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Medical Coverage

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!

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.

Summary of Benefits & Coverage (SBC)Updated SBC - Effective July 11, 2024Review Full Summary Plan Description (SPD)
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% ater 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)

Members 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.

Call: 702-433-5333Email: AFES-LasVegas@americanfidelity.com

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.

Summary of Benefits & Coverage (SBC)Updated SBC - Effective July 11, 2024Review Full Summary Plan Description (SPD)
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)

Members 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.

Call: 702-433-5333Email: AFES-LasVegas@americanfidelity.com

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.

Make an Appointment
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.

Make an Appointment
 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

Premiums

For our up to date premium information, please click here.

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