Welcome to Chapter 3A – Medical Coverage As a reminder, please remember: All Chapters provided in...

•Welcome to Chapter 3A – Medical Coverage

•As a reminder, please remember:• All Chapters provided in the 2015 Benefits Guide are intended to be part of a module series

•There are eight Chapters, several of which contain sub-chapters

• Follow along with and compile these into your own presentation (see below) in the order they are presented

• Text items in red are variables. Please modify them as necessary in order to fit your presentation’s and consumers’ needs

• Please pick and choose from the slides provided to create a custom presentation that is right for you and your consumers. To do this, refer to the instructions listed on the end slide of each Chapter

1Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.


Medical Coverage

• Insert

• List

• Of

• Plan

• Names

Why should you have health insurance? Check out UHC.TVSM for some things to think about!


PlanPlanNo referrals No referrals

requiredrequiredNon-network Non-network

coveragecoverageNationwide Nationwide

NetworkNetworkSpending Spending accountaccount PharmacyPharmacy

ChoiceChoice

Choice PlusChoice Plus

Options PPOOptions PPO

Choice Plus with Choice Plus with a Health a Health Reimbursement Reimbursement AccountAccount

Choice Plus with Choice Plus with a Health Savings a Health Savings AccountAccount

OtherOther

Your Medical Plan Options


ABOUT THE PLAN

You have the freedom to use any network doctor or hospital you want.

You do not have coverage if you choose to receive care outside the network, unless a qualified emergency.

You do not need to choose a primary care provider (PCP).

But a PCP can be helpful in managing your care.

CHOICE PLAN

Plan Specifics Ind. Family

Deductible $xxxx $xxxx

Out of Pocket Max $xxxx $xxxx

Network Non-Network

Co-insurance xx%* No Coverage

Office Visit Co-pay $xx No Coverage Specialist Co-pay $xx No Coverage Lab xx%* No Coverage Hospitalization $xx, then X No Coverage Emergency Room $xxx $xxx


ABOUT THE PLAN

You have the freedom to use any doctor or hospital you want.

You also have coverage if you choose to receive care outside the network. However, you will likely pay more for the service.



CHOICE PLUS PLAN




Network Non-Network

co-insurance xx%* xx%*

Office Visit Co-pay $xx $xx

Specialist Co-pay $xx $xx

Lab xx%* xx%*

Hospitalization $xx, then X $xx, then X

Emergency Room $xxx $xxx


ABOUT THE PLAN





OPTIONS PPO PLAN




Network Non-Network




Lab xx%* xx%*




ABOUT THE PLAN


Reduced out-of-pocket costs when using UnitedHealth Premium® Tier 1 physicians


UNITEDHEALTHCARE TIERED BENEFITS PLAN




Network Non-Network

co-insurance xx%* xx%* xx%*

Office Visit Co-pay $xx $xx $xx

Specialist Co-pay $xx $xx $xx

Lab xx%* xx%* xx%*

Hospitalization xx%* xx%* xx%*

Emergency Room $xxx $xxx $xxx


ABOUT THE PLAN




UNITEDHEALTHCARE EDGE® PLAN




Network Non-Network




Lab xx%* xx%* xx%*




ABOUT THE PLAN




UNITEDHEALTHCARE CHOICE PLUS PREMIER PLAN




Network Non-Network




Lab xx%* xx%* xx%*




ABOUT THE PLAN





UNITEDHEALTHCARE CHOICE PREMIER PLAN




Network Non-Network

co-insurance xx%* xx%* No Coverage

Office Visit Co-pay $xx $xx No Coverage Specialist Co-pay $xx $xx No Coverage Lab xx%* xx%* No Coverage

Hospitalization xx%* xx%* No Coverage



ABOUT THE PLAN





UNITEDHEALTHCARE CATALYST® PREMIER PLAN




Network Non-Network






ABOUT THE PLANYou have the freedom to use any network doctor or hospital you want.

You do not have coverage if you receive care outside the network, unless a qualified emergency.

Reduced out-of-pocket costs when using UnitedHealth Premium® Tier 1 physicians and a freestanding network facility instead of a hospital for outpatient services such as radiology and outpatient surgery.


UNITEDHEALTHCARE CHOICE ADVANCED PLAN




Network Non-Network






ABOUT THE PLANYou have the freedom to use any doctor or hospital you want.

Reduced out-of-pocket costs when using UnitedHealth Premium® Tier 1 physicians and a freestanding network facility instead of a hospital for outpatient services such as radiology and outpatient surgery.


UNITEDHEALTHCARE CHOICE PLUS ADVANCED PLAN




Network Non-Network







You do not have coverage if you receive care outside the network, unless a qualified emergency.

Reduced out-of-pocket costs when using a freestanding network facility instead of a hospital for outpatient services such as radiology and outpatient surgery.


UNITEDHEALTHCARE CHOICE DIRECT PLAN




Network Non-Network

co-insurance xx%* No Coverage

Office Visit Co-pay $xx No Coverage

Specialist Co-pay $xx No Coverage

Lab xx%* No Coverage

Hospitalization xx%* No Coverage




You have coverage if you receive care outside the network, unless a qualified emergency.

Reduced out-of-pocket costs when using a freestanding network facility instead of a hospital for outpatient services such as radiology and outpatient surgery.


UNITEDHEALTHCARE CHOICE PLUS DIRECT PLAN




Network Non-Network


Office Visit Co-pay $xx No Coverage

Specialist Co-pay $xx No Coverage

Lab xx%* No Coverage

Hospitalization xx%* No Coverage



ABOUT THE PLAN


You also have coverage if you choose to receive care outside the network at the same rate.

Care management if you require a hospital stay or surgery.

Prior authorization may be required for some services.

MANAGED INDEMNITY PLAN




co-insurance xx%*

Office Visit Co-pay $xx

Specialist Co-pay $xx

Lab xx%*

Hospitalization $xx, then X

Emergency Room $xxx


ABOUT THE PLAN

You will need to choose a primary care provider (PCP).Your PCP is your guide to quality care, your first contact who will help guide you to the right treatment, or the right specialist, at the right time

You do not have coverage if you choose to receive care outside the network, other than during a qualified emergency.

.

UNITEDHEALTHCARE NAVIGATE® PLAN




Network Non-Network




ABOUT THE PLAN

You will need to choose a primary care provider (PCP).More coverage for visits to network specialists with an electronic referral from your PCP.

You do not have coverage if you choose to receive care outside the network, other than during a qualified emergency. .

UNITED HEALTHCARE NAVIGATE BALANCED® PLAN




Network Non-Network




ABOUT THE PLAN

You will need to choose a primary care provider (PCP).More coverage for visits to network specialists with an electronic referral from your PCP.

You also have coverage if you choose to receive care outside the network. However, you will likely pay more for the service..

UNITED HEALTHCARE NAVIGATE PLUS® PLAN




Network Non-Network




ABOUT THE PLANYou will need to choose a primary care provider (PCP).Visits to network specialists require an electronic referral from your PCP.

You do not have coverage if you choose to receive care outside the network, other than during a qualified emergency.

Lower out of pocket cost for certain outpatient services at freestanding facilities rather than as an outpatient procedure at a hospital

.

UNITED HEALTHCARE NAVIGATE® DIRECT PLAN




Network Non-Network




ABOUT THE PLAN

You get a benefit allowance to pay for eligible medical expenses before you pay a deductible




CATALYST PLAN




Network Non-Network




Lab xx%* xx%*




What is a benefit allowance?It is money that is used to help pay for certain eligible medical expenses before you need to worry about paying a deductible

•Pays after you pay your co-pay or co-insurance

•Money is available first day

•Each family member gets their own

•Starts over in the new plan year

What is not covered by the benefit allowance?•Preventive care (already covered 100% in network)

•Prescriptions

CATALYST PLAN

Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

23

Combined Services Plan

You receive one (1) allowance for the year for all types of care, including:

• Routine and Emergency care• Surgery

Separate Routine & ER Services Plan

You receive two (2) allowances for the year

• Routine care allowance• Emergency care allowance

Combined Routine & ER Services Plan

You receive one (1) allowance for the year that can be used for both:

• Routine care• Emergency care

CATALYST PLAN OPTIONS


ABOUT THE PLAN

You have the freedom to use any Core network doctor or hospital you want.

You do have coverage if you choose to receive care outside the network. However, you will pay more for the service.



UNITEDHEALTHCARE® CORE PLAN




Network Non-Network


Office Visit Co-pay $xx $xx Specialist Co-pay $xx $xx Lab xx%* xx%* Hospitalization $xx, then X $xx, Emergency Room $xxx $xxx


ABOUT THE PLAN

You have the freedom to use any Core Essential network doctor or hospital you want.




UNITEDHEALTHCARE® CORE ESSENTIAL PLAN




Network Non-Network




As a resident of MA, ME or NH you can access Harvard Pilgrim and UnitedHealthcare networks

•Receive network benefits from the Harvard Pilgrim provider network when you are in MA, ME and NH

•Receive network benefits from the UnitedHealthcare provider network when you are

outside of MA, ME and NH

Combined Features

• Access to myuhc.com

• Co-branded health plan ID card

• Nationwide network access

PASSPORT CONNECT® WITH HARVARD PILGRIM

Harvard Pilgrim has been rated the #1 U.S.

commercial health plan for ten years


As a resident of MN, ND, SD or western WI, you can access Medica and UnitedHealthcare

networks

•Receive network benefits from the Medica provider network when you are in the Medica network service

area

•Receive network benefits from the UnitedHealthcare provider network when you are

outside of the Medica network service area

Combined Features

• Access to myuhc.com

• Co-branded health plan ID card

• Nationwide network access

PASSPORT CONNECT® WITH MEDICA

Medica is the second largest health plan in

the service area


Certain preventive services are covered at no cost to you when these services are provided by a network provider.

• Services may vary based on age, gender and health status.

• There may be services you had in the past that will now be covered as preventive, at no additional cost to you.

• And, there may be services you received in the past that were considered preventive, that may no longer be covered as preventive under the new guidelines

It’s important to review your plan documents for the preventive services included in your specific benefit plan.

PREVENTIVE CARE

Not sure why preventive care is important?

29Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Physician office services:

• Routine physical examinations

• Well baby and well child care

• Immunizations

Lab, X-ray or health screening tests:

• Screening mammography

• Colorectal screening

• Osteoporosis screening

*Many types of exams subject to health status and age/gender guidelines

EXAMPLES OF PREVENTIVE SERVICES

•This ends Chapter 3A – Medical Coverage

•Please open Chapter 3B – Flexible Spending Accounts

•Copy and Paste slides from Chapter 3B to this Power Point (Chapter 1)

1. Click on the first slide and then press shift while you click on the last slide

2. Right click on the first slide and select copy

3. Go to the first section

4. Click below the thumbnail of the last slide in that section

5. Right click there and select Copy—Use Source Formatting

•Whichever slides from Chapter 3B that do not apply to your customer, delete


Welcome to Chapter 3A – Medical Coverage As a reminder, please remember: All Chapters provided in...

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