MEDICAL INSURANCE  

The City maintains a self-insured health insurance plan administered by a third-party provider. 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. 

2020 Medical and Prescription Plan Book
2020 Medical Summary of Benefits and Coverage (SBC)

2020 Medical Premiums, Deductibles, and Out of Pocket Maximum

 

CLAIMING

 

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 $50.84 $2,000 $2,250 $3,000 $4,000
EMPLOYEE+1  $94.63 $2,000 per person $2,250 per person $6,000 $8,000
FAMILY $155.21 $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 Plan book (link above) for more information. 

Contact Information

UMR
1-800-826-9781
http://www.umr.com/

 

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

Teledoc

Teledoc is an add-on service integrated with UMR, the City’s third party administrator. This benefit 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 Teledoc will be $0 for any member of the City’s health insurance plan. This benefit provides a low cost alternative to in-person doctor’s visits.

Getting Started with Teledoc

Dermatology Care

Teledoc Frequently Asked Questions 

Video information on Teledoc 

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