As a self-funded insurance plan, the insured employers will assume the financial burden borne by most health care related costs.
It should also be noted that some companies that use a self-funded plan will have a stop loss insurance policy designed to cover them for any medical expense claims made over a set amount.
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A Brief History
Back in 2002, United Healthcare bought Midwest Security Administration. This acquisition was the company’s first move into being a third party administrator of heathcare-related insurance plans.
It was in 2005 that United Healthcare actually expanded even further when it purchased United Medical resources. One other historical item of note is that United Healthcare purchased Fiserv Health in 2008.
At this point, that all three of the administrative arms of the company were combined under UMR. That is the way that it remains to this day.
Some Statistics Worth Mentioning
To understand UMR and its overall impact on the health insurance industry, it is helpful to know some of the following statistics.
- The main headquarters for UMR is in Cincinnati, but it also has local and regional offices across the country
- Currently, more than 3,000 people are employed with UMB
- Employees serve roughly 1,400 clients with self-funded health plans
- Clients include individual companies, state governments, and employer formed groups
- There are more than two million subscribers to UMR
- UMR current processes roughly 14 million claims every year
These statistics help to highlight the scope of UMR, but it is also helpful to get a picture of the range of services that the organization is able to provided via these self-funded insurance plans.
Range of Services
When UMR is utilized, self-funded plans can be more comprehensively managed. These plans include not only medical insurance, but plans for disability, vision, and dental as well.
UMR effective works to tailor the services that it offers to the specific needs of each company that becomes its client including handling the claims process from start to finish, reporting issues, and cost control analysis.
Some clients will have several types of self-funded insurance plans under the UMR organization, while others will make use of just one or two.
For example, a company might offer a health insurance plan through an HMO, but self-fund its dental and vision insurance using UMB as its third party administration.
It is also important to note that UMR provides its clients with certain discounts on in-network health services with United Healthcare’s PPO Network is utilized. They also offer more than 100 other partner networks that employer insurance plans can utilize.
To round it all off, UMR provides the following:
- a host of pharmacy benefits
- programs aimed at wellness
- stop loss coverage
Policies and Procedures
In theory, UMR works like any other medical insurance company. The employer will provide a list of covered benefits to the employee, along with possible deductible and co-insurance requirements that need to be met.
In deference to an actual HMO plan, however, the employer will fund the plan on their own.
Any claims that are made against the policy will be paid out of this fund, and all of the expenses are organized by UMR.
They are a third party that governs the administration of the plan and ensures that each employee is adequately covered and receives that health care that he or she is entitled to.
Keep in mind that UMR is essentially a third party administrator.
They are hired by an employer and their sole aim to help ensure the claims made by the insured are paid correctly. This hiring is done in an effort to keep health care related expenses to a minimum and enable the individual to focus on his or her own well-being.
It is important to remember the UMR is not a health insurance company by any stretch of the imagination.
The employer under this arrangement will agree to pay a certain portion of the health care costs that are not paid by the insured. Finally, remember that UMR is now a part of the United Healthcare Company.
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