Medical

You and your eligible dependents can participate in the Parkland Employee Health Plan (PEHP) immediately upon hire. The PEHP has three coverage tiers — you can see a doctor in any tier. For more details, review the Summary Plan Description.

African American pediatrician with face mask talking to mother and daughter in a waiting room at the hospital

Tier 1

Parkland Network

  • Get the highest level of benefits and lowest copays.
  • You’ll pay a $20 copay for primary care office visits and a $50 copay for specialist office visits.
  • Tier 1 providers include Parkland doctors or UTSW physicians with Parkland privileges.
  • Tier 1 facilities include Parkland Memorial Hospital, the Employee Health Center (EHC), the Employee Women’s Wellness Center (EWWC), COPC centers and Children’s Medical Center.

Tier 2

UnitedHealthcare Choice Plus Network

  • You’ll pay higher copays and have to meet higher deductibles and out-of-pocket maximums compared to Tier 1.
  • You’ll have a $30 copay for PCP office visits and a $50 copay for specialist office visits.
  • Tier 2 providers/facilities include those in the UnitedHealthcare Choice Plus Network through UMR.
  • UTSW/Aston and Cook Children’s Medical Center facilities are also in Tier 2.

Tier 3

Out of Network

  • Use any provider/facility outside of Tiers 1 and 2 and receive out-of-network Tier 3 benefits.
  • This tier has the highest deductibles and out-of-pocket maximums.
  • After you meet the deductible, you pay 50% plus any charges over the reasonable and customary (R&C) amount.
  • In most cases, you’ll pay out of pocket and then file claims to be reimbursed.
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Frequently Asked Questions (FAQs)

Do I need to pick a primary care physician (PCP)?

You’re not required to choose a PCP, and you don’t need referrals to see a specialist. But choosing a PCP may still make sense. A PCP knows your medical history and can help coordinate your care. The amount you pay for office visits will be based on which tier your doctor is in.

Do all of my doctors need to be in the same tier?

No, you can see providers in any of the three tiers. For example, you might see your PCP who is a Tier 1 Parkland provider. Your allergist may be in Tier 2, and your dermatologist might be in Tier 3. What you pay for office visits will depend on which tier your doctor is in. Remember, Tier 1 providers offer the highest level of benefits and lowest copays. Log in to umr.com to see a list of Tier 1 and Tier 2 providers. Providers not on this list would be considered Tier 3, and you will receive out-of-network benefits for those office visits.

Medical Benefits at a Glance

Here’s a look at what you’ll pay when you need care under each of the three tiers. If a service is not provided by a Tier 1 provider or facility, you will need to receive the service from a Tier 2 or Tier 3 provider. Your benefit will be paid based on the tier of the provider that you use. If you reach the out-of-pocket maximum, the plan pays 100% of eligible charges for the remainder of the plan year.

Use the search bar at the top of the chart to help you find how your service is covered.

For a full list of covered services, refer to the PEHP Plan Documents posted in the Legal Notices section.

To find a provider, contact UMR, a UnitedHealthcare company, at umr.com or 877-370-0320.

TIER 1:
Parkland Network

TIER 2:
UnitedHealthcare
Choice Plus Network
TIER 3:
Out of Network

Calendar-Year Deductible
(Amount you must pay before the plan pays for some services. Amounts you pay towards the deductible count toward your out-of-pocket maximum.)

Per PersonDeductible

$500
(applies to coinsurance only)

$1,500
(applies to coinsurance only)
$3,000
Per FamilyDeductible$1,000
(applies to coinsurance only)
$4,500
(applies to coinsurance only)
$18,000
Calendar-Year Out-of-Pocket Maximum1
(Maximum amount you will pay out of pocket for the calendar year. If you reach this limit, the plan will pay 100% of your covered expenses for the rest of the calendar year.)
Per PersonOut-of-Pocket Maximum$2,500$6,000$15,000
Per FamilyOut-of-Pocket Maximum$6,000$13,000$48,000
Lifetime Maximum
Per PersonLifetime MaximumUnlimitedUnlimitedUnlimited
What You Pay
Preventive Care2rowlabel
Routine health assessments and immunizationsPreventive Care$0 copay3$0 copay350% after deductible
Physician Services (office or virtual visits)rowlabel
Primary carePhysician Services$20 copay$30 copay50% after deductible
SpecialistPhysician Services$50 copay$50 copay50% after deductible
Emergency Care4 rowlabel
Hospital emergency room visit5Emergency Care$250 copay$250 copay$250 copay
Urgent care/outpatient facility $35 copay$50 copay50% after deductible
Ground ambulance services (for emergencies only)Emergency Care$0 copay$0 copay$0 copay
Inpatient Hospitalrowlabel
Per admissionInpatient Hospital10% after deductible30% after deductible50% after deductible
Outpatient Medicalrowlabel
In physician’s officeOutpatient Medical$20 or $50 copay
(based on provider)
$30 or $50 copay
(based on provider)
50% after deductible
In hospital (day surgery)Outpatient Medical10% after deductible
(at Parkland facilities only)
30% after deductible50% after deductible
Lab and X-rayrowlabel
Office visit onlyLab and X-ray0%0%50% after deductible
Diagnosticrowlabel
Routine diagnostic services0%0%50% after deductible
Mental Health and Substance Abuse Treatmentrowlabel
Outpatient
Mental Health Substance Abuse Treatment
$20 copay$20 copay50% after deductible
Inpatient
Mental Health Substance Abuse Treatment
10% after deductible10% after deductible50% after deductible
Maternity Carerowlabelpregnancy
Initial visit to confirm pregnancymaternity care$20 or $50 copay
(based on provider)
$30 or $50 copay
(based on provider)
50% after deductible
Subsequent physician services including deliverymaternity carepregnancy10% after deductible30% after deductible50% after deductible
Hospitalization (per admission)maternity carepregnancy10% after deductible30% after deductible50% after deductible
Radiologyrowlabel
Invasive/contrast and diagnostic service (subject to your deductible and coinsurance)radiologyNo deductible/coinsurance for
routine radiology services at
Parkland, Children’s Medical
Center or William P. Clements
Jr. University Hospital
30% after deductible50% after deductible
Durable Medical Equipmentrowlabel
Durable medical equipment services10% after deductible10% after deductible50% after deductible
Skilled Nursing Care in Facility6rowlabel
Up to 60 days/year instead of acute hospital careskilled nursing10% after deductible10% after deductible50% after deductible
Home Health Carerowlabel
Home nursing visits prescribed by a doctorhome health care10% after deductible10% after deductible50% after deductible
Hospice Carerowlabel
If pre-authorizedhospice10% after deductible10% after deductible50% after deductible
Rehabilitation Services6rowlabel
Outpatient (up to 60 days/year)rehabilitation$20 copay$30 or $50 copay
(based on provider)
50% after deductible
Inpatient (up to 60 days/year)rehabilitation10% after deductible10% after deductible50% after deductible
Family Planningrowlabel
Family planning counselingfamily planning$20 or $50 copay
(based on provider)
$30 or $50 copay
(based on provider)
50% after deductible7
Infertility testing and treatmentfamily planning$20 or $50 copay
(based on provider)
$30 or $50 copay
(based on provider)
50% after deductible7
Sterilization procedurefamily planning$20 or $50 copay
(based on provider)
or 10% after deductible if admitted
$30 or $50 copay
(based on provider)
or 30% after deductible if admitted
50% after deductible7
Outpatient medically necessary pregnancy terminationfamily planning$50 copay30% after deductible50% after deductible7
Inpatient medically necessary pregnancy terminationfamily planning10% after deductible30% after deductible50% after deductible7
Hearing Aidsrowlabel
Up to $2,000 every 36 months for each devicehearing$0 copay$0 copay50% after deductible
Routine Hearing and Speechrowlabel
1 exam per yearhearingspeech$0 copay$0 copay50% after deductible
Allergy Testing and Evaluationrowlabel
Testing and physician visitsallergy$20 or $50 copay
(based on provider)
$30 or $50 copay
(based on provider)
50% after deductible
Serum and injectionsallergy$0 copay$0 copay50% after deductible
Physician visitsallergy$20 or $50 copay
(based on provider)
$30 or $50 copay
(based on provider)
50% after deductible

1 Calendar-year out-of-pocket maximum includes amounts you pay toward the deductible. It does not include copays, amounts over plan limits and penalties.

2 Routine health assessments include routine physicals, such as well-adult checkups, well-woman care and well-baby/well-child care.

3 These preventive services are covered at a $0 copay if billed by a separate facility: routine adult/child lab and X-rays, annual mammogram (including 3D), PSA (prostate-specific antigen) and Pap smear.

4 If not a true emergency, you pay deductible and coinsurance.

5 Hospital emergency room visit copays are not charged if admitted.

6 60 days combined maximum per calendar year for skilled nursing facility, rehabilitation (inpatient and outpatient) and sub-acute facilities.

7 All services must be preauthorized.

Free-Standing Emergency Room Visits

The PEHP will no longer cover visits to out-of-network, free-standing emergency rooms, which are facilities that:

  • Provide emergency medical services at a place outside of a regular hospital campus, and
  • Are not attached to a hospital or even located near one.
Pregnant Couple On Sofa At Home Looking At Baby Clothes

Save on Maternity Care

The Parkland Employee Health Plan will waive deductibles and coinsurance for all obstetric office visits related to your prenatal care if you participate in the Maternity CARE Program during your first or second trimester.

Delivering at Parkland?

  • If you participate in the program, go to the new Employee Women’s Wellness Center for doctor’s visits during pregnancy and deliver at Parkland, you’ll pay just a $250 flat fee for all services, including anesthesiology and facility charges.
  • If you participate in the program, go to a doctor who is not at the new Employee Women’s Wellness Center for doctor’s visits during pregnancy and deliver at Parkland, you will pay a $500 copay for the birth.

To be eligible for these incentives, you must enroll in Maternity CARE during your first or second trimester and continue to participate in the program each trimester of your pregnancy.

Learn more

Utilization Management

To help you determine if the services you receive are a covered benefit, UMR performs utilization management and provides pre-authorization on certain services.

Learn more

Smiling young man sitting on floor and texting friend

Teladoc: Anytime, Anywhere Care

You and your covered dependents can use the Teladoc benefit if you’re enrolled in the PEHP. You’ll pay a $24 copay for each Teladoc visit.

24/7 via phone, video, or mobile app, talk to a U.S. board-certified doctor who can answer your questions, make a diagnosis and even prescribe basic medications (subject to availability by state).

Teladoc doctors can treat many medical conditions, including:

  • Cold and flu symptoms
  • Allergies
  • Pink eye
  • Respiratory infections
  • Sinus problems
  • Skin conditions

If you provide consent, Teladoc can pass on information about your visit to your PCP.

Set up your account at Teladoc.com or call 800-Teladoc (800-835-2362). You choose the time that works for you: pick as soon as possible or schedule a same-day or next-day appointment.

Virtual Visits (PEHP)

The PEHP also covers virtual visits when you see a physician who is not in the Teladoc network. You’ll pay your regular office visit copay (for Tier 1 and Tier 2), which differs depending on the tier of your doctor.

Real Appeal: Weight Loss Support

Real Appeal® is a free online lifestyle program to help you lose weight, feel better and improve your health — one small step at a time. It’s available to you and your covered spouse if enrolled in the PEHP.

 

Learn more

Your 2022 Medical Biweekly Benefit Deductions

For full-time employees, deductions are based on annual wages as shown in the chart below.

Full-Time Employees Whose Annual Wages ArePart-Time Employees With Benefits
WagesrowlabelUnder $35,000$35,000–$45,000$45,001–$65,000$65,001–$100,000Over $100,000All Hourly Rates
Coverage Category
Employee Only$32.31$46.62$60.00$75.23$78.46$124.71
Employee Plus Children$87.69$122.31$155.08$189.69$222.00$327.22
Employee Plus Spouse$107.54$149.54$192.00$234.92$270.46$398.59
Employee Plus Family$149.54$207.23$264.92$321.69$372.92$567.29

Covering Your Spouse

If your spouse has access to health care coverage through his/her own employer, you will pay a surcharge to cover them under the PEHP. The surcharge will be $46.15 per pay period. Watch your mailbox for a packet containing next steps on the Working Spouse Health Coverage verification process. Failure to complete the verification process by the deadline means Parkland will apply the surcharge. You must repeat this process every year.

Find Answers Fast at umr.com.

View My taskbar, your personalized benefits to‑do list.

Check your benefits and see what services are covered.

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Use the Health cost estimator to price a treatment or procedure in your area.

Look up what you owe and how much you’ve paid.

Use tools, apps and calculators to track your health goals.

Need advice? Call UMR at 877‑370‑0320 and ask for the 24-hour NurseLine. You can connect with a registered nurse 24/7. You can also listen to the audio education library with hundreds of health topics.