The Navigators Health Plans
The Navigators has three self-funded medical plans, which means that we pool premium contributions from our members to pay the medical and pharmacy claims of our Navigators family. We partner with UMR/UHC to administer our claims and provide member customer service.
UnitedHealthcare (UHC) specializes in global health care so that members can find health care providers almost anywhere around the world. By selecting UHC, The Navigators seeks to provide its employees with a smooth transition between their U.S. and overseas health care needs.
This UHC partnership provides a higher standard of care and services to all UHC members. These services include pre-trip planning, coordination of care, medical evacuation and/or emergency assistance. These benefits and more can be accessed by calling the customer service number on your UHC Medical ID Card.
Medical Plan Comparison | ||||||
Key Medical Benefits | UHC Platinum PPO | UHC Gold HDHP | UHC Silver HDHP | |||
In-Network | Out-of-Network1 | In-Network | Out-of-Network1 | In-Network | Out-of-Network1 | |
Calendar Year Deductible | ||||||
Individual Family | $2,000 $6,000 Embedded | $6,000 $18,000 Embedded | $2,0002 $4,0002 Aggregate | $4,0002 $8,0002 Aggregate | $3,200 $6,400 Embedded | $6,400 $12,800 Embedded |
Coinsurance | ||||||
Plan Pays You Pay | 80% 20% | 60% 40% | 80% 20% | 60% 40% | 80% 20% | 60% 40% |
Calendar Year Out-of-Pocket Maximum | ||||||
Individual Family | $6,000 $12,000 | $18,000 $36,000 | $4,0002 $8,0002 | $8,0002 $16,0002 | $6,000 $12,000 | $12,000 $24,000 |
Covered Services | ||||||
Office Visit (Physician/Specialist) | $35 / $75 copay | 40%* | 20%* | 40%* | 20%* | 40%* |
Virtual Visits | Varied copays | N/A | 0%* | N/A | 0%* | N/A |
Routine Preventive Care | No charge | 40%* | No charge | 40%* | No charge | 40%* |
Emergency Room | $150 copay | $150 copay | $150 copay | $150 copay | $150 copay | $150 copay |
Urgent Care | $75 copay | 40%* | 20%* | 40%* | 20%* | 40%* |
Prescription Drugs (Tiers) | ||||||
Retail Pharmacy (30-day supply) | $25 / $55 / $100 / 20% $250 max | N/A | 20%* / 30%* / 50%* | N/A | 20%* / 30%* / 50%* | N/A |
Mail Order (90-day supply) | $50 / $110 / $200 / 20% | N/A | 20%* / 30%* / 50%* | N/A | 20%* / 30%* / 50%* | N/A |
Coinsurance percentages and copay amounts shown in the above chart represent what the member is responsible for paying.
*Benefits with an asterisk ( * ) require that the deductible be met before the Plan begins to pay.
To be eligible for the HSA, you cannot be covered through Medicare Part A or Part B or TRICARE programs. See the plan documents for full details.
- If you use an out-of-network provider, you will be responsible for any charges above the maximum allowed amount.
- Aggregate Deductible and Out-of-Pocket Maximum: HDHP Gold plan members have an aggregate deductible and out-of-pocket maximum. This means if you enroll one or more family members, you must meet the full family deductible and out-of-pocket maximum before the plan starts to pay for covered services.
Aggregate vs. Embedded Deductible
Medical plans have one of two deductible models: an aggregate deductible or an embedded deductible. The main difference between the two is that one individual cannot meet the deductible for the family with an embedded deductible, whereas they can achieve this under an aggregate model.
So, with an aggregate deductible, your whole family will be paying the deductible until the entire family deductible is met. With an embedded family deductible, the plan begins to make payments as soon as one member of the family has reached their individual deductible.
Learn more here.
Commonly Asked Questions
Who do I contact with prescription drug questions?
You can reach out to the CARES team at caresumr4@optum.com. You can also call OptumRX 24 hours a day at (877) 559-2955. Be sure to include your member ID number in your request. Turnaround time for non-urgent requests is 24 to 48 hours.
Why does my prescription cost more this year?
There are a few reasons why your prescription costs may have risen:
- Drug manufacturers may increase their prices, particularly at the beginning of the year.
- You may need to re-satisfy deductibles or out-of-pocket maximums that reset each year.
- There may be changes in the drug formulary that can take place in January and July.
Why does my prescription cost less this year?
There are a few reasons why your prescription costs may have fallen:
- Drug manufacturers may decrease their prices, particularly at the beginning of the year.
- You may have already satisfied your deductible or out-of-pocket maximum for the year.
- There may be changes in the drug formulary.
How do I compare drug and pharmacy prices?
Visit umr.com and click on the “Pharmacy” widget to be taken to optumrx.com. You can also call OptumRx at 1 (877) 559-2955.
Where can I get more information on my prescription program?
Log on to the optumrx.com website or call UMR at (800) 207-3172 to speak to a Plan Advisor.
Monthly Medical Plan Contributions
Medical - Gold HDHP | |||
Glen Eyrie, HQ, Admin. Cost Sharing | |||
Coverage Tier | Employee Deduction | Navigators Dept. | Total |
Employee Only | $118.00 | $472.00 | $590.00 |
Employee + Spouse | $310.00 | $929.00 | $1,239.00 |
Employee + Child(ren) | $280.00 | $841.00 | $1,121.00 |
Employee + Family | $502.00 | $1,504.00 | $2,006.00 |
Medical - Silver HDHP | |||
Glen Eyrie, HQ, Admin. Cost Sharing | |||
Coverage Tier | Employee Deduction | Navigators Dept. | Total |
Employee Only | $108.00 | $432.00 | $540.00 |
Employee + Spouse | $284.00 | $851.00 | $1,135.00 |
Employee + Child(ren) | $257.00 | $770.00 | $1,027.00 |
Employee + Family | $459.00 | $1,378.00 | $1,837.00 |
Medical - Platinum PPO | |||
Glen Eyrie, HQ, Admin. Cost Sharing | |||
Coverage Tier | Employee Deduction | Navigators Dept. | Total |
Employee Only | $127.00 | $507.00 | $634.00 |
Employee + Spouse | $333.00 | $999.00 | $1,332.00 |
Employee + Child(ren) | $301.00 | $904.00 | $1,205.00 |
Employee + Family | $539.00 | $1,618.00 | $2,157.00 |
Field Staff Fundraising Responsibility Medical - Gold HDHP | |
Coverage Tier | Monthly Premium |
Employee Only | $590.00 |
Employee + Spouse | $1,239.00 |
Employee + Child(ren) | $1,121.00 |
Employee + Family | $2,006.00 |
Field Staff Fundraising Responsibility Medical - Silver HDHP | |
Coverage Tier | Monthly Premium |
Employee Only | $540.00 |
Employee + Spouse | $1,135.00 |
Employee + Child(ren) | $1,027.00 |
Employee + Family | $1,837.00 |
Field Staff Fundraising Responsibility Medical - Platinum PPO | |
Coverage Tier | Monthly Premium |
Employee Only | $634.00 |
Employee + Spouse | $1,332.00 |
Employee + Child(ren) | $1,205.00 |
Employee + Family | $2,157.00 |
Overseas Field '24 | |
Coverage Tier | Monthly Premium |
Employee Only | $407.21 |
Employee + Spouse | $895.85 |
Employee + Child(ren) | $773.69 |
Employee + Family | $1,262.34 |
Field Staff Fundraising Responsibility 2nd Year EDGE (Grandfathered Gold Plan) | |
Coverage Tier | Monthly Premium |
Employee Only | $431.00 |
Employee + Spouse | $956.00 |
Employee + Child(ren) | $941.00 |
Employee + Family | $1,542.00 |
Field Staff Fundraising Responsibility Staff in Training (Grandfathered Gold Plan) | |
Coverage Tier | Monthly Premium |
Employee Only | $526.00 |
Employee + Spouse | $1,126.00 |
Employee + Child(ren) | $976.00 |
Employee + Family | $1,820.00 |