Employer Groups
Healthcare Solutions for Businesses
University of Michigan Health Plan (UM Health Plan) offers employers a variety of plans so you can find one that best suits your needs and budget. We can also tailor plans to accommodate special circumstances.
Our Plans
The health care industry uses lots of lingo, including HMO and PPO. Here’s a brief breakdown of what various terms mean at UM Health Plan.
UM Health Plan’s original health care product has been keeping members healthy for more than 40 years. In that time, UM Health Plan has developed a reputation for assisting members and their providers with managing their care.
UM Health Plan’s HMO (Health Maintenance Organization) offers a statewide network of providers, pharmacies, and hospitals. Members have the freedom to see any provider within our network without a referral. UM Health Plan’s POS (Point of Service) product allows your employees to see any provider they choose, in-network or out-of-network.
UM Health Plan also offers several plans compliant with the Mental Health Parity Act and Addiction Equity Act and that also work well with health reimbursement arrangements.
UM Health Plan’s PPO (Preferred Provider Organization) insurance plans, available to employers located anywhere in Michigan, give employees the freedom to see the providers they want at a low cost.
Take a look at our plan offerings and call your insurance agent or Sales at Sales@UofMHealthPlan.org for more information.
A high-deductible health plan (HDHP) is an inexpensive option that generally doesn’t start paying for enrollees’ healthcare expenses until a high threshold is met (usually a several thousand dollar deductible) but typically covers them after that. Preventive care is covered at 100 percent and is not subject to the annual deductible. There is no coverage for preventive services out-of-network.
Other plan features:
- All services, except preventive care, apply to the deductible
- Deductibles, coinsurance and prescription copays all apply to the out-of-pocket (OOP) maximum
- The family deductible and out-of-pocket (OOP) maximum are nonembedded, meaning no individual in the family has satisfied the deductible or OOP maximum until the entire family amount has been satisfied
- There are separate accumulators for in-network and out-of-network deductibles and out-of-pocket maximums
- Except for prescription drugs, these plan designs do not include any flat-dollar copay
To help members pay for medical expenses until their deductible is met, employers can set up a health savings account (HSA) for employees. Employers, employees or both can contribute to the HSA. Learn more about HSAs below.
Beyond our core products, UM Health Plan also offers a number of ways to customize the health coverage you offer your workforce. These include additional medical services as well as techniques for reducing your and your employees’ health care costs.
Health Savings Accounts (HSA)*
A health savings account is an alternative to traditional health insurance; it is a savings product that offers a different way for consumers to pay for their healthcare. HSAs enable employees to pay for current health expenses and save for future qualified medical and retiree health expenses on a tax-free basis.
An HSA is a savings account into which employees can deposit money on a tax-preferred basis. They must be covered by a high-deductible health plan (HDHP) to be able to take advantage of an HSA. An HDHP generally costs less than traditional healthcare coverage, so the money employees save on insurance premiums can go into the health savings account.
Employees own and control the money in their HSA. Decisions on how to spend the money are made by them without relying on a third party or a health insurer. Employees also decide what types of investments to make with the money in the account in order to make it grow.
Prescription Drug Plans (HMO/POS; PPO)*
UM Health Plan also offers several prescription drug plans to choose from. All prescription plans include coverage for mail order – a 90-day supply for two retail copays.
*These ancillary products are purchased in conjunction with medical plans and cannot be bought separately.
UM Health Plan can provide third-party administrator (TPA) services for large employers that want to self-insure their employees’ health coverage. The plan can also provide network access and medical management services to self-insured companies.
What Is Self-Insurance?
Self-insurance, or self-funding, allows an employer to pay claims rather than insurance premiums. It means you would assume some or all of the risk. A TPA, such as PHP, can administer and pay the claims for self-insured benefit plans.
Why Self-Insure?
With the right TPA, a self-funded benefit plan can save money on health benefit costs and allow for flexibility in plan offerings – from HMO to POS and PPO plans.
Should My Company Self-Insure?
Whether or not a company should self-insure depends on a number of factors, which could include the number of employees, their general health and their location, as well as the amount of risk a company is willing to assume and its past claims history.
UM Health Plan offers stop-loss insurance to employers who self-fund their employee benefits through PHPMM-TPA. Stop-loss coverage protects employers against the severity of large losses from claims. Stop-loss coverage is available in two types:
- Specific which protects against the severity of large losses from a single individual’s claims.
- Aggregate which protects against a high level of total claims.
UM Health Plan can help you select the appropriate stop-loss coverage for your company’s particular situation.
