| Plan Features | ||
|---|---|---|
| Alliance HMO (California) | Harmony HMO (California) | |
| Choice Plus Network | Choice Plus Network | |
| In-Network Only | In-Network Only | |
| Annual Deductible* Individual/Family | $500 / $1,000 | $500 / $1,000 |
| Annual Out-of-Pocket Maximum* Individual/Family | $3,500 / $7,000 | $3,500 / $7,000 |
| Renovo Annual HSA Contribution Individual/Family | N/A | N/A |
| You pay: | You pay: | |
| Preventive Care | Covered in full | Covered in full |
| Telemedicine | $0 | $0 |
| Primary Care | $20 | $20 |
| Specialist | $40 | $40 |
| Lab & X-ray | $20 | $20 |
| Urgent Care | $20 | $20 |
| Emergency Room | $300 | $300 |
| Outpatient Hospital | Covered in full, deductible waived | Covered in full, deductible waived |
| Inpatient Hospital | 30% after deductible | 30% after deductible |
| Retail Prescription Drugs (30-day supply) | ||
| Generic | $10 | $10 |
| Preferred Brand | $50 | $50 |
| Non-Preferred Brand | $100 | $100 |
| Specialty** | Up to $250 | Up to $250 |
| Mail Order Prescription Drugs (90-day supply) | ||
| Generic | $25 | $25 |
| Preferred Brand | $125 | $125 |
| Non-Preferred Brand | $250 | $250 |
| Specialty** | N/A | N/A |
*The annual deductible for the HMO plans is embedded. An embedded deductible has a limit that one person can contribute before they meet their individual deductible. This also counts towards the family deductible, meaning the family deductible will kick in after the combination of individual deductibles adds up to the family deductible.
**Call the phone number on the back of your member ID card or visit specialty.optumrx.com to locate a designated specialty pharmacy for your medication.
| Plan Features | UMR/UHC Choice Plus Network | |||
|---|---|---|---|---|
| PPO Choice Plus Low | PPO Choice Plus High | HSA Choice Plus Low | HSA Choice Plus High | |
| In-Network | In-Network | In-Network | In-Network | |
| Annual Deductible* Individual/Family | $750 / $1,500 | $2,000 / $4,000 | $2,000 / $4,000 | $5,000 / $10,000 |
| Annual Out-of-Pocket Maximum* Individual/Family | $3,000 / $6,000 | $5,000 / $10,000 | $3,500 / $7,000 | $5,000 / $10,000 |
| Renovo Annual HSA Contribution Individual/Family | N/A | N/A | $500 / $1,000 | N/A |
| You pay: | You pay: | You pay: | You pay: | |
| Preventive Care | Covered in full | Covered in full | Covered in full | Covered in full |
| Telemedicine | $40 | $65 | 20% after deductible | 0% after deductible |
| Primary Care – First Stop Health (Virtual) | Covered in full | Covered in full | Covered in full | Covered in full |
| Primary Care – UHC Tier 1 | $25 | $50 | 20% after deductible | 0% after deductible |
| Primary Care – UHC Tier 2 | $75 | $100 | 40% after deductible | 30% after deductible |
| Specialist – First Stop Health (Virtual) | $0 | $0 | Covered in full | Covered in full |
| Specialist – UHC Tier 1 | $40 | $65 | 20% after deductible | 0% after deductible |
| Specialist – UHC Tier 2 | $80 | $120 | 40% after deductible | 30% after deductible |
| Lab & X-ray | 20% after deductible | 30% after deductible | 20% after deductible | 0% after deductible |
| Urgent Care – First Stop Health (Virtual) | $0 | $0 | Covered in full | Covered in full |
| Urgent Care | $75, then 20% after deductible | $150, then 20% after deductible | 20% after deductible | 0% after deductible |
| Emergency Room | $150 | $150 | 20% after deductible | 0% after deductible |
| Outpatient Hospital | 20% after deductible | 30% after deductible | 20% after deductible | 0% after deductible |
| Inpatient Hospital | 20% after deductible | 30% after deductible | 20% after deductible | 0% after deductible |
| Generic | $10 | $15 | 20% up to $250 | 0% after deductible |
| Preferred Brand | $35 | $50 | 20% up to $250 | 0% after deductible |
| Non-Preferred Brand | $65 | $100 | 20% up to $250 | 0% after deductible |
| Specialty | 20% up to $250 | 20% up to $250 | 20% up to $250 | 0% after deductible |
| Generic | $20 | $30 | 20% after deductible, up to $250 | 0% after deductible |
| Preferred Brand | $70 | $100 | 20% after deductible, up to $250 | 0% after deductible |
| Non-Preferred Brand | $130 | $200 | 20% after deductible, up to $250 | 0% after deductible |
| Specialty | 20% up to $250 | 20% up to $250 | 20% after deductible, up to $250 | 0% after deductible |
*The annual deductible for the HSA Choice Low plan is a True Family deductible which means a family can meet the deductible by pooling together expenses (there is no limit to the amount one member can pay toward the family deductible), all other accumulators are embedded. An embedded deductible has a limit that one person can contribute before they meet their individual deductible. This also counts towards the family deductible, meaning the family deductible will kick in after the combination of individual deductibles adds up to the family deductible.
**Must be filled through Script Care specialty pharmacy.
Stay on top of your health with annual checkups! Use your FREE in-network preventive care benefits each year to take care of yourself and your family. Preventive care visits can catch health issues early and prevent them from becoming chronic conditions. And again, they’re FREE!
All PPO and HSA plan members can access FREE virtual care through First Stop Health. Speak with a primary care physician, specialist, or mental health expert at no cost to you.
You have choices when you access care. UMR members who see an in-person primary care doctor or specialist can pay less and receive a higher level of care when visiting a Tier 1 provider. Tier 1 providers are proven to have better outcomes, reduced wait times, and better follow-up with their patients. We encourage you to Spot the Dot and visit a Tier 1 doctor when possible. To find out if your provider is Tier 1, visit umr.com.
| UMR Tier 1/Tier 2 Provider Plan Costs | ||||
|---|---|---|---|---|
| Plan | PPO Low | PPO High | HSA Low | HSA High |
| Primary Care Physician – Tier 1 | $25 copay | $50 copay | 20% after deductible | 0% after deductible |
| Primary Care Physician – Tier 2 | $75 copay | $100 copay | 40% after deductible | 30% after deductible |
| Specialist – Tier 1 | $40 copay | $65 copay | 20% after deductible | 0% after deductible |
| Specialist – Tier 2 | $80 copay | $120 copay | 40% after deductible | 30% after deductible |
Script Care partners with Prescription Mart to get your medications delivered right to your home for less than you pay at the pharmacy! Sign up at presmartinc.com.
Pharmacy benefits for the PPO and HSA plans will be administered through Script Care. Ask your doctor to e-prescribe a 90-day prescription through presmartinc.com or call the number on your card, and they’ll contact your doctor for you.
Transfer retail prescriptions to home delivery by clicking “Add to Cart” and then check out. You can also refill and renew prescriptions.
Rx Savings Solutions is your personal money-saving sidekick. It checks your medications and suggests affordable options. Simply sign up for an online account to compare prices, get alerts when you’re overspending on prescriptions, and get recommendations for changing to a less expensive prescription.
Rx Savings Solutions will handle all the details so you can just sit back and enjoy the savings.
Looking to save on your medical coverage? Here’s the scoop: With the Medical Premium Discount, PPO & HSA Plan participants can earn a 15% (or more!*) discount on medical premiums by registering with Quantum Health, engaging with Rx Savings Solutions (click to learn how!), and completing a virtual primary care visit with First Stop Health.
Complete all Medical Premium Discount requirements by September 15, 2025, to receive the rate starting October 1, 2025.
Note: The premium discount is awarded on a quarterly basis. You must have met Medical Premium Discount requirements by the 15th of the month, prior to the new quarter, to be eligible.
Additionally, your Medical Premium Discount won’t appear in ADP. After meeting the requirements, you’ll see a “MED INCENTIVE” credit under Deductions, on your first paycheck after the effective date.
*HSA Choice Plus High plan members can save up to 35%, if they are enrolled in Employee Only coverage.
Connect with a Quantum Health Care Coordinator at 866-920-1980.
Check out the charts below to see the difference between Standard Rates and Medical Premium Discount Rates.
| Standard Rates vs. Medical Premium Discount Rates You must register with Quantum Health, engage with Rx Savings Solutions (click here to learn more!), and complete a virtual primary care visit with First Stop Health to receive the 15% (or more!*) premium discount. Complete all Medical Premium Discount requirements by September 15, 2025, to receive the rate starting October 1, 2025. *HSA Choice Plus High plan members can save up to 35%, if they are enrolled in Employee Only coverage. |
||||
|---|---|---|---|---|
| Bi-Weekly Standard Rate / Medical Premium Discount Rate |
||||
| Plan | Employee Only | Employee + Spouse | Employee + Child(ren) | Employee + Family |
| PPO Low | $188.48 / $160.20 | $405.48 / $344.65 | $413.86 / $351.78 | $727.06 / $618.00 |
| PPO High | $156.60 / $133.11 | $329.97 / $280.48 | $341.16 / $289.98 | $617.44 / $524.82 |
| HSA Low | $144.29 / $122.65 | $325.5 / $276.67 | $316.55 / $269.07 | $587.24 / $499.15 |
| HSA High | $54.92 / $35.65 | $160.14 / $136.12 | $195.93 / $166.54 | $281.58 / $239.35 |
| Harmony HMO CA Only |
$51.66 | $237.75 | $172.15 | $385.35 |
| Alliance HMO CA Only |
$72.32 | $306.12 | $226.30 | $485.40 |
| Annual Savings with Medical Premium Discount | ||||
|---|---|---|---|---|
| Plan | Employee Only | Employee + Spouse | Employee + Child(ren) | Employee + Family |
| PPO Low | $735.06 | $1,581.35 | $1,614.07 | $2,836.53 |
| PPO High | $640.73 | $1,286.89 | $1,330.52 | $2,408.02 |
| HSA Low | $562.74 | $1,269.44 | $1,234.55 | $2,290.24 |
| HSA High | $501.36 | $624.54 | $764.13 | $1,098.18 |
scriptcare.com
800-880-9988
myrxss.com
800-268-4476
This website highlights some of your benefit plans. Your actual rights and benefits are governed by the official plan documents. If any discrepancy exists between this communication and the official plan documents, the plan documents will prevail. The company reserves the right to change any benefit plan without notice. Benefits are not a guarantee of employment.
Quantum Health Care Coordinators
866-920-1980
RenovoBenefits.com –
Gold DotComm Award Recipient