Welcome to the Orion Health Insurance Pool website!

This website has been designed to provide information about your health benefits and to give you online access to provider directories, forms, plan documents and other information at the click of a button.

NEW for 2022

  1. Orion’s medical network is changing to UnitedHealthcare (UHC), with UMR as the medical claims payor/processor. Have questions? Visit the UMR website at umr.com or call 800.826.9781.
  2. Orion’s pharmacy network is changing to OptumRx. For more information go to optumrx.com or call 877.559.2955.
  3. Orion’s telehealth vendor is Teladoc. You can use your telephone or computer to conduct a live virtual visit with a board-certified medical professional—any day, anytime, anywhere. Call 800.835.2362 or visit teladoc.com
  4. New medical/prescription ID cards will be sent to everyone this year. Be on the lookout.
  5. The Core plan has been eliminated for 2022.
  6. Orion and UMR are teaming up to provide a new and improved health care advocacy program.
  7. ComPsych will be the new employee assistance program (EAP), giving 24/7 access to counseling and work-life resources. For help, call 866.335.4847 or visit guidanceresources.com (use Web ID: OrionEAP).
  8. Prescription copays are changing. Refer to the medical plan pages for the new amounts.
  9. We have extended no-cost-share preventive services to conditions like diabetes and asthma. Refer to your plan document for more information.
  10. Allowable HSA contributions increased to $3,650 for employee only coverage and $7,300 for family coverage.

Do you know the requirements for precertification?

How does it work?

Precertification review is a procedure for ensuring that various healthcare services being sought by covered individuals are medically necessary. An entity known as the utilization management (UM) company makes this determination. The UM company’s medical staff uses established medical standards to determine if recommended hospitalizations, confinements in health care facilities, surgeries, an/or other health care services meet or exceed accepted standards of care.

What services must be precertified (approved before they are provided)?
  1. All elective hospital admissions, including admissions for behavioral health (mental health and substance abuse) and transplants. Note: For pregnant women, precertification is required only for hospital stays that last or are expected to last longer than 48-hours for a vaginal delivery, and 96 hours for a C-section.
  2. Admission to an inpatient rehabilitation facility, skilled nursing facility, subacute care facility, or residential treatment program.
  3. Chemotherapy and radiation.
  4. Durable medical equipment (DME) exceeding $1,000 per item.
  5. Elective MRI and CT scans.
  6. Treatment of sleep disorders after the diagnosis is confirmed.
  7. Bariatric procedures.
  8. Admission for a transplant.
  9. Genetic testing.
  10. Routine costs associated with a certain “approved clinical trial” related to cancer or other life threatening illnesses. For individuals who will participate in a clinical trial, precertification is required in order to notify the plan that routine costs, services, and supplies may be incurred by the eligible individual during his/her participation in the clinical trial.
  11. Specialty medications.
  12. Outpatient therapies.