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PPO $2500 SBC
PPO $5000 SBC
HSA $3500 SBC
HSA $5000 SBC
UMR Summary Plan Description
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Meridian Healthcare offers a choice between four medical plans through UMR utilizing United Healthcare’s Choice Plus network. The chart below is a brief outline of the plans. Please refer to the summary plan description for complete plan details. The plan year begins July 1st.

Your plan allows you to see any network provider without a physician referral. The level of benefits you receive is dependent upon your choice of using a network or a non-network provider. Significantly higher benefits will be received when you obtain care from a participating network provider. Please see umr.com to locate a “Choice Plus” network provider or download the UMR On The Go mobile app.

Medical Per Pay Cost*

  PPO $2500 PPO $5000 HSA $3500 HSA $5000
  Wellness Non-Wellness Wellness Non-Wellness Wellness Non-Wellness Wellness Non-Wellness
Employee Only $101.87 $126.87 $89.49 $114.89 $65.35 $90.35 $0.00 $25.00
Employee & Spouse $270.43 $320.43 $237.58 $287.58 $194.31 $244.31 $45.69 $95.69
Employee & Child(ren) $246.18 $271.18 $216.27 $241.27 $176.89 $201.89 $41.60 $66.60
Family $386.85 $436.85 $339.85 $389.85 $277.96 $327.96 $65.36 $115.36

*NOTE: The spousal surcharge of $150.00 was not applied to the monthly cost or contribution above.

Wellness Incentive

As an enrolled member in the Meridian’s medical plan, we encourage you and your spouse to participate in completing your annual preventive care exam. Your wellness rate is contingent upon the completion of your annual preventive care exam. If your spouse is enrolled in the medical plan, they must participate in order for you to obtain the maximum incentive effective July 1, 2026.

PPO 2500

Services In-Network  Out-of-Network
Calendar Year Deductible (Embedded) $2,500 individual
$5,000 family		 $22,500 individual
$45,000 family
Annual Out-of-Pocket Maximum $6,600 individual
$13,200 family		 $23,100 individual
$46,200 family
Coinsurance 80% 50% 
Primary Care Visits $35 Copay 50% after Deductible
Preventive Care Covered at 100% 50% after Deductible
Specialist Visits $70 Copay 50% after Deductible
Emergency Room $350 Copay, then 20%
Urgent Care $75 Copay 50% after Deductible
Inpatient Hospital 20% after Deductible 50% after Deductible
Outpatient Surgery 20% after Deductible 50% after Deductible
Lab / X-Ray / MRI 20% after Deductible 50% after Deductible
Prescription Drug Coverage Retail Pharmacy (30 Day Supply)
Generic (Tier 1) $10 Copay
Preferred (Tier 2) $40 Copay
Non-Preferred (Tier 3) $70 Copay
Preferred Specialty (Tier 4) 25% up to $350 maximum
Mail Order Pharmacy (90 Day Supply)
Generic (Tier 1) $25 Copay
Preferred (Tier 2) $100 Copay
Non-Preferred (Tier 3) $175 Copay
Preferred Specialty (Tier 4) 25% up to $350 maximum

**Deductibles, coinsurance and copayments (medical and prescription drug) accumulate toward the Out-Of-Pocket Maximum.

PPO $5000

Services In-Network Out-of-Network
Calendar Year Deductible (Embedded) $5,000 individual
$10,000 family		 $22,500 individual
$45,000 family
Annual Out-of-Pocket Maximum $9,450 individual
$18,900 family		 $24,500 individual
$48,900 family
Coinsurance 80% 50%
Primary Care Visits $35 Copay 50% after Deductible
Preventive Care Covered at 100% 50% after Deductible
Specialist Visits $70 Copay 50% after Deductible
Emergency Room $350 Copay, then 20%
Urgent Care $75 Copay 50% after Deductible
Inpatient Hospital 20% after Deductible 50% after Deductible
Outpatient Surgery 20% after Deductible 50% after Deductible
Lab / X-Ray / MRI 20% after Deductible 50% after Deductible
Prescription Drug Coverage Retail Pharmacy (30 Day Supply)
Generic (Tier 1) $10 Copay
Preferred (Tier 2) $40 Copay
Non-Preferred (Tier 3) $70 Copay
Preferred Specialty (Tier 4) 25% up to $350 maximum
Mail Order Pharmacy (90 Day Supply)
Generic (Tier 1) $25 Copay
Preferred (Tier 2) $100 Copay
Non-Preferred (Tier 3) $175 Copay
Preferred Specialty (Tier 4) 25% up to $350 maximum

**Deductibles, coinsurance and copayments (medical and prescription drug) accumulate toward the Out-Of-Pocket Maximum.
*Out-of-network retail pharmacy is covered at 50% after the deductible. Out-of-network mail order pharmacy is not covered.

HSA $3500

Services In-Network  Out-of-Network
Calendar Year Deductible (Embedded) $3,500 individual
$7,000 family		 $7,000 individual
$14,000 family
Annual Out-of-Pocket Maximum $6,900 individual
$13,800 family		 $20,700 individual
$41,400 family
Coinsurance 80% 50%
Primary Care Visits 20% after Deductible 50% after Deductible
Preventive Care Covered at 100% 50% after Deductible
Specialist Visits 20% after Deductible 50% after Deductible
Emergency Room 20% after Deductible
Urgent Care 20% after Deductible 50% after Deductible
Inpatient Hospital 20% after Deductible 50% after Deductible
Outpatient Surgery 20% after Deductible 50% after Deductible
Lab / X-Ray / MRI 20% after Deductible 50% after Deductible
Prescription Drug Coverage Retail Pharmacy (30 Day Supply)
Generic (Tier 1) Deductible then; $10 Copay
Preferred (Tier 2) Deductible then; $50 Copay
Non-Preferred (Tier 3) Deductible then; $100 Copay
Preferred Specialty (Tier 4) Deductible then; 25% up to $250 maximum
Mail Order Pharmacy (90 Day Supply)
Generic (Tier 1) Deductible then; $25 Copay
Preferred (Tier 2) Deductible then; $125 Copay
Non-Preferred (Tier 3) Deductible then; $250 Copay
Preferred Specialty (Tier 4) Deductible then; 25% up to $250 maximum

***Deductibles, coinsurance and copayments (medical and prescription drug) accumulate toward the Out-Of-Pocket Maximum.

HSA $5000

Services In-Network  Out-of-Network
Calendar Year Deductible (Embedded) $5,000 individual
$10,000 family		 $8,000 individual
$16,000 family
Annual Out-of-Pocket Maximum $6,000 individual
$12,000 family		 $12,000 individual
$24,000 family
Coinsurance 75% 50%
Primary Care Visits 25% after Deductible 50% after Deductible
Preventive Care Covered at 100% 50% after Deductible
Specialist Visits 25% after Deductible 50% after Deductible
Emergency Room 25% after Deductible
Urgent Care 25% after Deductible 50% after Deductible
Inpatient Hospital 25% after Deductible 50% after Deductible
Outpatient Surgery 25% after Deductible 50% after Deductible
Lab / X-Ray / MRI 25% after Deductible 50% after Deductible
Prescription Drug Coverage Retail Pharmacy (30 Day Supply)
Generic (Tier 1) Deductible then; $10 Copay
Preferred (Tier 2) Deductible then; $35 Copay
Non-Preferred (Tier 3) Deductible then; $60 Copay
Preferred Specialty (Tier 4) Deductible then; 25% up to $250 maximum
Mail Order Pharmacy (90 Day Supply)
Generic (Tier 1) Deductible then; $25 Copay
Preferred (Tier 2) Deductible then; $90 Copay
Non-Preferred (Tier 3) Deductible then; $150 Copay
Preferred Specialty (Tier 4) Deductible then; 25% up to $250 maximum

***Deductibles, coinsurance and copayments (medical and prescription drug) accumulate toward the Out-Of-Pocket Maximum.

Informational Videos

 

HDHP High Deductible Health Plan

Medical Plan PPO Preferred Provider Organization

Medical Plan HDHP with HSA

Meridian Healthcare
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