Choosing a Health Plan That’s Right For You
As an employee, the health benefits available to you represent a significant component of your compensation package. They also provide important protection for you and your family in case of illness or injury.
St. Vrain Valley Schools offers multiple health coverage options. You can find more information about our medical plans below or by visiting our 2026 Benefits Guide.
COMMON MEDICAL COVERAGE TERMS
The more you know about health insurance, the easier it will be to choose a plan that is right for you and your family. Understanding these common terms may help you feel more confident in your selection.
- Premium – the monthly amount you pay to purchase health plan coverage through one of the district’s health plan options. You pay the same monthly premium regardless of whether you use your coverage or not.
- Deductible – the amount you pay for covered health services before your insurance plan starts to share in the costs. If you have a $2,000 calendar-year deductible, you’ll pay 100 percent of your medical bills until the amount you’ve paid reaches $2,000.
- Coinsurance – the percentage of the cost you pay for each office visit, test, hospital visit, etc. (20%, for example) after you’ve met your deductible.
- Out-of-Pocket Maximum (OOP Maximum) – The maximum amount you pay during a calendar year for covered medical services under your health plan. After you reach the OOP Maximum, your health plan pays 100% of covered services for the rest of the year.
When comparing different plans, think about your family’s medical needs and the type of treatment you’ve received in the past. If you have a preferred doctor or hospital and want to keep using the same provider, make sure they are part of the network for the plan(s) you are considering. If you take a medication on a regular basis, check what it will cost under the health plan’s preferred drug list. St. Vrain Valley Schools offers three health plan options to benefits-eligible employees and their eligible family members: the UMR Choice Plus plan, the UMR Direct Care plan and the Kaiser Permanente DHMO plan.
UMR Choice Plus Plan
The self-insured UMR Choice Plus Plan is a Preferred Provider Organization (PPO) plan that offers a large, nationwide, network of doctors, hospitals and other providers to choose from whenever care is needed. The Plan is administered through UMR. In-network care is available, through the United Health Care Choice Plus PPO network.
Plan features include:
- $2,500 individual deductible / $5,000 family deductible (in-network)
- Low or no copay for visits to Premium Designated providers
- 10% cost-share once you’ve met your deductible
- In-network preventive care covered at 100%
- Out-of-network care is covered at a reduced benefit level
- Comprehensive hospitalization, emergency, pharmacy and mental health coverage
- Free virtual pain relief and physical therapy services through Hinge Health, free physical therapy, orthopedics, lab tests, x-rays and advanced imaging and more through Zero Health and low-cost in-home urgent care, hospitalist and infusion services through Origin Healthcare
UMR Choice Plus Summary of Benefits and Coverage (SBC)
Health Reimbursement Account (HRA) – Available with the UMR Choice Plus Plan
The district-funded HRA can be used to pay expenses that are applied to your UMR Choice Plus health plan deductible. It cannot be used to pay for other expenses such as dental or vision claims, prescriptions or coinsurance amounts.
- Annual Contribution: $1,000 individual / $2,000 family (prorated for new hires)
- District-funded
- Fund balance carries over annually to a maximum of $2,500 individual / $5,000 family
The district does not contribute into an HRA for any of the district’s other health plan options.
Health Reimbursement Account – Summary Plan Description
UMR Direct Care Plan
The self-insured UMR Choice Plus Plan is a Preferred Provider Organization (PPO) plan that offers a large, nationwide, network of doctors, hospitals and other providers to choose from whenever care is needed. The Plan is administered through UMR. In-network care is available, through the United Health Care Choice Plus PPO network. In addition to
Plan features include:
- $2,500 individual deductible / $5,000 family deductible (in-network)
- Low or no copays for visits to Premium Designated providers or Nextera Healthcare
- 20% cost-share once you’ve met your deductible
- In-network preventive care covered at 100%
- Out-of-network care is covered at a reduced benefit level
- Comprehensive hospitalization, emergency, pharmacy and mental health coverage
- Free virtual pain relief and physical therapy services through Hinge Health, free physical therapy, orthopedics, lab tests, x-rays and advanced imaging and more through Zero Health and low-cost in-home urgent care, hospital and infusion services through Origin Healthcare.
2025 UMR Direct Care Summary of Benefits and Coverage (SBC)
UMR Plan Extras
Hinge Healthcare – An app-based program offering free virtual, personalized physical therapy. No need to take off work or drive to a therapist’s office. No long wait times to schedule an appointment. You can complete therapy in your own home at a time that is convenient for you. Connect via text, email, phone call or video chat. Access is available to UMR members 18 years of age or older. hinge.health/svvsd
Origin Healthcare – Origin Healthcare brings health care services to you! Access acute care medical services that may have previously been provided in higher cost setting like the hospital, emergency room or infusion center. Now you can receive many of the same services in the comfort of your own home — including in-home labs, x-rays, hydration therapy, electrolyte replacement and some chemotherapy treatments. Origin provides post-surgical care at a lower cost — saving you and the district money. Origin services are available to UMR plan members 18 years of age or older. originhc.com
Zero Card – Through Zero Card, when you or your covered family members use a contracted Zero Card provider for a covered service, you pay zero dollars — no copays, deductibles or coinsurance — for dozens of covered services including physical therapy, sleep studies, non-emergency surgeries, including tonsillectomies, sinus surgeries and gall bladder removal, orthopedics, including spinal fusions, knee, hip and shoulder surgeries, labs, X-rays and advanced imaging (such as CT, MRI and ultrasounds) and more. Access to Zero Card is automatic when you enroll in the UMR Choice Plus or Direct Care plans. zero.health
Nextera Healthcare (Available to Participants in the Direct Care Plan only) nexterahealthcare.com/svvsd
- No cost urgent, primary and chronic care office/virtual visits (not subject to copays,
deductibles or coinsurance) - Priority appointments (same- and next-day access depending on medical need)
- Exceptional, personalized patient care including extended appointment times and after-hours
access via phone, secure video and text with your Nextera provider
PrudentRx Specialty Medication Program – Reduce your out-of-pocket cost on many specialty medications. Click here to view the list of covered specialty drugs. To get started, call 1-800-578-4403.
Kaiser Permanente DHMO Plan
The district offers a Deductible Health Maintenance Organization (DHMO) plan through Kaiser Permanente that offers a low upfront deductible and copays when care is received through Kaiser Permanente doctors, partner hospitals and other health care facilities. (Out-of-network coverage is only available in urgent care and emergency situations where you become injured or unexpectedly ill while outside the service area.) Each time you visit a Kaiser Permanente pharmacy or other provider for care, you pay a copay or an amount based on your deductible and coinsurance responsibility. Your out-of-pocket costs for eligible expenses are capped annually at $4,000 for an individual or $8,000 for a family. Refer to the coverage chart below for additional coverage details.
Kaiser DHMO Summary of Benefits and Coverage (SBC)
Kaiser Permanente Prescription Drug Listing
Transparency in Coverage
UnitedHealthcare, UMR and HealthSCOPE Benefits create and publish the following Machine-Readable Files on behalf of St. Vrain Valley School District. To link to the Machine-Readable Files, please click here UMR Transparency in Coverage Readable File
Knowing what you can expect to pay for medical procedures before receiving care, can help you plan ahead and avoid potential surprises. To begin using the UMR Treatment Cost Calculator, log in to your personal member account on umr.com and click on the shopping cart icon.
UMR Transparency in Coverage Pricing Comparison Tool
Kaiser Permanente Transparency in Coverage Pricing Comparison Tool