MEDICAL INSURANCE  

The City maintains a self-insured health insurance plan administered by a third-party administrator. Our third-party administrator is UMR. UMR can assist you and address your questions regarding:

  • Whether or not a provider is in network
  • EOB's or explanation of benefits
  • ID cards
  • Precertification or Preauthorization required for health care coverage

Visit UMR online at http://www.umr.com/ or call UMR at 1-800-826-9781. 

The Medical and Prescription Plan Book, and Summary of Benefits and Coverage provide you with information on what the plan covers. 

2022 Medical and Prescription Plan Book
2022 Medical Summary of Benefits and Coverage (SBC)

2022 Medical Premiums, Deductibles, and Out of Pocket Maximum

COVERAGE

 

NON- REPRESENTED EMPLOYEE PREMIUM
PER PAYROLL
(BASED ON FULL-TIME
EMPLOYMENT)

REPRESENTED EMPLOYEE PREMIUM
PER PAYROLL
(BASED ON FULL-TIME
EMPLOYMENT)

DEDUCTIBLE
(IN NETWORK) 

 

 DEDUCTIBLE
(OUT OF NETWORK)

MEDICAL OUT OF
POCKET MAXIMUM
(IN NETWORK) 

MEDICAL OUT OF
POCKET MAXIMUM
(OUT OF NETWORK)

SINGLE $26.51 $39.76 $2,000 $2,250 $3,000 $4,000
EMPLOYEE+1 $49.33 $74.00 $2,000 per person $2,250 per person $6,000 $8,000
FAMILY $80.91 $121.37 $2,000 per person,
$4,000 max.
$2,250 per person
$4,500 max.
$7,000 $8,000

Prescriptions 

  • $10 co-pay for Level 1
  • $20 co pay for Level 2
  • $40 co-pay for Level 3
  • 20% not to exceed $350 for Level 4
  • Co-pays are per each 30-day prescription

Mail Order Prescriptions

Members can receive a 90 day supply of medication for the cost of 60-days at CVS, Target or through mail order.
Mail Order Flyer

See the 2022 Medical and Prescription Plan Book for more information. 

Contact Information

UMR
1-800-826-9781
http://www.umr.com/
Through UnitedHealthcare, UMR creates and publishes the Machine-Readable Files on behalf of the City of De Pere. To link to the Machine-Readable Files, please click on the URL provided:  https://transparency-in-coverage.uhc.com/

CVS/Caremark
1-866-818-6911
http://www.caremark.com

Near Site Services 

The City of De Pere has partnered with Prevea Health and Bellin Health to provide our health plan participants select services for FREE* at most area locations.

  • Prevea - All plan participants will receive a separate insurance card called “Prevea Partnered Health Access” card which must be provided by the members at the time of check-in.  
  • Bellin - Members must inform the front desk at the provider’s office that they have near site services to receive this free benefit. 

If the member fails to inform the front desk of the provider, Prevea or Bellin, at the time of service, the appointment will be processed under the City’s insurance plan and the member may be responsible for paying costs such as: copay/deductible/co-insurance for non-preventative services.

FREE Near Site Health Services (Includes Urgent Care at Prevea locations only)

Primary Care Services - Includes Family Medicine, Internal Medicine and Pediatrics

  • Preventative and Non-Preventative (i.e. diagnostic services) care
  • Includes most labs and routine vaccinations (excludes travel medicine)
  • X-ray and other imaging not included

Physical and Occupational Therapy (Examples Include)

  • Manual therapy
  • Chronic Pain and muscle or joint discomfort throughout body
  • Headaches, jaw pain and dizziness
  • Range-of-motion, flexibility, balance and strength training
  • Pre-and post-surgical therapy
  • Posture and body mechanics training
  • Blood flow restriction
  • Dry needling
  • Ergonomic and gait assessments
  • Injury prevention

For more specific information on near site services, including covered services, finding a provider, and to schedule an appointment, please visit:

Prevea: www.prevea.com/PPH
Bellin: bellin.org/CityofDePere

Please note: You do not have to schedule an appointment through the websites above to receive the near site services benefit, the scheduling options are available via those websites for your convenience.   

*These services that are processed under this benefit will be billed directly to the City of De Pere.  Therefore, plan members will not receive an EOB from the insurance company, nor will they receive a bill from the provider.  

Where you go for medical services can make a big difference in how much you pay and how long you wait to see a health care provider. The Choose the Right Health Care Setting flyer can help you select the right setting for your needs.

Teladoc

Teladoc is an add-on service integrated with UMR, the City’s third party administrator.  This low cost alternative to in-person doctor’s visits provides anytime access to on-call doctors.  It connects members to a network of physicians who can diagnose, treat and prescribe medications when needed.  It offers one on one consultation where patients have the option to communicate via phone, online video or mobile app. The cost for a visit through Teladoc is $0 for any member of the City’s health insurance plan.

Getting Started with Teladoc

Dermatology Care

Teladoc Frequently Asked Questions 

Teladoc Informational Videos

The City of De Pere Employee Benefits Plan Notice of Privacy Practices

This notice describes the privacy practices that the City of De Pere has established for the self funded benefit plans.

City Of De Pere Benefit Plan Notice Of Privacy Practices