Health Insurance

Enrolling and Changing Your Health Coverage

Employees would be able to either enroll within 2 weeks of hire, during the annual open enrollment or in case of a life-changing event. Employees have 30 days to submit a life-changing event (example:  marriage, divorce, birth/adoption of baby); once the 30 days have passed, employees need to wait for annual open enrollment.

Member cards will be mailed to the employee's home address within 10-14 business days. If you do not receive your ID cards, please call UMR directly to request a card. If you enrolled in the health plan and need health care services before receiving your ID card, please contact Clarkson Human Resources at clarksonhr@clarkson.edu.

Provider Network:

Visit providers without referral & PCPs not required. Use the provider search tool at www.umr.com.

Coverage:

• In-Network = Provider has a negotiated rate with UMR
  • Deductible: $1,000 Single / $2,000 Family
  • Embedded deductible – each member on the plan does not exceed $1,000. Maximum Family deductible is $2,000.
  • Out-of-Pocket Plan Year Maximum: $3,500 Single / $7,000 Family
  • Co-Pays: $30 Primary Care Physicians / $50 Specialist / $50 Urgent Care / $250 Emergency Room
  • Co-Insurance: 20% after deductible has been met up to out-of-pocket year maximum of $3,000 Single / $7,000 Family
  • Preventative Screenings are covered by the Plan and include Well-Child Visits, Adult Physicals (One/Contract Year), Screening Mammography, Pap Tests, Immunizations etc. Well Adult and Child Care Visits – covered at 100% once a year annually.
  • Once deductible plus the out-of-pocket maximum is met all claims will be covered at 100% for remainder of plan year 
     
• Out-of-Network = provider does not have a negotiated rate with UMR
  • Deductible: $1,400 Single / $4,200 Family
  • Out-of-Pocket Plan Year Maximum: $6,000 Single / $12,000 Family
  • Co-Pays: $250 Emergency Room
  • Co-Insurance: 30% after deductible has been met up to out-of-pocket year maximum of $6,000 Single / $12,000 Family
  • Preventative Screenings are covered by the Plan and include Well-Child Visits, Adult Physicals (One/Contract Year), Screening Mammography, Pap Tests, Immunizations etc. Well Adult and Child Care Visits – covered at deductible then 30% co-insurance
  • Once deductible plus the out-of-pocket maximum is met all claims will be covered at 100% for remainder of plan year
     

In-Network deductibles/out-of-pocket maximums are separate from Out-of-Network deductibles/out-of-pocket maximums per plan year. TWO individual amounts.

Premiums:

*For part-time Employees working 17.5 - 29 hours weekly the premium rates are doubled bi-weekly.