Medical & Prescription

Vail Resorts offers the option of two medical plans – the Basic and Enhanced plans. Both plans are administered by UMR and includes a Company-funded Health Reimbursement Account (HRA) that can be used to pay for eligible medical expenses. The plan year begins on August 1st and ends on July 31st.

Similarities in Plans
Both plans:
  • Cover the same services
  • Offer access to the same network of providers and facilities
  • Have the same prescription drug coverage
Differences in Plans
The plans differ in:
  • Coinsurance percentage
  • Out-of-pocket maximums
  • HRA contribution by Vail Resorts
  • What you pay out of your paycheck
The Enhanced plan has higher per-paycheck deductions, but you generally pay less for eligible healthcare expenses compared to the Basic plan. The Basic plan has lower per-paycheck deductions, but you generally pay more for eligible healthcare expenses at the time of service. compared to the Enhanced plan.

Medical Plan Comparison
Below is a summary of in-network coverage. If you use out-of-network providers, you will have a higher cost share. For additional details, please refer to the Summary Plan Description (SPD) or Summary of Benefits and Coverage (SBC).

Your out-of-pocket expenses can be paid for with the Health Reimbursement Account, funded by Vail Resorts.

In-Network Benefits Basic HRA Plan Enhanced HRA Plan
HRA Contribution* $250 individual / $750 family (plus any rollover from prior year) $750 individual / $1,750 family (plus any rollover from prior year)
Deductible $1,500 individual / $3,000 family $1,500 individual / $3,000 family
Coinsurance 30% 20%
Out-of-Pocket Maximum
(includes deductible, coinsurance and prescription drug copays)		 $5,500 individual / $11,000 family $3,500 individual / $7,000 family
Preventive Care
(exams, cancer screenings, immunizations)		 Covered in full Covered in full
Doctor’s Office Visit 30% after deductible 20% after deductible
Specialist Visit 30% after deductible 20% after deductible
Outpatient Therapy**
(physical, occupational, chiropractic, speech)		 30% after deductible 20% after deductible
Mental Health / Chemical Dependency
(inpatient and outpatient)		 30% after deductible 20% after deductible
Lab or X-ray 30% after deductible 20% after deductible
Imaging 30% after deductible 20% after deductible
Urgent Care Center 30% after deductible 20% after deductible
Emergency Room 30% after deductible 20% after deductible
Hospital
(inpatient and outpatient)		 30% after deductible 20% after deductible

*If coverage is only effective 2/1 – 7/31, you will receive 50% of the annual HRA contribution funded by Vail Resorts.
**Maximum limits may exist.

How the Health Reimbursement Account (HRA) Works
Vail Resorts contributes funds to your eligible medical expenses each plan year through the HRA. This is an account you can use the money to cover deductibles and coinsurance expenses. Vail Resorts contributes money to your HRA to reduce the money you pay out of your pocket.
  1. All expenses are paid through your HRA first.
  2. Then you pay up to your deductible amount.
  3. Next, you and Vail Resorts share the costs through the applicable coinsurance amounts up to your out-of-pocket maximum.
  4. Once you meet the out-of-pocket maximum, Vail Resorts pays 100% of eligible expenses for the rest of the plan year.
Important Information About the HRA
  • There is no “use it or lose it” rule – if there is money left in the account at the end of the plan year, it will roll over and can be used the following plan year.
  • You don’t need to pay any medical expenses when you visit a provider – wait until UMR has processed your claim and review your explanation of benefits (EOB) to see the amount you owe.
Contact UMR
Call 800-826-9781 for Consumer Concierge; 866-494-4502 for UMR Care
Visit umr.com
Download the UMR app at the App Store or Google Play.

Prescription

When you enroll in one of the UMR medical plans, you automatically receive prescription drug coverage through CVS Caremark that includes:
  • Retail Pharmacy: Fill your short-term prescription at your nearest pharmacy.
  • Mail Order: Use the mail order program for your maintenance medications to save money and time. You will receive three months’ worth of medication for a lower cost than retail.
Prescription Plan Comparison
Below is a summary of in-network coverage.

Basic Plan Enhanced Plan
Retail 30-day supply
Generic 50% with $15 min/ $25 max 50% with $15 min/ $25 max
Preferred Brand Name 50% with $25 min/ $50 max 50% with $25 min/ $50 max
Non-Preferred Brand Name 50% with $50 min/ $100 max 50% with $50 min/ $100 max
Mail Order 90-day supply
Generic $30 copay $30 copay
Preferred Brand Name $60 copay $60 copay
Doctor’s Office Visit 30% after deductible 20% after deductible
Non-Preferred Brand Name $120 copay $120 copay

You will need to pay for the prescription up front, and then submit a written request to CVS Caremark for reimbursement. You can be reimbursed for covered prescription products up to the contracted rate of a participating pharmacy.
Specialty medications are commonly used to treat chronic, complex or rare conditions such as rheumatoid arthritis, psoriasis, irritable bowel disease, multiple sclerosis, cancer, cystic fibrosis and other conditions.

They can fall into any tier of cost pricing.
Contact CVS Caremark
CVS Caremark – Caremark.com
CVS Specialty – CVSspecialty.com/EducationCenter
CVS Mail Service – Caremark.com/RxDelivery

Telehealth

With MDLIVE, connect with board-certified physicians and licensed therapists from the comfort and safety of your home for free. Available 24/7, you can see a doctor virtually for non-emergency conditions such as a sore throat, cold and flu, rashes, urinary tract infections, and more. You can also connect with a behavioral health specialist for help dealing with stress, depression, anxiety, addictions, parenting issues and more.

Register now so you’ll be ready to use it when you need it.

Contact MDLIVE
There are 4 confidential ways to connect with a provider:
Visit MDLIVE.com/VailResorts
Call 800-657-6169
Text Vail to 635-483
Download the MDLIVE app at the App Store and Google Play

Cost of Coverage

Review the bi-weekly premiums below for medical and prescription coverage:

Basic Plan Enhanced Plan
Employee Only $90.83 $111.98
Employee + Spouse $199.84 $246.35
Employee + Child(ren) $163.49 $201.54
Employee + Family $299.76 $369.54