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MTM Select EPO Plan

(Administered by UMR)

 

At MTM, your health—and the health of your family—comes first. Our medical plans are designed to give you access to quality care, comprehensive coverage, and the wellness support you need to feel your best. From preventive services to everyday care and long‑term well‑being, MTM is here to support your whole health journey with compassion and care.

 

The MTM Select EPO Plan, administered by UMR, provides quality medical coverage with a focus on simplicity and predictable costs. An EPO, or Exclusive Provider Organization, means your care must be received in‑network to be covered. There is no out‑of‑network coverage, except in true emergencies. When you use in‑network providers, you get access to affordable care with set copayments and cost‑sharing.

What the EPO Offers

  • In‑network care only (no referrals needed)
  • No out‑of‑network coverage, except emergencies
  • Lower premiums compared to broader networks
  • Predictable copays for many services

Your Medical Network

MTM partners with UnitedHealthcare to give employees access to high‑quality providers, hospitals, and specialists across the country.

Before scheduling care—especially if you’re new to MTM or visiting a new provider—be sure to check the UHC provider search tool to confirm the doctor or facility is in your designated network.

 

UnitedHealthcare Choice Plus Network

For most MTM employees, your medical coverage uses the UnitedHealthcare Choice Plus network. This large, nationwide network offers:

  • A wide selection of in‑network doctors and specialists
  • Access to major hospitals and care facilities
  • No referrals needed to see a specialist
  • Lower out‑of‑pocket costs when you stay in‑network

 

Madison, WI Employees – UnitedHealthcare Options PPO Network

If you work in Madison, Wisconsin, your medical plan uses the UnitedHealthcare Options PPO network. This network provides strong regional coverage and offers similar access to doctors, hospitals, and specialists within the Options network.

 

Why It Matters

Using in‑network providers gives you:

  • Lower costs and predictable copays
  • Full access to preventive services at 100%
  • Better coordination of care within the network

Plan Costs at a Glance

You can view your benefit premiums in Workday during the enrollment event. Since costs vary based on the plan, your coverage level, and who you enroll, your premium will be tailored to your specific selections. For general rate information at any time, search “Employee Premiums” in the Workday search bar. Be sure to review your elections to see your exact cost.

Preventive Care – Covered at 100%

Preventive services—including annual physicals, well‑child visits, recommended screenings, and immunizations—are covered at 100% when using in‑network providers. This means no deductible, no copay, and no cost to you.

 

Medical Deductible

The amount you pay out‑of‑pocket each year before the plan begins sharing costs:

  • Individual: $1,250
  • Family: $2,500

 

Medical Coinsurance

After meeting the deductible, the plan pays a percentage of the cost:

  • You pay: 20%
  • Plan pays: 80%

 

Medical Out of Pocket Maximum

The maximum amount you will pay each plan year for in-network services before the plan pays 100% of covered charges for the remainder of the year.  All allowed out-of-pocket expenses accumulate toward the annual out-of-pocket maximum.

  • Individual: $2,000
  • Family: $4,000

 

Medical Copayments

You pay a set amount for certain services—no deductible required:

  • Primary Care Visit: $25
  • Specialist Visit: $50
  • Urgent Care: $35           
  • Emergency Room: $250 plus 30% after deductible

 

Pharmacy Benefits

Your prescription coverage is included with your medical plan.

Retail 30‑day supply:

  • Tier 1 (Generic): $20
  • Tier 2 (Preferred Brand): $40
  • Tier 3 (Non‑Preferred Brand): $80

 

Mail Order 90‑day supply:

  • Tier 1 (Generic): $50
  • Tier 2 (Preferred Brand): $100
  • Tier 3 (Non‑Preferred Brand): $200

 

Only the Select EPO plan covers weight loss medications with:

  • BMI of 35+ or 30-34 with 2 weight-related co-morbidities, and
  • Engagement in Omada App

Why Choose the Select EPO

The MTM Select EPO Plan is a great fit for employees who:

  • Prefer lower out-of-pocket expenses
  • Are comfortable staying within a strong in‑network provider list
  • Want predictable copays for most care
  • Appreciate 100% covered preventive care
  • Want coverage that’s simple to understand and use

Plan Comparison

Review the side‑by‑side comparison of the medical plans administered by UMR to get a quick, high‑level look at how the plans differ. For a more personalized comparison—based on your health care needs and those of your family—use the Decision Support Tool. This confidential tool helps you see how each plan may work for you and can be a helpful guide when deciding which option best fits your needs.

Learn More

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