WELCOME Jefferson Local Schools

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My Jefferson Local Schools benefits information

UMR Customer Service..............................1-800-826-9781

Need ID Cards................................................1-800-826-9781

UMR CARE........................................................1-866-494-4502

Teladoc..............................................................1-800-Teladoc

UnitedHealthcare Hearing......................1-855-523-9355

Your Preferred Provider Network UnitedHealthcare Choice Plus
Your Pharmacy Provider CVS/Caremark 800-334-8134
Your Dental Provider UMR
Find it online at www.umr.com
Write us UMR
PO Box 30541
Salt Lake City, UT 84130-0541

			

Welcome / key contacts

Greetings from UMR!

Welcome to the Jefferson Local Schools benefits plan guide! The purpose of this booklet is simple: To help you get the most out of your health care plan.

As your benefits administrator, we’ll walk you through the plan to give you a better understanding of what it all means. Of course our main goal is to provide you and your family with timely, accurate and caring service.

It starts here, but you also have a whole team of UMR customer service and benefits experts behind you whenever a need or question arises.

To help you reach us, we’ve included this list of key contacts
and information.

Stick it on your refrigerator or bulletin board if you wish, or place it in your wallet or purse, so it’s there when you need it. You can also find this same information on your UMR ID card.

We’re available for you:

24 hours a day, 7 days a week

Your UMR customer service team is ready to help you!

A handy contact card for your fridge or wallet

Member services

Working with UMR

UMR provides benefits administration services to you and your employer.

Your employer has hired us to assist in managing your benefits plan. For example, we help new employees sign up to receive health benefits. We also process your health claims, making sure they are handled quickly and accurately.

UMR even has medical professionals on staff. They help coordinate your care if you are in the hospital or are dealing with a health condition.

Filing a claim

A claim is a request that your benefits plan pays for a health service. You now have an easier way to file claims
with UMR. In fact, we call it EZ Claim.

We don’t need any claim forms, except for prescription drug claims.

With EZ claim, your doctor submits your bills directly for processing. Your ID card has instructions on the reverse side for your doctor’s ofice.

To file a claim, simply show your identification (ID) card at your doctor’s ofice. If you’re planning or scheduling a treatment or procedure, you can also write or call us before-
hand to find out if it will be covered.

How do I contact UMR?

Simply call the toll-free number
located on the back of

your UMR ID card.

Member services

You will receive an explanation of benefits (EOB) form after your claim is processed. It will tell you:

• How much of your cost is covered

• Where checks will be sent

• What amount you are responsible for paying, if anything

Claim appeals

You may sometimes wish to have UMR review a claim decision. This is called an appeal. Appeals must be made within 180 days after you receive written notice of a denied claim. To file an appeal, send us a written request to the address on your ID card to have a
claim reviewed.

After you have filed an appeal, UMR will notify you in writing of the final decision within the time limit listed in your employee benefit booklet.

Member services

UMR has assigned people to help you answer benefit and claim questions. They are trained on your specific benefit plan.

If you have any questions, you can reach a UMR Customer First
Representative by calling the toll-free

number on the back of your ID card.

Questions?

Talk to your UMR Customer First
Representative for answers.

Benefits terminology

Learn the language of health care

Let’s face it. Understanding health and benefits terms is like learning a foreign language for most of us. Knowing the difference between co-insurance and co-payment can be confusing. And deciphering an EOB from COB shouldn’t require a PhD.

Fortunately, you don’t need a foreign language professor or CIA code-breaker to understand all of these terms. That’s because our own UMR team of language experts has already defined them for you, along with a few others.

What is a deductible?

Definition: The amount you have to pay before your plan pays for specified services. Deductibles are usually an annual set amount. A deductible may apply to all services or just a portion of your benefits. It depends on your benefits plan.

What is a co-insurance?

Definition:A set percentage of costs that are covered by your plan after your deductible has been paid. Your plan pays a higher percentage.
You pay a lower percentage.

What is a co-payment?

Definition:A small set fee. It is paid each time you have an ofice visit, outpatient service or prescription refill. The fee is determined by your health plan. Co-payments don’t vary with the cost of service.

What is an out-of-pocket?

Definition: The amount you pay out of your pocket for particular health care services during a particular period of time. An out-of-pocket maximum limits the amount you have to pay during a particular
period of time.

Still confused?

Go to justplainclear.com for a searchable glossary of
health care terms.

Benefits terminology

What is coordination of benefits (COB)?

Definition: Many families are covered by more than one health plan. The coordination of benefits (COB)process determines which plan pays first. It also determines if the second plan will pay any remaining charges not covered by the first plan. The process makes sure your doctor doesn’t get
paid twice for the same service.

What is an explanation of benefits (EOB)?

Definition: An EOB is simply the statement explaining your benefits activity. It includes the services provided, the amount billed and the amount paid, if any. You should review your EOBs carefully. Call the customer service number on your ID card or visit www.umr.com if you
have any questions about your EOB.

How to read your EOB

Understanding your EOB, as easy as 1-2-3

An explanation of benefits (EOB) is not a bill. It simply tells you everything you might want to know about how your recent medical service was covered by your benefits plan. You’ll receive a bill from your provider for any amount you may owe.

1 Cost summary

The first page of your EOB is a summary of how much your provider billed, how much was covered by your plan and the total you may owe to your provider.

2 Benefits update

On the next page, you’ll find a breakdown of how much you and/or your family have applied toward your annual deductibles and out-of-pocket amounts.

Deductible: The amount you have to pay before your plan pays for specified services. Deductibles are usually an annual set amount.

Out-of-pocket: The most you could pay during a coverage period (usually one year) for your share of the costs of covered services. After you reach your “to go” amount, the plan will usually pay 100% of the allowed amount.

How to read your EOB

3 Service and payment details

This section includes information about who received the medical service, the name of the provider and what types of care they received. It gives you a breakdown of how the claim was processed, including:

• How much your provider billed

• Your network discount

• The amount paid by your employer-sponsored plan

• The amount you may owe, including co-pays, deductibles and out-of-pocket amounts

Go paperless on umr.com

Sign up for digital EOBs and you’ll receive email reminders every time you have a new EOB. PLUS, we’ll let you know if you need to take action on the EOB and give you more
details about your claim.

Money saving tips

10 ways to control health care costs

Everybody can play a role in controlling the rising cost of health care. In fact, there are many things you can do to reduce how much you spend on health care now and in the future.

1 See preferred doctors

Most health plans let you see any doctor you want. But you can save a bundle by seeing doctors that are
part of your plan’s preferred network of health care providers. Going to a preferred, in-network doctor usually saves you 20 percent to 30 percent or even more off your bill.

2 Go generic

Generic drugs are the same as other medications, just without the brand name. The biggest difference is the price. Generics usually cost you
30 percent to 70 percent less than brand names.

3 Practice prevention

Preventive care includes things like physical exams, vaccines, blood tests and cancer screenings. These services can prevent you from getting sick or detect a health issue before it gets serious. Check your health plan to see if preventive care is covered in full or at discounted
rates.

4 Get online

It makes sense to find out everything you can to make informed, cost-saving health care choices. That’s why we offer a number of web tools to help you review your health care options, pharmacy benefits and health coverage estimates using the Internet. Visit our website at umr.com.

5 Choose the right care

There is a time and place for everything. A trip to the emergency room may be needed if you are seriously injured or ill. Consider
a cheaper option, like a walk-in clinic or urgent care, if you have a minor illness or issue, such as an ear infection. It may save you time as
well as money.

Fast fact...

Generic drugs usually cost you 30 percent to 70 percent less than
brand names.

Money saving tips

6 Think long-term

Some people go to the doctor for minor reasons once they meet their yearly deductible. While that may not have an instant impact on health care costs, it is a major factor in driving up everyone’s overall costs of care.

7 Eat right

A balanced diet can save you money.

It keeps you healthier in the short-

9 Take care of yourself

The harmful effects of unhealthy habits, such as tobacco use and alcohol abuse, are well known in regard to health issues like cancer and heart disease. If you use tobacco products, seek help to try quitting. Practice moderation if you drink alcohol. Get help if stress or depression are an issue. You will feel
better and also save a few dollars.

term and lessens the chances of developing more serious and costly medical conditions in the future.

8 Exercise

Just 30 minutes of walking or other regular exercise each day helps manage weight, stress and possibly your pocketbook. Exercise helps control and prevent high blood pressure and cholesterol, two of the
major risk factors for heart disease.

10 Review your EOB

Billing mistakes sometimes happen. Review your explanation of benefits (EOB) statement to make sure you are properly billed. Contact your doctor or other care provider if you
suspect an incorrect charge.

Remember...

Review your explanation of benefits (EOB) statement
to make sure you are properly billed.

Your PPO network

A valuable connection

Congratulations! Your employer has given you access to a preferred provider organization (PPO) network through UMR. Here are a few frequently asked questions to help you understand what your PPO network is all about and the benefits of using it.

What is a preferred provider?

Any doctor, hospital or other medical facility that is part of your PPO network. They are sometimes referred to as in-network providers.

Why is a PPO important?

You will pay less for medical services if you see a preferred provider that is part of the network. Plus, there are usually no claim forms for you to worry about when you go to a PPO doctor or hospital.

Can I get medical services from a doctor or hospital that is not a part of my PPO network?

Yes, but you will pay more for their services and may need to
submit a claim form.

How much will I save if I get services from a preferred provider?

You can compare cost savings by looking at your schedule of benefits, which is found in your summary plan description.

What if my normal doctor is not part of my PPO network?

We encourage you to have your doctor apply to join. Here’s how:

• Go to umr.com

• Select Find a provider • Click Medical
• Scroll down to your provider network list
• The next page you will see has a link you can click to view and
print application instructions for

your doctor

What is a PPO network?

A group of doctors and hospitals that have agreed to reduce what they charge for
their services.

Your PPO network

Get the most from your benefit plan...

Use participating network health care providers whenever
possible.

Where can I get information about my PPO network?

Your member ID card contains information about your plan’s PPO.

How often can I see a preferred provider?

As often as needed.

How do I find a network doctor or hospital?

You can call the toll-free phone number on the back of your UMR ID card or go to umr.com and
click Find a provider.

How do I make sure I get my PPO discount?

Just show your UMR ID card when you visit your PPO network doctor or medical facility. It includes all the important information and phone
numbers that are needed.

24/7 service on umr.com

Find what you need at umr.com

Getting your benefits information is easy using umr.com. You’ll be able to find everything you’re looking for in no time!

Select Login/ Register to enter your username and password, or to register for a new account.

24/7 service on umr.com

Your live connection to UMR customer service

Our team members are available online to answer your questions about your claims and benefits with just the click of your mouse. Once you’ve logged in to your umr.com account, just click the Live Chat icon in the top navigation bar on your member home page. It’s that easy.

Click to chat

You can click to chat with a Customer First team member 24 hours a day, seven days a week.*

Get connected

Once you start a chat session, you’ll be prompted to tell us more about your question. Within minutes, a team member will join you to assist with your question.

* excluding major holidays

24/7 service on umr.com

A launch pad for all your health benefit needs

From your personalized home page, you can see a summary of your benefits, link to key areas of the site using myMenu, find out what tasks you need to complete to keep your benefits up to date, and chat with a UMR customer service team member.

myMenu

One-click access to claims, coverage and other resources.

My taskbar

My taskbar Your personalized taskbar will prompt you to take action in three main areas:

• Managing your account

• Reviewing claims and benefits

• Completing health and wellness activities

Get your questions answered, anytime Use Live Chat to get answers

to your claims and benefits questions 24 hours a day, Monday through Friday.

Benefits snapshot
A short summary

of your benefits.

24/7 service on umr.com

Protecting your health information

UMR follows strict rules and security procedures to ensure your information stays safe and is accessed only by you or authorized providers and/or representatives. If you, your spouse or a dependent age 18 or older wishes to allow online access to another covered family member, each member must grant access to view his or her information:

Once you’ve logged in to umr.com and selected account settings, scroll to the bottom and locate the access privileges portion to review and make any necessary changes.

Not registered? Dependents will be asked during the registration process to select family members they will allow to view their personal health information. To register, have your covered family member visit umr.com and select Login/Register.

If your spouse or adult dependent has already registered for online services, your covered family member can log into umr.com to access their account settings.

24/7 service on umr.com

View your claim activity

Claim search

Set up your search preferences by dependent(s), claim type, time period and status.

Get all the details You have the option to view a PDF of your EOB or click the View claim details link to see more
information about a claim.

Take action

When you need to take action on a claim, UMR will let you know. Claims are sometimes put on hold because we need other information from you. Now you can easily Click here to give us the information needed to process your claim.

See your total spend You can see how much you and your employer plan have paid toward your medical and/or dental expenses based on your search parameters.

24/7 service on umr.com

Benefits and coverage summary at-a-glance

Know how much you’ve contributed to your deductibles and out-of-pocket expenses using this easy-to-read summary.

Benefit summary Shows helpful benefit information, including co-pays, coverages and how much you have paid toward deductibles and
(01/01/2019)	out-of-pocket maximums.

Benefit search Set up your search preferences by
dependent(s), coverage type, network level and coverage period.

Get more details Sometimes you need to know about a specific benefit or procedure and what is covered in your plan. Select from the drop down of Additional benefits information to get more details. Or, click on the Summary plan description button if you still can’t find what you are looking for.

24/7 service on umr.com

Health information all in one place

Online health information: up-to-date and ad-free

• Search your health symptoms

• Understand your treatment options

• Learn about drug interactions

• Find first aid information

Our top picks for healthy eating and exercise

• Get the essentials on men’s, women’s and kids’ health

• Watch step-by-step recipe videos

• Log your exercise and activity

Free tools, apps and calculators • Calculate your body-mass index (BMI)

• Download apps to help you stay healthy

• Track your nutrition and fitness goals
The healthy plate

Symptom navigator

First aid

Fitness tools

Health education library

Healthy “U” presentations

Chronic conditions

Health apps

24/7 service on umr.com

Always have your ID card handy

With a couple of clicks, you can have a copy of your ID card pulled up on your smart phone or get a new card mailed to your home.

I want to

Allows you to easily order an ID card or fax a copy of your ID card.

Front          Back

View your ID card Shows all the details of everything that is included on the front and back of your ID card, including your member ID, group number and customer service number (located on
the back).

24/7 service on umr.com

Welcome to
umr.comon the go 

As a UMR member you can access your benefits and claims information anytime, anywhere using your mobile device. There’s no app to download. Simply log in to umr.com

My taskbar View upcoming tasks right from the homepage.

Share your ID card with your provider
Now there’s no need to carry it with you, it’s at your fingertips.

Look up claims Review a claim for yourself or an authorized dependent.

Check your benefits
View medical/dental benefits and see who's covered under your plan.

Find a provider Find an in-network provider while you are on the go.

Estimate health care costs See what you can expect to pay before receiving care with the Health Cost Estimator tool.

Access account balances
Look up balances for your special accounts, including HRAs and FSAs.

Want to bookmark umr.com on your mobile device?

iPhone:Touch and hold the open book icon to addumr.com Android:Tap on the menu. Then select “Add Bookmark.”

Note: The images above reflect available features within our mobile site. These features may or may not be available to all users depending on your individual and company benefits. If you are having trouble accessing or logging into our mobile site, contact the 800 number on the back of your ID card for fastest service. You can click the “Contact us” link on the home screen.

24/7 service on umr.com

A trusted source for health information

There are articles, images, videos and other visuals on diseases, conditions, symptoms, medications, injuries, surgeries, procedures and preventive health tips. This wealth of health knowledge comes
in a variety of forms, including:

• Health encyclopedia • Health navigator
• Drug information

• Drug interaction tool

Just click on an area of the body or select from a list of nearly 300 symptoms to quickly find what you need to know.

Over 1,600 diseases and conditions are covered in male, female, adult and child views.

Health education library

It’s easy to get started. Just look for the Health education library tile on your personal home page.

24/7 service on umr.com

Know what you’ll pay before getting care

The health cost estimator allows you to research treatment options and learn about the recommended care and estimated costs associated with your selected treatment option. You can even access quality and eficiency measurements for participating providers.

Refine results Narrow or expand your search area or refine your search for only preferred providers or by star reviews from
actual patients.

View services & costs
You can get an estimate

based on your location, provider and remaining out-of-pocket cost. You can also see if a provider is above, below or in line
with the local average cost.

Health cost estimator

It’s easy to get started. Just look for the Health cost estimator tile on your personal home page.

explain your options.

UMR CARE

A valuable part of your medical benefits

Few things in life are more important than the health of you and your family. Fortunately, you have UMR CARE on your side to help you understand all your medical care options.

UMR CARE has a staff of experienced,	For example, we can assist you
caring nurses (RNs) who help you	during a hospital stay, after you are	BONUS! get the most out of your health plan	released and with your home care.
benefits. They work with you, your	You can concentrate on getting	Our services can doctors and other medical advisors	well, knowing your UMR CARE nurse	save you money to get the services that best meet	will review your progress with your                           and prevent your needs.	doctor.                                                                    delays in your
Our expert CARE nurses can guide	As an added bonus, our services can	medical claim you before, during and after your	save you money and prevent delays                           processing.
medical care. They will listen to your	in your medical claim processing. concerns, answer questions and	You will also learn about quality
medical services and become a more
Helpful support in	informed health care consumer. any situation

Whether you’re having a baby, have an emergency hospitalization or need non-emergency care, our CARE nurses are there for you.

UMR CARE

Important note...

Your doctor remains solely responsible for decisions concerning your medical treatment and
care.

Here for you in times of crisis

Hopefully, you or a family member never experience a serious injury or long-term illness. But if you do, we will have UMR CARE nurses on the case at no cost to you.

They will assist with your medical care and treatment by:

• Helping negotiate treatment from the beginning of your care
to recovery

• Helping you look at treatment needs and options under the direction of your doctor

• Serving as your advocate with your benefits administrator

• Providing an understanding of any complex issues to your claims payer

• Helping you better understand

your health benefits

The information provided by this program is for general educational purposes only. It is not intended as medical advice and cannot replace or substitute for individualized medical care and advice from a personal physician. Individuals should always consult with their physicians regarding any health questions or concerns.

Teladoc®

24/7 doctor visits via phone or mobile app

Teladoc gives you round-the-clock access to U.S. board-certified doctors, from home or on the go. Call or connect online or using the Teladoc mobile app for affordable medical care, when you need it.

Talk to a doctor anytime, anywhere you happen to be

A network of doctors that can treat every member of the family

Receive quality care via phone, video
or mobile app

Prescriptions sent to pharmacy of choice if medically necessary

Prompt treatment, median call back, in 10 minutes

Teladoc is less expensive than the ER or urgent care

Talk to a doctor anytime!

visit Teladoc.com or call
1-800-Teladoc

Get the care you need

Teladoc doctors can treat many medical conditions, including:

• Cold & flu symptoms • Allergies
• Pink eye

• Respiratory infections

• Sinus problems • Skin problems
• And more

With your consent, Teladoc is happy to provide information about your Teladoc visit to your primary care physician.

UnitedHealthcare Hearing

Save on hearing aids and hear life to the fullest

Through UnitedHealthcare Hearing, you have access to hundreds of name-brand and private-label hearing aids, plus convenient ordering options and personalized care to help you improve your hearing.

Hearing health care made easier

Treating your hearing loss may allow you to reconnect with the world around you and make it easier to engage with family and friends. UnitedHealthcare Hearing gives you options, care and convenience so you can start hearing the sounds you’ve been missing.

Name-brand and private-label hearing aids at significant savings

Choose from hundreds of name-brand and private-label hearing aids from major manufacturers, including Beltone™, Oticon, Phonak, ReSound, Signia, Starkey®, Unitron™ and Widex® and more at savings of up to 80% off industry prices.1

More than 5,000 credentialed hearing provider locations

Access the largest nationwide network2 of credentialed hearing professionals that provide hearing tests, hearing aid
evaluations and follow-up support.

Personal support, every step of the way

You’ll receive access to professional, nation-wide support, online tutorials, hearing health tips and more, so you can stay connected and get the most out of your hearing aids.

Convenient ordering

Order hearing aids in person through a hearing provider or have them delivered right to your home in 5–10 business days.

RIC, ITE,
UnitedHealthcare Hearing

Custom-programmed hearing aids for your unique hearing loss.

With a large selection of private-label and name-brand hearing aids and convenient home delivery and in-person care options, you can choose what works best for your needs.

	
BASIC
	
RESERVE
	
ENTRY
	
ESSENTIAL
	
STANDARD
	
ADVANCED
	
PREMIUM

Hearing Aids	Private Label	Private Label	Name Brand	Name Brand	Name Brand	Name Brand	Name Brand

Cost
	
$
	
$+
	
$$
	
$$$
	
$$$$
	
$$$$$
	
$$$$$$

Styles*	BTE	Ultra Power	All styles BTE, CIC

Batteries
		
1-year supply
	
5-year supply

Follow-up care
	Additional cost per follow-up visit
	
Hearing aid fitting and 3 free follow-up visits included with-in the first year, after the 45-day trial period.
	
Trial Period
	70 days
	
45 days
	
Warranty
	3-year extended warranty (covers repair and a 1-time loss/damage replacement)**

* BTE = behind-the-ear; RIC = receiver-in-canal; ITE = in-the-ear; CIC = completely-in-canal ** One-time replacement cost may apply.

1 Compared to industry average on a pair of hearing aids. Consumer Reports, 2017. 2 2019 UnitedHealthcare Internal Data.

All trademarks are the property of their respective owners.

UnitedHealthcare Hearing is provided through UnitedHealthcare, offered to existing members of certain products underwritten or provided by UnitedHealthcare Insurance Company or its afiliates to provide specific hearing aid discounts. This is not an insurance nor managed care product, and fees or charges for services in excess of those defined in program materials are the member’s responsibility. UnitedHealthcare does not endorse nor guarantee hearing aid products/services available through the hearing program. This program may not be available in all states or for all group sizes. Components subject to change.

Insurance coverage provided by or through UnitedHealthcare Insurance Company or its afiliates. Administrative services provided by United HealthCare Services, Inc. or their afiliates.

Contact UnitedHealthcare Hearing
today to start using your hearing benefit.

Call: 1-855-523-9355, TTY 711

Visit: uhchearing.com

© 2022 United HealthCare Services, Inc. 0522

No part of this document may be reproduced without permission.