Medical Plans
Lumexa Imaging offers three medical plan options through UMR, a UnitedHealthcare company.
You have the choice of one High Deductible Health Plan (HDHP) and two Preferred Provider Organization (PPO) plans:
- HDHP
- PPO 2750
- PPO 6000
All three plans have access to the national UnitedHealthcare Choice Plus network, cover preventive care at 100%, and include prescription drug coverage through Optum Rx.
Understanding your medical plan options
When choosing a medical plan, consider any medical needs you may have in the upcoming plan year, your overall health, and any medications you currently take.
HDHP vs. PPO
- The HDHP can be paired with a Health Savings Account (HSA). You’ll pay the full cost of non-preventive medical services, including prescription medications, until you reach your deductible.
- The PPO plans can be paired with a Healthcare Flexible Spending Account (FSA). Primary care and specialist office visits and prescription medications are not subject to the deductible — you’ll pay a fixed copay for each visit and prescription.
What’s the difference between an HSA and FSA?
Compare HSAs and FSAs by eligibility, ownership, taxation, contributions, payment and year-end treatment.
How an embedded deductible works
If you cover dependents, there is an embedded deductible. This means that once a dependent meets the individual deductible, they move to the copay arrangement. In other words, no one dependent would be responsible for more than the individual deductible.
Compare coverage details
The tables below show in-network coverage. Out-of-network coverage is shown after the tables. For full coverage details, view the Summary Plan Description for each plan on the Documents & Forms page.
The deductible is the amount you pay before the plan starts to pay. The out-of-pocket maximum is the most you’ll pay for covered expenses each plan year. These reset annually on Jan. 1.
| HDHP | PPO 2750 | PPO 6000 | |
|---|---|---|---|
| Annual HSA Contribution Provided | $1,000 | Not eligible | Not eligible |
| Annual deductible Individual |
$3,500 | $2,750 | $6,000 |
| Annual deductible Family |
$6,500 | $5,500 | $12,000 |
| Out-of-pocket maximum (includes deductible) Individual |
$6,000 | $7,000 | $7,000 |
| Out-of-pocket maximum (includes deductible) Family |
$12,000 | $14,000 | $14,000 |
Once you meet the deductible, the plan shares the cost of care with you. You’ll pay either a percentage of the cost, called coinsurance, or a fixed fee, called a copay.
Unless a copay is shown, the amounts below are what you pay after you meet the deductible.
Note about PPO plans: Services with a copay, like office visits and urgent care on the PPO 2750, are not subject to the deductible. On the PPO 2750, the emergency room copay applies first, then the deductible and coinsurance.
| HDHP | PPO 2750 | PPO 6000 | |
|---|---|---|---|
| Preventive care | Covered at 100% | Covered at 100% | Covered at 100% |
| PCP office visit | You pay 20% | $50 copay | $25 copay |
| Specialist office visit | You pay 20% | $75 copay | $50 copay |
| Urgent care visit | You pay 20% | $100 copay | You pay 0% |
| X-ray and lab | You pay 20% | You pay 25% | You pay 0% |
| Emergency room | You pay 20% | $300 copay, then you pay 25% after the deductible | You pay 0% |
| Outpatient services | You pay 20% | Office visit: $25 copay All other: you pay 25% |
Office visit: $25 copay All other: you pay 0% |
| Inpatient services | You pay 20% | You pay 25% | You pay 0% |
| Fertility Care | You pay 20% | You pay 25% | You pay 0% |
Fertility care coverage has a $10,000 lifetime medical maximum and a separate $10,000 lifetime prescription drug maximum.
Out-of-network coverage
You can see providers outside the UMR network, but you’ll pay more. After you meet the out-of-network deductible, you pay 50% of covered services on all three plans. Emergency room care is covered at the in-network level.
| HDHP | PPO 2750 | PPO 6000 | |
|---|---|---|---|
| Annual deductible Individual |
$6,800 | $5,500 | $12,000 |
| Annual deductible Family |
$13,600 | $11,000 | $24,000 |
| Out-of-pocket maximum (includes deductible) Individual |
$12,000 | $14,000 | $14,000 |
| Out-of-pocket maximum (includes deductible) Family |
$24,000 | $28,000 | $28,000 |
| Preventive care and other covered services | You pay 50% | You pay 50% | You pay 50% |
Out-of-network providers can bill you for the difference between their charge and the amount the plan allows.
Want added protection?
Consider enrolling in supplemental health coverage that helps you pay for expenses not covered by your medical plan.
Cost for coverage
You pay for medical and prescription drug coverage through semi-monthly paycheck deductions. The amount you pay is determined by the plan you choose and who you cover.
Additional costs
- Working spouse surcharge: If your spouse has access to medical coverage through their employer and you add them to your Lumexa Imaging medical coverage, you’ll pay a monthly $150 spouse surcharge, subject to the exceptions described on the Eligibility page.
- Tobacco surcharge: If you smoke or vape and enroll in the Lumexa Imaging medical plan, you’ll pay a monthly $100 tobacco surcharge. Ready to quit? Call your Clinical Advocate at 1-800-876-9835 for guidance on where to start. North Carolina residents can also get support at no cost from QuitlineNC at 844-862-7848.
How to enroll
You can enroll in medical coverage during Open Enrollment through Employee Navigator , as a new hire, or if you experience a qualifying life event.
Coverage begins the first day of the month following the date you were hired or became eligible for benefits.
Using your medical plan
Finding medical care
Not sure where to go for care? Learn when to use primary care, virtual care, urgent care or the emergency room. You can also find in-network providers through UMR and learn more about preventive care and Teladoc.
Find the right providers, services and facilities for you
Mental health
All our medical plans cover inpatient and outpatient services for mental health and substance use treatment. You and your family also have free sessions with licensed professionals through your Employee Assistance Program.
View mental health coverage and services
Pharmacy
All our medical plans include prescription drug coverage through Optum Rx.
View and compare pharmacy coverage
Garner Health
Garner Health helps you find high-quality, in-network doctors based on real patient outcomes. When you receive care from a Garner Top Provider, you may be eligible for reimbursement of qualifying out-of-pocket medical expenses.
Health support
Get additional help navigating healthcare through the Better Health Bundle and HealthChampion. Resources include clinical advocacy, treatment and care coordination, resolving billing and claims issues, medication savings, cancer navigation and support, telemedicine, preventive care guidance and more.
Explore health support resources
Lantern Surgical Benefit
Lumexa has partnered with Lantern to give you access to the highest quality care at the lowest cost when you need a planned, non-emergency surgery. Ready to schedule your surgery? Contact a Lantern Care Advocate at 855-200-2099.
Not sure if Lantern is right for you? Call your Clinical Advocate at 1-800-876-9835 for guidance.
International travel
Your plan covers emergency treatment when you travel outside the U.S. Routine physicals, immunizations and screenings are not covered, and there’s no coverage if the sole purpose of the trip is to get medical care.
Your ID card shows that you have coverage, but it can’t be used to bill the plan directly. Expect to pay the provider up front, then file a claim when you get home.
How to file an international claim
- Get a detailed bill. A summary statement won’t be accepted. The bill must include:
- The patient’s name, gender, date of birth, address and relationship to you
- A description of the emergency (for example, broken bone, laceration or heart palpitations)
- Date and place of service, and the provider’s billing name, address and phone number
- A description of each procedure, service or supply, and the charge for each
- Number of days or units
- Total billed charges and the provider’s signature
- Pay the provider. The provider won’t coordinate payment with the plan, so pay up front with a credit card or cash.
- Ask for the bill in English, if possible.
- Submit the bill to UMR when you return, with your plan number and member ID: UMR Claims Unit, PO Box 30541, Salt Lake City, UT 84130.
You’ll receive an Explanation of Benefits (EOB) and reimbursement in U.S. dollars for eligible services. The amount is based on the exchange rate on the date you paid the claim, or on the date of service if the paid date isn’t known.
Your Contacts
Medical insurance
800-207-3172
Monday–Friday, 7 a.m.–7 p.m. ET