You can find Los Angeles UMR mental health therapy with in-network treatment centers, but the cost of care will vary based on your summary of benefits.
UMR offers four levels of care:
Bronze Plus Plan–PPO
The Bronze Plus Plan has UMR mental health coverage as follows:
- In-network inpatient UMR mental health coverage at 30% after deductible, which is $2,000 per person or $4,000 per family for in-network providers. For non-network providers, the family deductible is $8,000.
- Outpatient Los Angeles UMR mental health therapy coverage is $30 copay per visit, with a deductible waived for office visits and 30% for other outpatient services.
- Non-network provider inpatient services are 50% after deductible.
- Non-network outpatient UMR mental health coverage is also 50% after deductible.
When it comes to medication, the Bronze Plus Plan has three tiers of coverage:
Tier 1
This is preferred generic drugs. If you get medication from an in-network provider and you pick it up from a pharmacy or a mental health treatment center, you only have to cover a $10 copay for each prescription. if you need something sent through the mail, it is a $25 copay.
Tier 2
This is for preferred brand drugs, which means brand name instead of generic name, and it has a $50 copay for medications you pick up from an in-network provider and a $125 copay for medications you get through the mail.
Tier 3
This is for non-preferred generic and non-preferred brand drugs, which comes with a $70 copay for medication you pick up and a $175 copay for medication ordered through the mail.
All non-network prescriptions come with a 50% coinsurance requirement, meaning you have to pay half the total medication cost.
Tier 4
This is for specialty drugs, which fall under the generic or brand drugs category, but they are not covered if provided by an out-of-network facility.
Note: In addition to the deductible, UMR policies have a maximum out-of-pocket expense, and this can be applied to things like coinsurance payments or the percentage of care you have to cover in certain situations. There is a maximum expense per calendar year per family that differs depending on your plan and whether you are choosing an in-network facility.
Silver Plan–HDHP
The next level of coverage is the Silver Plan.
- In-network inpatient UMR mental health coverage at 20% after deductible. The deductible per person is $1,500 regardless of whether the UMR mental health treatment center in Los Angeles is in-network or not.
- Outpatient Los Angeles UMR mental health therapy coverage is 20% after deductible for all services.
- Non-network provider inpatient services are 40% after deductible.
- Non-network outpatient UMR mental health coverage is also 40% after deductible.
For prescription medication for any mental health treatment, UMR Silver Plan has a 20% deductible for Tier 1-Tier 4 for any in-network medication (both picked up at a CVS or mailed to your home). For non-network providers, the medication has a 50% coinsurance requirement, so you have to pay half the cost.
Gold Plan–PPO
The Gold Plan is the third highest tier with similar coverage to the Silver for mental health services.
- In-network inpatient UMR mental health coverage at 20% after deductible. The deductible per person is $600 for in-network providers per person and $1,200 for non-network providers.
- Outpatient Los Angeles UMR mental health therapy coverage is a $20 copay per visit, with a deductible waived for office visits and 20% for other outpatient services.
- Non-network provider inpatient services are 40% after deductible.
- Non-network outpatient UMR mental health coverage is also 40% after deductible.
Tier 1
This is preferred generic drugs. For medication from an in-network provider that you pick up at a store, you have an $8 copay. if it comes to you in the mail, you have a $20 copay.
Tier 2
This is for preferred brand drugs. This comes with a $30 copay if you pick it up at a CVS and a $75 copay if you have it mailed to you.
Tier 3
This is for non-preferred generic and non-preferred brand drugs. It has a $50 copay for medication you pick up and a $125 copay for medication that gets mailed to you.
All non-network prescriptions come with a 50% coinsurance requirement for Tier 1-3.
Tier 4
This is for specialty drugs that fall under the category of generic or brand drugs. Non-network coverage does not apply, but the in-network costs are based on whether it is a generic or brand name medication.
Platinum Plan–PPO
The Platinum Plan is their best plan and also the one with the most expensive premiums. However, it does give you the highest level of coverage for in-network providers.
- In-network inpatient UMR mental health coverage at 20% after deductible. The deductible per person is $250 for in-network providers per person and $5,000 for non-network providers.
- Outpatient Los Angeles UMR mental health therapy coverage is a $20 copay per visit, with a deductible waived for office visits and 10% for other outpatient services.
- Non-network provider inpatient services are 30% after deductible.
- Non-network outpatient UMR mental health coverage is also 30% after deductible.
For prescription medications, you have a $4 copay for retail and a $10 copay for mail-order medications under Tier 1. There is a $20 copay for medication you pick up and a $50 copay for mail-order medic for Tier 2. Tier 3 has a $40 copay for medication. You pick up any $100 copay for medication that is mailed to you.
Any medication prescribed by a non Network provider has a 50% coinsurance fee.
Not sure what your policy covers? Call us at 877-564-1319 and let our team help you review your benefits today.
