Medical
CHOOSING A HEALTH PLAN THAT IS 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. To help you make an informed decision, below are documents pertaining to Summary of Benefits and Coverage (SBC), which summarizes important information to help you compare options.
Click the links to review a current copy of the district’s SBCs. A paper copy is also available by contacting a member of our Benefits Team.
UMR Choice Plus PPO Summary of Benefits and Coverage (SBC)
· 2023 UMR Choice Plus SBC Coverage Chart
UMR Direct Care PPO Summary of Benefits and Coverage (SBC)
· 2023 UMR Direct Care SBC Coverage Chart
Kaiser Permanente DHMO Summary of Benefits and Coverage (SBC)
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.
Transparency of 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
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:
- $2,000 individual deductible / $4,000 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 services through Zero Health including physical therapy, orthopedics, labs, x-rays and advanced imaging and more
Refer to the Enrollment Guide for additional details.
UMR PPO
Health Reimbursement Account (HRA)
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: $750 individual / $1,500 family (prorated for new hires)
- District-funded
- Fund balance carries over annually to a maximum of $2,000 individual / $4,000 family
The district does not contribute into an HRA for any of the district’s other health plan options.
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:
- $2,000 individual deductible / $4,000 family deductible (in-network)
- Low or no copays for visits to Premium Designated providers or Nextera Healthcare
- 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 services through Zero Health including physical therapy, orthopedics, labs, x-rays and advanced imaging and more
Refer to the Enrollment Guide for additional details.
KAISER PERMANENTE (DHMO) Plan — Check out this presentation to learn more.
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 Permanente DHMO
ZERO CARD — Watch a video to learn more
Zero Card is available to participants in both UMR Plan options at no additional premium cost. Say goodbye to deductibles, copays and coinsurance when you use the Zero Card to obtain dozens of covered non-emergency surgical procedures and medical services. If you opt to use a participating Zero Card provider for the procedure, you will pay zero dollars—no copays, deductibles or coinsurance—for covered procedures including knee replacements, hysterectomies, gall bladder removals, MRI’s, colonoscopies and more.