Is UMR the Same as UnitedHealthcare? Understanding the Relationship

When it comes to health insurance and employee benefits, you may have heard of both UMR and UnitedHealthcare. But what exactly is the relationship between these two companies? Are UMR and UnitedHealthcare the same entity? Or are they completely separate organizations?

This article will clarify the connection between UMR and UnitedHealthcare and explain how they work together to provide services to employers and their employees.

What is UMR?

UMR is a third-party administrator (TPA) that provides administrative services for companies that choose to self-fund their employee health plans.

As a third-party administrator, UMR’s key responsibilities include:

• Adjudicating and paying health claims on behalf of self-funded employer clients
• Providing access to provider networks and discounted rates through network contracts
• Offering consolidated billing, reporting, and other administrative services
• Helping self-funded employers design customized plan options to meet their benefit goals
• Providing cost management solutions to help control expenses
• Delivering high-touch customer service for members and HR administrators

In essence, UMR handles the day-to-day administration of health plans so self-funded employers don’t have to build these competencies in-house.

UMR has over 70 years of experience serving self-funded employers. Today, they administer health plans for over 5 million members across the United States.

What is UnitedHealthcare?

UnitedHealthcare is one of the largest health insurers in the United States. It offers a wide range of insured health plan options for employers, individuals, and public sector clients.

As an insurance carrier, UnitedHealthcare’s core offerings include:

• Fully insured group health plans for employers of all sizes
• Individual health insurance plans compliant with the Affordable Care Act
• Medicare Advantage and Part D prescription drug plans
• Medicaid managed care plans
• Specialized plans like dental, vision, life, disability, and more
• Nationwide provider networks enabling access to care
• Health management programs and wellness resources
• Claims processing technology and support services

In addition to comprehensive commercial health benefits, UnitedHealthcare provides employers with absence management, disability, workers’ comp, clinical care management, and other ancillary services.

Is UMR Part of UnitedHealthcare?

Yes, UMR is part of UnitedHealthcare and has been for over 20 years. UnitedHealthcare acquired UMR in 1999 and operates UMR as a standalone division within the UnitedHealthcare family.

Specifically, UMR functions as UnitedHealthcare’s third-party administrator, serving self-funded employers that want customized administrative services rather than fully insured plans.

While part of UnitedHealthcare, UMR maintains its own brand, management team, account services model, and operating approach tailored to the needs of self-funded employers.

How UMR Complements UnitedHealthcare

UMR and UnitedHealthcare work hand-in-hand to support employers across the health benefits spectrum, leveraging shared capabilities when it makes sense.

Here are some of the key ways UMR complements UnitedHealthcare’s offerings:

Expanded Employer Options

With UMR in its stable, UnitedHealthcare can offer both fully insured plans and self-funded administrative services to meet each employer’s needs.

Integrated Technology

UMR leverages UnitedHealthcare’s shared technology platform, enabling real-time data exchange and a connected experience for members, employers, and providers.

Network Access

UMR clients and members get comprehensive provider network access through UnitedHealthcare’s contracts. This includes over 1.2 million providers nationwide.

Scale and Stability

As part of a large, diversified enterprise like UnitedHealthcare, UMR offers clients added scale, stability, and resources they may not find with standalone TPAs.

Innovation Investments

UMR can tap into UnitedHealthcare’s vast budget for developing innovations like digital member tools, analytics, transparency solutions, and more.

Ancillary Services

UnitedHealthcare’s portfolio of ancillary benefits like dental, vision, life, and disability integrates smoothly with UMR’s health offerings.

Clinical Excellence

UMR leverages UnitedHealthcare resources like preventive care guidelines, utilization management, and care management programs.

Cost Management

UMR applies UnitedHealthcare’s accumulated expertise in pharmacy benefit management, claims editing, and other cost control tactics.

How UMR Differs from UnitedHealthcare

While part of the UnitedHealthcare enterprise, UMR operates distinctly from UnitedHealthcare’s health insurance units in important ways:

Administrative Focus

UMR specializes in group health plan administration whereas UnitedHealthcare specializes in health insurance and underwriting.

Service Model

UMR utilizes high-touch, single point of contact, while UnitedHealthcare uses tiered approaches by customer size.

Technology Platform

UMR administers claims on its legacy platform tailored to self-funding while UnitedHealthcare uses platforms optimized for insurance.

Brand Identity

UMR maintains its own distinct brand and identity that employers recognize and trust.

Account Management

UMR has dedicated account management teams who get to know each self-funded client’s priorities and culture.

Operational Expertise

UMR staffers possess deep expertise in self-funded plan administration versus insurance operations.

Customer Base

UMR exclusively serves self-funded employers whereas UnitedHealthcare primarily serves insured employer groups.

Plan Design

UMR helps clients tailor self-funded plans while UnitedHealthcare offers preset, regulated insured products.

Regulatory Oversight

As a TPA, UMR avoids state insurance regulations while UnitedHealthcare must comply as a licensed insurer.

UMR’s Value as a Third-Party Administrator

UMR delivers unique advantages as a standalone TPA that make it an attractive option for self-funded employers:

Specialization

With a sole focus on self-funding, UMR is 100% dedicated to this niche, not divided across multiple products.

Independence

UMR offers truly independent support and guidance, with no vested interest in recommending insured plans.

Flexibility

UMR’s systems and processes are built for adaptation to each client’s changing benefit needs versus strict insurance regulations.

Transparency

As a TPA, UMR provides full pricing transparency with disclosed fees versus insurers’ bundled premiums.

Cost Savings

UMR returning profits to clients in strong years provides potential long term savings versus insured premiums.

Customization

UMR enables tailored plan design and personalized support unlike the one-size-fits-all nature of insurance.

Employer Control

Clients maintain control over their plans, from design to cost management, when self-funding with UMR’s partnership.

Data Integration

UMR readily provides data feeds and connections to sync with HRIS, payroll, wellness programs, and other platforms.

Member Focus

With UMR, each member interacts directly with their employer’s dedicated team versus a large insurance company.

UMR Delivers Unique Advantages as UnitedHealthcare’s TPA

While operating distinctly, UMR unlocks unique advantages for self-funded employers by being part of UnitedHealthcare:

Added Resources

UMR clients gain economies of scale, technology, and added resources from UnitedHealthcare they wouldn’t access as a standalone TPA.

National Reach

UMR delivers coast-to-coast service capabilities leveraging UnitedHealthcare’s infrastructure versus a regional TPA’s footprint.

Network Savings

UnitedHealthcare’s network contracts and discounts pass through to UMR clients, providing savings self-funded groups couldn’t achieve independently.

Integrated Data

UMR and UnitedHealthcare data integration provides insights and innovations not possible between disconnected TPAs and carriers.

Clinical Leadership

UMR clients benefit from clinical excellence, care standards, and innovations driven by UnitedHealthcare’s massive care delivery system.

Ancillary Benefits

UnitedHealthcare’s full portfolio integrates smoothly with UMR’s health plan administration.

Renewability

UMR offers virtually guaranteed renewability versus independent TPAs who could go out of business or drop a plan.

Brand Equity

The UnitedHealthcare brand provides credibility and instant recognition for UMR versus having to build trust from scratch.

Key Takeaways on UMR and UnitedHealthcare

To recap the key points:

• UMR is UnitedHealthcare’s third-party administrator serving self-funded employers.

• UMR handles health plan administration while UnitedHealthcare provides insured coverage.

• Though part of UnitedHealthcare, UMR operates independently