Healthy Me Copay A (UMR) At-a-Glance (Reflects Member’s Responsibility) Medical and Mental Health Benefits — Administered by UMR Network Cost Non-Network Cost Individual Deductible Maximum $0 $0 Family Deductible Maximum $0 $0 Individual Out-of-Pocket Maximum. $8,550 $17,100 Family Out-of-Pocket Maximum. $17,100 $34,200. UMR: DICKINSON FLEET SERVICES, LLC: 7617 001 Coverage Period: – Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual + Family Plan Type:PPO Questions: Call 1-800-826-9781 or visit us at www.umr.com. Page 1 of 8 If you aren’t clear about any of the bolded terms used in this form, see the Glossary.
Umr Health Plan
*Terms and Conditions apply. Honghua digital usb devices driver. This benefit covers HUMIRA® (adalimumab) alone or, for rheumatology patients, HUMIRA plus one of the following medications: methotrexate, leflunomide (Arava®), or hydroxychloroquine (Plaquenil®). Eligibility: Available to patients with commercial prescription insurance coverage for HUMIRA who meet eligibility criteria. Co-pay assistance program is not available to patients receiving prescription reimbursement under any federal, state, or government-funded insurance programs (for example, Medicare [including Part D], Medicare Advantage, Medigap, Medicaid, TRICARE, Department of Defense, or Veterans Affairs programs) or where prohibited by law or by the patient’s health insurance provider. If at any time a patient begins receiving prescription drug coverage under any such federal, state, or government-funded healthcare program, patient will no longer be able to use the HUMIRA Complete Savings card and patient must call HUMIRA Complete at 1-800-4HUMIRA to stop participation. Patients residing in or receiving treatment in certain states may not be eligible. Patients may not seek reimbursement for value received from the HUMIRA Complete Program from any third-party payers. Offer subject to change or discontinuance without notice. Restrictions, including monthly maximums, may apply. Patients who are members of insurance plans that claim to reduce or eliminate their patients' out of pocket co-pay, co-insurance, or deductible obligations for certain prescription drugs based upon the availability of, or patient's enrollment in, manufacturer sponsored co-pay assistance for such drugs (often termed 'maximizer' programs) will have an annual maximum program benefit of $6,000.00 per calendar year. This assistance offer is not health insurance. To learn about AbbVie’s privacy practices and your privacy choices, visit www.abbvie.com/privacy.html
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- UnitedHealthcare is waiving cost share (copay, coinsurance or deductible) for in-network and out-of-network testing and testing-related telehealth services. COVID-19 treatment Effective April 1, 2021, for both in-and out-of-network providers, members are responsible for any copay, coinsurance.
- V1 – 09.01.18 2 of 8 Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: – UMR: DIGNITY HEALTH: 7629 Arizona Premier Plan Coverage for: Individual + Family Plan Type: PPO For more information about limitations and exceptions, see the plan or policy document at www.umr.com.
- UMR is PEIA's third-party administrator that handles medical claim processing, case management, utilization management, precertification, prior approval and customer service for the PEIA PPB Plans. Contact UMR for answers to questions about eligibility, benefits and networks.
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Arava and Plaquenil are registered trademarks of their respective owners.