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The West Bend School District partners with UMR to provide eligible employees and their eligible dependents health insurance. UMR is a third party vendor that administer's the district's health insurance plan and claims. The district's health insurance network is through the UnitedHealthcare NexusACO Network.
Who is Eligible?
Who is Eligible?
An eligible employee is a person who is classified by the employer on both payroll and personnel records as Certified Staff that are contracted at least 75% FTE, Administrator, Custodial/Maintenance, Clerical and Professional Technical and are assigned 30 or more hours per week with the West Bend Joint School District on a regular basis.
What are the health insurance plan options?
What are the health insurance plan options?
The district has two different plans to choose from, Plan 1 or Plan 2. Click here to see a summary and definitions of deductibles, co-insurance, out of pocket maximums and copays for these two plans.
What are the monthly premiums for each health insurance plan?
What are the monthly premiums for each health insurance plan?
Premiums are the amount you pay per paycheck to have health insurance every month.
Click here to see a summary of the cost for the 2025 monthly premiums for the two health insurance plans.
Is there supplemental insurance offered through the District's health insurance plan?
Is there supplemental insurance offered through the District's health insurance plan?
Yes, there are two district paid supplemental insurance plans offered through the health insurance plan. These plans include Accident Insurance and Critical Illness Insurance. Click here for a summary of these supplemental insurance and who is covered by these district paid supplemental insurances for each health insurance plan as these supplemental insurances may help you make a decision as to what health insurance plan to choose.
What is the difference between Tier 1 (NexusACO), In Network and Out of Network?
What is the difference between Tier 1 (NexusACO), In Network and Out of Network?
The district’s health insurance network is the UnitedHealthcare NexusACO provider network.
The UnitedHealthcare NexusACO is a three tiered benefit plan designed to encourage members to seek care from Tier 1 health care professionals. Members have lower deductibles, co-insurance and out of pocket maximums for services rendered by Tier 1 providers. The other two tiers of the NexusACO network include In-Network and Out-of-Network. To learn more about the NexusACO network please click here.
Do the deductibles and out of pocket maximums cross fill between each tier?
Do the deductibles and out of pocket maximums cross fill between each tier?
Yes, the deductibles and out of pocket maximums cross fill between Tier 1, In Network and Out of Network. If you primarily see a Tier 1 provider, but then need to see an In Network provider any deductibles and out of pocket maximums you have accumulated from Tier 1 cross fill into the In Network tier. Your deductibles and out of pocket maximums do not start over if you see a provider in a different tier. If you don't ever go Out of Network, the most you would pay for an individual out of pocket maximum would be $3,500 on Plan 1 and $3,750 on Plan 2.
How do I know if my provider or any provider I choose is Tier 1, In-network or Out-of-Network?
How do I know if my provider or any provider I choose is Tier 1, In-network or Out-of-Network?
Click here for directions to search for providers who are a part of the NexusACO network.
How do I register for an account through UMR’s website?
How do I register for an account through UMR’s website?
By registering an account with UMR, you will have access to a variety of services, including:
Viewing your medical claims
Status of your deductibles and out of pocket maximums
Finding Tier 1 and In-Network providers
Ordering ID cards
Online tools to help you live a healthier life
And much more!
Click here to find out how to register for a UMR account. PLEASE NOTE: To register an account you will need your member ID number from your insurance card.
Why am I required to select a Primary Care Provider (PCP) through UMR's website?
Why am I required to select a Primary Care Provider (PCP) through UMR's website?
The goal of the plan and the UnitedHealthcare NexusACO Provider Network is to have members build a relationship with a primary care provider to make sure members are getting the quality healthcare they need. Please click here to learn how to find and select a primary care provider through UMR’s website.
Are preventive services covered at 100%?
Are preventive services covered at 100%?
Yes, preventive services are covered 100% under the district’s health insurance plan. Below are some of the most common preventive services, but not limited to:
Routine physicals both adult and annual well child checks
Routine Mammograms
Routine Pelvic Exam and Pap Test
Routine Prostate Exam
Routine Colonoscopy
*Other service charges may apply to your deductible and out of pocket maximums.
Are there any FREE health care options available?
Are there any FREE health care options available?
Yes, the district offers a variety of free healthcare options to employees working 20 or more hours per week and any family members enrolled on the district’s health insurance plan. These options include:
Click the links above to learn more about each of the FREE healthcare options available.
Is prescription drug coverage included with the district's health insurance plan?
Is prescription drug coverage included with the district's health insurance plan?
Yes, prescription drug coverage is included and it is through OptumRx. Click here for a schedule of benefits and more information regarding the prescription drug coverage.
Should I open a Flexible Spending Account (FSA) to help pay for medical expenses?
Should I open a Flexible Spending Account (FSA) to help pay for medical expenses?
You will want to review your health care expenses to consider if you’ll need to contribute to a healthcare FSA. If you would like more information about an FSA, please click here.
What health insurance plan should I choose?
What health insurance plan should I choose?
We cannot legally serve as your advisor, however this calculator may help you make your decision.
Things to consider while you decide which health insurance plan to choose:
How much healthcare does you and your family usually utilize
When you look at your healthcare needs do you value a lower deductible with a higher monthly premium or a higher deductible with a lower monthly premium
The coverage for you and your family of the district paid accident and critical illness insurance
If you have questions related to health insurance insurances, please contact Nicole Gruenewald at ngruenewald@wbsd-schools.org, 515120, or 262.335.7881.
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