MEDICAL

Our lives and our needs are diverse. Some are young; some are old. Some of us have families to consider, others don’t. Some have major ongoing health issues; others see a doctor once a year just for a physical. These variables and many more influence the decisions we make as individuals. Which means not everyone needs the same type of health insurance plan or drug coverage.

New Horizons Baking Company offers three medical plans administered by UMR using the United Healthcare Choice Plus Network. Medical plans feature a deductible, office visit copayments, prescription drug and coinsurance for certain services.

Through these plans you have access to thousands of network physicians and hospitals in the United States. You, the employee, and your dependents are responsible for ensuring the providers that you utilize are In Network. To access a listing of providers, logon to the UMR website at www.umr.com

Working Spouse Medical Carve-Out

New Horizons Baking Company’s benefits plan for employees has a Working Spouse Medical Coverage Carve- Out. This encourages the spouses of New Horizons Baking Company’s employees to obtain available coverage under another employer’s plan instead of the New Horizon Baking Company plan.

In order to determine whether your spouse can be covered under New Horizons Baking Company’s plan, all employees are required to fill out and provide the Working Spouse Carve-out Form.

Resources

OPTION #1 PPO SBC

OPTION #2 PPO SBC

OPTION #3 HSA SBC UMR

Adult Screenings & Immunizations Guide

Compare Quality and Cost with UMR

Find a Provider - Choice Plus Network

How To Read Your ID card

How To Read Your UMR Explanation of Benefits

In-Network Lab Services

Know Where to Go When You Need Services

UMR Accidents Happen - Don't pay more than you should

UMR Coordination of Benefits

UMR Member Portal Registration

umr.com Mobile App

OnlineServices SPANISH

UMR 10 Ways to Control Costs SPANISH

UMR Accident Info Flier SPANISH

UMR Find a Provider SPANISH

Base Option #1

	In-Network	Out-of-Network
Annual Deductible (Individual/Family)	$750 / $1,500	$3,000 / $6,000
Out-of-Pocket Maximum (Includes Deductible)	$2,500 / $5,000	$8,000 / $16,000
Preventive Care	Covered in Full	40% after deductible
Primary Office Visit	$20 copay	40% after deductible
Specialist Office Visit	$30 copay	40% after deductible
Well Child-Care	Covered in Full	40% after deductible
Inpatient Hospital Services	20% after deductible	40% after deductible
Outpatient Hospital Services	20% after deductible	40% after deductible
Routine Pediatric Immunizations	Covered in Full	40% after deductible
Emergency Room Care	$250 copay	$250 copay
Urgent Care	$50 copay	40% after deductible

Base Option #2

	In-Network	Out-of-Network
Annual Deductible (Individual/Family)	$1,250 / $2,500	$3,000 / $6,000
Out-of-Pocket Maximum (Includes Deductible)	$3,000 / $6,000	$8,000 / $16,000
Preventive Care	Covered in Full	Covered in Full
Primary Office Visit	20% after deductible	40% after deductible
Specialist Office Visit	20% after deductible	40% after deductible
Well Child-Care	Covered in Full	40% after deductible
Inpatient Hospital Services	20% after deductible	40% after deductible
Outpatient Hospital Services	20% after deductible	40% after deductible
Routine Pediatric Immunizations	Covered in Full	40% after deductible
Emergency Room Care	$250 copay	$250 copay
Urgent Care	$50 copay	40% after deductible

Base Option #3

HDHP with HSA

	In-Network	Out-of-Network
Annual Deductible (Individual/Family)	$3,000 / $6,000	$5,000 / $10,000
Out-of-Pocket Maximum (Includes Deductible)	$3,500 / $7,000	$7,000 / $14,000
Preventive Care	Covered in Full	30% after deductible
Primary Office Visit	0% after deductible	30% after deductible
Specialist Office Visit	0% after deductible	30% after deductible
Well Child-Care	Covered in Full	30% after deductible
Inpatient Hospital Services	0% after deductible	30% after deductible
Outpatient Hospital Services	0% after deductible	30% after deductible
Routine Pediatric Immunizations	Covered in Full	30% after deductible
Emergency Room Care	Covered in Full	Covered in Full
Urgent Care	0% after deductible	30% after deductible

Please Note: Copays, coinsurance, and deductible accumulate toward the out of pocket maximum.

What you need to know for the upcoming plan year.

New Horizons has implemented an Avoidable Emergency Room Program. To help minimize the effects of rising health care costs, services for non-emergency conditions will not be covered when treated in a hospital emergency department – that these conditions will not be covered if more appropriate settings are available.

Employees and covered dependents who choose to receive non-emergency care in the ER are responsible for the charges incurred.

There are many options that can be more convenient, less expensive and more appropriate than the emergency room.

An Urgent Care Center is a walk-in clinic staffed by doctors who treat conditions that aren’t as severe as emergencies. Doctors in an urgent care often do X-rays, lab tests and stitches.

A Walk-In Doctor’s office is convenient option because consumers don’t have to be an existing patient or have an appointment to receive care. These offices handle most routine care and common illnesses.

A Retail Health Clinic is a clinic where medical professionals provide basic medical care. These clinics are almost always located in retail stores, supermarkets and pharmacies.

Your ID card will have your medical and pharmacy information. If you need additional cards, call UMR at 800-826-9781 AFTER January 1st.

Please take a minute to ensure your provider or preferred facility is in the Choice Plus Network.

Prescription Drugs

Below is a brief overview of what you can expect to pay for a prescription drug, depending on which “tier” category it falls under in the CVS Caremark Drug List for your plan when using an in-network pharmacy. To find out what tier applies to a specific medication, see the CVS Caremark Drug List at www.caremark.com

If you have a Maintenance Drug, one you take every day, week, or month; take advantage of the mail order programs with your medical plan. Please see www.caremark.com for more information.

Click here to view information on the CVS Caremark formulary changes effective July 1, 2023. Note, updated preventive drug lists are coming soon. Please be on the lookout for a letter to members and prescribers about the upcoming changes.

CVS Caremark Advanced Control Speciality Formulary (April 2023)

CVS Caremark Diabetic Meter Program

CVS Caremark Digital Benefits

CVS Caremark Generic Medication

CVS Caremark Performance Drug List (April 2023)

CVS Caremark Rx Delivery by Mail

CVS Caremark Specialty Medication

Welcome to CVS Caremark

Base Option #1

Rx Retail Copays
Generic	$10 copay
Preferred Brand	$30 copay
Non-Preferred Brand	$60 copay
Rx Mail Order
Generic	$10 copay
Preferred Brand	$75 copay
Non-Preferred Brand	$150 copay

Base Option #2

Rx Retail Copays
Generic	$10 copay
Preferred Brand	$40 copay
Non-Preferred Brand	$60 copay
Rx Mail Order
Generic	$10 copay
Preferred Brand	$100 copay
Non-Preferred Brand	$150 copay

Base Option #3

Rx Retail Copays
Generic	$10 copay after deductible
Preferred Brand	$40 copay after deductible
Non-Preferred Brand	$60 copay after deductible
Rx Mail Order
Generic	$10 copay after deductible
Preferred Brand	$100 copay after deductible
Non-Preferred Brand	$150 copay after deductible

*NOTE: HDHP with HSA prescription copays do not start until the deductible has been met.