|---|---|---|
| Plan Year Deductible (Individual/Family) | $1,500/$3,000 | $3,000/$6,000 |
| Out-of-Pocket Maximum Medical and Pharmacy combined. Includes deductible, copays, and coinsurance. |
$7,000/$14,000 | $7,000/$14,000 |
| Preventive Care | THT pays 100% | 50% after deductible |
| Telehealth / Telemedicine | THT pays 100% | 50% after deductible |
| Physician Services | ||
| • Primary Care Physician | 20% after deductible | 50% after deductible |
| • Behavioral Health Office visits | 20% after deductible | 50% after deductible |
| • Physical Therapy | 20% after deductible | 50% after deductible |
| • Specialist | 20% after deductible | 50% after deductible |
| • Urgent Care / CVS Minute Clinic | 20% after deductible | 50% after deductible |
| • In-Home Urgent Care (Dispatch Health / Doctoroo) | 20% after deductible | 50% after deductible |
| Labwork | ||
| • Outpatient Clinical Lab | 20% after deductible | 50% after deductible |
| • Hospital Lab | 20% after deductible | 50% after deductible |
| • All other lab facilities | 20% after deductible | 50% after deductible |
| Diagnostic Imaging | ||
| • Diagnostic X-Ray Imaging | 20% after deductible | 50% after deductible |
| • High Tech Services (CT, MRI, PET) | 20% after deductible | 50% after deductible |
| • All other imaging facilities | 20% after deductible | 50% after deductible |
| Hospital Services (Inpatient & Outpatient) | 20% after deductible | 50% after deductible |
| Emergency room | 20% after deductible | 20% after deductible |
Health Savings Account (HSA)
Active employees on this plan are eligible for a Health Savings Account (HSA) through American Fidelity. Contact American Fidelity for more information and to open your Health Savings Account. Retirees on this plan are eligible for an HSA 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. Signature Plan 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. Signature Plan 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 members. Quest offers an at-home colorectal cancer screening test called “InsureONE”. If opting for a non-invasive screening, Signature members must 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
