Open Enrollment MeetingsJanuary 1, 2013

Goodwill Industries

Today’s AgendaMedical Plan ReviewBeing a Good ConsumerUsing the UHC BenefitsReminder: Health AdvocateEnrollment Procedures/ID Cards

Effective January 1, 2013There will be no change in carriers.The current plan designs will remain in

place but there will be a slight increase in the employee contribution.

Health Plan Review

Health care costs continue to rise New technology, drug development Poor lifestyle habits and behaviors Inability for consumers to recognize the

difference in quality & cost Choice of options allow you to decide where to spend your

money – paycheck or doctor’s office Plans both encourage employees/dependents to continue to

utilize preventative services and fill prescriptions

Health Plan Review

Insurance Terminology Annual Deductible

The amount you must pay for certain covered health services in a calendar year before the plan will begin paying for major medical benefits in that calendar year.

CoinsuranceThe amount or percentage the plan (UHC) pays and you pay after the deductible is met.

Maximum Out-of-PocketThe maximum amount of Annual Deductible and Coinsurance you pay every calendar year. Once you reach the Out-of-Pocket maximum, benefits are payable at 100% of Eligible Expenses during the rest of that calendar year.

NOTE: These do not include benefits that are subject to copays.

Plan OptionsPlan Designs

The plan designs – deductible, coinsurance, out of pocket expenses – remains the same.

Certificate of Coverage through UHCWhile the essential benefits of the plan stay the same, there are a few enhancements with the Womens’ Wellness coverage.

Employee Contribution There will be slight increases to both plan options this year.

Choice Plus

  In Network Out of Network

Annual Deductible    

Individual $1,500 $5,000

Family $3,000 $10,000

CoInsurance 80% 60%

Maximum Out-of-Pocket    

Individual $4,000 $10,000

Family $8,000 $20,000

Preventive Care Covered at 100% 60% after Deductible

Dependent Coverage Up to age 26.

NOTE: The Out-of-Pocket Maximum INCLUDES the Annual Deductible. Copayments do not accumulate to the Deductible or Maximum Out-of Pocket.

Navigate – WI HMO  In Network Out of Network

Annual Deductible    

Individual $2,000 N/A

Family $4,000 N/A

CoInsurance 80% N/A

Maximum Out-of-Pocket    

Individual $4,000 N/A

Family $8,000 N/A

Preventive Care Covered at 100% N/A

Emergency Coverage In-Network Deductible / Coinsurance

Dependent Coverage Up to age 26.

NOTE: The Out-of-Pocket Maximum INCLUDES the Annual Deductible. Copayments do not accumulate to the Deductible or Maximum Out-of Pocket.

Both Plans – Employee Cost

Single per month

Family per month

Choice Plus $117.38 $305.20

Navigate (WI HMO)

Choice (IL HMO)

$108.56 $282.17

Introducing the UnitedHealthcare NavigateSM Plan

Cover area with cropped image.

Do not overlap blue bar.

Completely cover gray area.

UnitedHealthcare NavigateSM Plan

Connects you to a primary care physician (PCP) that you can trust who will provide and manage most of your care

The Navigate Plan Stresses delivery of quality care Coordinates care across specialists,

hospitals and other health care providers

Helps to improve the overall health care experience

Helps set a path to better health outcomes

12

UnitedHealthcare NavigateSM PlanYou must select a primary care physician (PCP) near where you live.

Network coverage only (unless emergency)

Referrals are required to see network specialists

Not receiving the right care can result in: • Unnecessary procedures• Duplication of services• Needed care not being recognized• Poor quality and outcomes• Patient confusion and frustration

Selecting a Primary Care Physician

Search by clicking on the plan link.

The Primary Care Physician

14

Once you select a PCP, he or she will:

• Provide your preventive care and routine care for most illnesses & injuries

• Coordinate all of your care, from staying healthy to managing serious and chronic conditions 

• Refer you to other network physicians and specialists as needed

The following physicians can be selected as a PCP:  • General Practitioners  • Family Practitioners • Internists • Pediatricians

Your PCP will be your guide to the right treatment, the right specialist, at the right

time.

15

Selecting a Primary Care Physician

• You must select a PCP

• Each family member may select a different PCP in your area

• If you do not select a PCP, UnitedHealthcare will assign one

• Navigate health plan ID cards will include the name of your PCP

• You can request to change your PCP after you enroll. This process could take up to 6 weeks.

Health plan ID cards will include name of your PCP

Selecting a Primary Care Physician

16

If you want to change your PCP

• Call Customer Care or log in to myuhc.com®

• Must submit change request by the 15th of the month to have new PCP by the 1st of the next month (e.g., submitted June 15th, effective July 1st)

• If submitted on the 16th (or after), change won’t occur until the following month (e.g., submitted June 16th, effective August 1st)

• New health plan ID cards will be issued whenever there is a PCP change

• Retroactive changes will not be permitted

June 2011

July 2011

August 2011

Your PCP evaluates you.

17

Obtaining Referrals

You’re not feeling well. You make an appointment with your PCP

You make an appointment with your PCP

1.

Your PCP asks questions to try to understand what may becausing the illness. If necessary, your physician will order some tests.

2.

Based on the evaluation, your PCP may:

Provide a treatment plan and/or prescribe medications

3. ORRefer you to a network specialist

18

Obtaining Referrals• Navigate members must receive referrals before

seeing another network primary care physician or specialist

• Referrals are not needed for emergency care even if received at a non-network hospital

Referrals are NOT REQUIRED for services from network:

• OB/GYNs and Chiropractors

• Behavioral health and substance abuse disorder clinicians

• Optometrist/ophthalmologist for refractive exams

• Urgent and convenience care centers

Good Consumers of Health Care DollarsSaving money starts with

communication…..Make sure you at least have a Primary

Care Physician. Ask questions and be in control of your

care. Create a healthcare journal – track your

own condition as well as your treatments and concerns.

Good Consumers of Health Care DollarsUse your insurance plan’s resources.Register on www.myuhc.com. Know how to read your Explanation of

Benefits. Use the Treatment Cost Estimator to

determine and plan for the costs of your treatment.

Remember, your health care involves both your coverage as well as your treatment.

Good Consumers of Health Care DollarsTake charge! It’s your health and money! Use the Care24 services to help deciding

on place of service (ER vs Urgent Care). Find out if generics are available and if

they qualify for the pill-splitting program. Do your homework – find the Premium

Designated physicians and facilities for your diagnosis.

Using the UHC Benefits

Register for MyUHC websiteOnce you receive your UHC ID CardVisit www.myuhc.comSelect REGISTER NOWType in the requested informationGet started!

Using the UHC Benefits - MyUHC.com

- Find a Doctor – send to cell phone- Find a Hospital- Look up Claims- Improve Health- Order Prescriptions online- Replace ID card- Enhanced Personal Health Record- Embrace Wellness- Check Benefits- Treatment Cost Estimator- And Much More!

71 percent of all eligible users access myuhc.com

for claim/benefit information

Using the UHC Benefits - Care24 Services

Seven days a week – 24 hours a dayToll-free number (1-888-887-4114)Access to registered nurses –

assistance with place of service decisions

Goodwill Industries

Health Advocate Offers a Personalized and Comprehensive

Service Find qualified doctors, dentist,

hospitals, other healthcare providers anywhere in the country

Expedite appointments including hard-to-reach specialists; arranges for specialized treatments and tests

Help resolve insurance claims; negotiates billing/payment arrangements

Assist with eldercare such as finding adult daycare, assisted living and other related issues facing parents, parents-in-law

Obtain unbiased health information about complex medical conditions to help make informed decisions

Work with insurance companies to obtain appropriate approvals for needed services

Answer general questions about test results, treatments and medication prescribed by the physician

Assist in the transfer of medical records, x-rays and lab results

Locate and research the newest treatments for a medical condition

Assist with finding qualified wellness programs, providers and services

Consumer /Member

Health Plan

MD’s/Hospitals

Wellness Programs

Disease Management

Claim Appeals

Health Health AdvocateAdvocate

PBM or EAPCommunicationResolution

= happy member

Health Advocate Connects Member

Community &Government Programs

Healthcare Cost Estimator

• Pre-service pricing tool

• Integrated into Health Advocate’s work-flow

• Largest source of private sector claims data – MedStat

• Database of over 69 million member records

Privacy and Confidentiality Protection

We protect your privacy

Your healthcare information is kept strictly confidential

We fully comply with the federal HIPAA law

Medical Authorization Form

Employee Testimonials

“I used it and it was great! My daughter seen an out-of network provider and I called Health Advocate to assist with the billing. The clinic worked with them and ended up writing off half of the bill. ”

“I’ve used Health Advocate 2 or 3 times already.  I’ve used them to help interpret why a service either isn’t covered or isn’t covered fully and to help decipher the multiple bills that are sent sometimes when you have hospital services (i.e. hospital, doctor, anesthesiologist…they all get their own bill!)”

““I had a question about coverage for my son’s allergy shots.  I contacted Health Advocate & the question was answered right away from the source itself (United Health Care).  No long waits and I dealt only with customer service representatives (not automated computer-generated messages).  I will definitely contact them again.”

How to Reach Health Advocate

Telephone: 1-866-695-8622 (toll-free)

Email: answers@HealthAdvocate.com

Website: www.HealthAdvocate.com

Open: Monday – Friday 8am and 9pm Eastern Time

After hours: Health Advocate can be accessed 24/7. After hours and during weekends, on-call staff is always available for assistance with issues that need to be addressed during non business work hours.

Enrollment RemindersOpen Enrollment: Nov 15th -Nov 30th

PLEASE NOTE: This election will be from 1/1/13 – 12/31/13.

For January 1st, 2013 the medical, dental, and Flexible Spending enrollments are all aligned. The next opportunity for changes will be in November of 2013 for January 1, 2014 outside of a Qualifying Event.

If you are not making any changes to your current plans, the only form to complete is the FSA Enrollment form if you are making an election for 2013. This must be done annually.

Enrollment RemindersIf you need to make any changes (new

enrollment/add/move to HMO/cancel coverage) or enrolling in the FSA plan for 2013, you will need to complete an enrollment form.You can send forms in by:Mailing forms to the Benefits Dept at MSCScan and email forms to Benefits@goodwillsew.comFax forms to 414-847-4193

Enrollment Forms Due: Nov 30th

THANK YOU!

For any Benefits-related questions,

call Goodwill at 414-847-4233.