Connecting you to better health In a hurry?

Transcription

1 Connecting you to better health In a hurry? Check out the Benefit plan quick reference guide on pages 2-3.

2 Welcome We re glad you re here. We know your health is important to you. And we also know that when people know more about their health and health care, they make better informed health care decisions. You are a valued member and we want to help you understand more about your health care and the resources that are available to you. UnitedHealthcare offers access to many resources, and this guide will help you discover where to find exactly what you need. Let s get started.

3 1 2 3 Membership Basics Accessing your health benefit plan There s never been a better time to become a member of UnitedHealthcare. While no one can predict the future, you can prepare for it. Your membership provides access to professionals and resources to help you when you aren t feeling your best and to work toward improving your health and wellness. We believe that knowledge is the heart of health care, so we want to provide you with the resources to help you get involved with your health care, make healthy choices, find answers, save money and take charge of your health. Benefit plan quick reference guide Where to find your plan documents Getting the most out of your health care plan UnitedHealth Premium designation program When you need care What laboratory should you use? Get to know myuhc.com ID card information Better health services Everyone needs help sometime. If only you had a team of health care professionals on call to answer your questions quickly, confidentially and at no cost to you. Now you do. As a UnitedHealthcare member, you have access to resources 24-hours a day, seven days a week to help when you need it most. Health statement Pharmacy benefits Emergency vs. urgent care Care24 services Care Coordination SM and behavioral solutions Care solutions Create your health We believe that understanding your health care benefit plan and what is available will help you be more successful and healthy. That s why we ve developed programs and offer educational resources such as informative articles, newsletters, health assessment tools and more to help you focus on creating a healthy life. So, whether you re juggling hectic home and work schedules, or facing life from a new perspective, we provide resources that fit your lifestyle. Five ways to invest in yourself Healthy Mind, Healthy Body e-newsletter Healthy Pregnancy program What does that word mean? Your responsibilities Bill of rights Renewing members Welcome back. Please take a close look at this year s benefit coverage documents. Changes have been made that may affect you. If you have questions, please call the toll-free, member phone number on the back of your ID card.

4 Accessing your health benefit plan Benefit plan quick reference guide The picture below shows where you can find specific information on myuhc.com. A B C D E F Your plan information and important numbers you may need Quick access to the most frequently viewed and needed items Don t have access to a computer? Call the toll-free, member phone number on the back of your ID card to speak to a customer care professional. 2

5 Accessing your health benefit plan A B C D E F Claims & Accounts Claim information Amount paid Date processed and other details Claim status Amount applied to deductible Out-of-pocket information Patient responsibility Claim forms Mailing address for claim submissions Physicians & Facilities Find network doctors, hospitals, laboratories, pharmacies, vision care, mental health clinician, and medical equipment/supplies View tips for choosing health care Treatment cost estimator Pharmacies & Prescriptions* Pharmacy location Prescription drug list information Prescription claim form Benefits & Coverage How your plan works for medical, preventive care, pharmacy, vision, mental health and substance abuse, extra programs Verify eligibility/covered dependents Personal Health Record Create personal health profile Track your health, conditions, allergies, medications and more Health & Wellness Take a confidential health assessment Access to hundreds of health and wellness articles Health calculators Account information Medical claims summary Flexible spending account View health statements View claim letters Coordination of benefits Issue resolution How to file an appeal How to voice a complaint UnitedHealth Premium designation program View doctor quality and cost efficiency View high performing hospitals Price medication Order and Refill prescriptions Prescription claim form Copayment amounts Deductible amounts Out-of-pocket amounts Certificate of Coverage documents View claims and create reports Drug guide Do you have the cold or flu? Symptom checker Health improvement tools and features and much more *Check your Certificate of Coverage to see whether UnitedHealthcare pharmacy benefits are available to you. 3

6 Accessing your health benefit plan Where to find your plan documents These symbols tell you where to find the important documents you may need. Visit online at Call the toll-free, member phone number on the back of your ID card Arrives in your mailbox Certificate of Coverage Your Certificate of Coverage is a legal document that describes your benefit plan coverage in detail. Directory of doctors and other health care professionals This list shows you all the network doctors and facilities in your area, including those ranked by the UnitedHealth Premium designation program. You generally will have much lower costs if you use a network doctor or facility for your care. Health statement A health statement shows all claims processed in a month for all covered members, plus remaining balances for deductibles and out-of-pocket expenses. If there are no claims, you will not receive a health statement for that month. Medical claim form If you receive care from a doctor who does not participate in our network, you will need to fill out a medical claim form. Our network doctors normally take care of claim forms for you. Temporary member ID card Lose your member ID card? Get a temporary one quickly and easily. Prescription claim form If you fill a prescription with a pharmacy that does not participate in our network, you will need to fill out a prescription claim form. Our network pharmacies normally take care of claim forms for you. Benefits & Coverage Physicians & Facilities Claims & Accounts Claims & Accounts Print an ID card Pharmacies & Prescriptions 4

7 Accessing your health benefit plan Getting the most out of your health care plan Select a health care partner First, be sure you have a doctor. Selecting a doctor (or primary care provider) can lead to one of the most important relationships in your health plan. Do some research to find a doctor who suits your needs. No matter what kind of coverage you have, when you choose the right doctor someone you feel comfortable with you re choosing a partner for good health. No matter where you are, we re here to help You have access to a national network of more than 580,000 doctors and 4,900 hospitals. Wherever you are, chances are there is a network doctor to help you when you need treatment. To help you find the right doctor, we provide information on doctors in our network on myuhc.com or by calling the Member number on the back of your ID card. Remember, it s your choice, and we want to help you make an educated one. Start putting our network to work for you Did you know the doctor or facility you choose may save you money? If your benefit plan allows for coverage outside of our network, chances are it will cost you more for services from doctors who are not in our network. If you seek care outside the network, we only pay a portion of the charges, and you re responsible for paying the remainder. In some states, we ll send you a check for our portion of the covered charges, and it s your responsibility to pay the doctor or facility. To make sure you re not billed for your laboratory or diagnostic imaging services, tell your doctor you want to be referred to a network provider. By the numbers: } 580,000 doctors } 4,900 hospitals } 56,000 pharmacies } 57,000 counselors and mental health practitioners Close to retirement? Find out from your employer what health benefits, if any, extend to you during your retirement years. With this information, you can make other important choices, like finding out if you re eligible for Medicare and Medigap insurance coverage and the Medicare prescription drug program. 5

8 Accessing your health benefit plan UnitedHealth Premium can help you make informed choices about your care With the UnitedHealth Premium designation program, we make it easier for you to find doctors and facilities in your area meet quality and cost-efficiency criteria. The UnitedHealth Premium program* evaluates doctors in 20 specialties, including primary care, cardiology, orthopedics, cancer care, and facilities in six specialties, including congenital heart disease, cardiac care, neonatology, infertility, total joint replacement and spine surgery. Criteria for designation comes from national industry, evidence-based quality standards and market-based cost efficiency standards. Ask yourself these questions when seeking care: } What do specialty societies recommend for my condition? } Is there scientific evidence supporting the treatment? } What approaches minimize complications? } What steps are taken to minimize medical mistakes? * UnitedHealth Premium is not available in all geographic locations. For a complete description of the UnitedHealth Premium designation program, including details on the methodology used, geographic availability and program limitation, please visit myuhc.com. 6

9 Accessing your health benefit plan UnitedHealth Premium* offers you: Informed choice We help you make a more informed choice about your care by providing you with a list of doctors and facilities that follow national evidence-based quality of care guidelines and market-based cost-efficiency guidelines. Peace of mind You can rest easy knowing you re receiving care from doctors and facilities that demonstrate they follow practices that meet national industry and evidence-based standards, as well as criteria set by national medical specialty societies. Resources at your fingertips It s easy for you to get information, online or over the telephone, so you can spend time focusing on other important care decisions. Find a leading doctor Visit your member Web site, myuhc.com, to search the directory, and look for these symbols next to your results: MM UnitedHealth Premium quality and cost efficiency physician Easy access These doctors are part of UnitedHealthcare s network, so you can easily identify and access them without a referral. For our members with special medical concerns, we also provide information from the National Committee for Quality Assurance (NCQA) Doctor Recognition Program. The program highlights performance and practice for doctors in three important areas: diabetes care, cardiac care and stroke care. Plus, the NCQA Doctor Practice Connection recognizes doctors who use up-todate information and systems to enhance patient care. NCQA is an independent, nonprofit organization that has developed these programs in association with the American Diabetes Association, American Heart Association and American Stroke Association. M UnitedHealth Premium quality physician NCQA/ADA Diabetes Physician Recognition Program (DPRP) NCQA/AHA/ASA Heart/ Stroke Recognition Program (HSRP) NCQA Physician Practice Connection (PPC) * UnitedHealth Premium is not available in all geographic locations. For a complete description of the UnitedHealth Premium designation program, including details on the methodology used, geographic availability and program limitation, please visit myuhc.com. 7

10 Accessing your health benefit plan When you need care, you may follow these steps: 1 Choose any doctor or other health care professional in our network. No referral needed. Remember, our network is big, but it doesn t include every doctor. Before you visit a doctor, check to make sure he or she is in our network and evaluated by the UnitedHealth Premium program. You can find the most up-to-date information about participating primary and specialty doctors and hospitals in the directory at myuhc.com. Also, before your doctor s visit, find out what percentage of the care is covered, and, if necessary, make sure you re prepared to pay for any expenses that aren t covered. For example, health plans often vary in their coverage of brand-name drugs, emergency care and different aspects of surgery. If you aren t sure, check your Certificate of Coverage. You may be paying more out-of-pocket in addition to a high deductible or copayment. 2 Pay a copayment (if applicable) at the time of your visit for an illness or injury. It s important to know that a copayment normally isn t needed when you see your doctor for preventive care, such as an annual physical, screenings or immunizations. 3Your network doctor will take care of filing any UnitedHealthcare claim forms for you. You may receive a bill in the mail for any amount not covered by your benefit plan. If your share of costs reaches the out-of-pocket maximum for the year, we will begin paying for 100 percent of the eligible charges for care you get from network doctors.* If more than one health insurance plan covers your medical services, we work together with the other plan. This is called coordination of benefits. For more information, log on to myuhc.com or call the toll-free, member phone number on the back of your ID card. * Check your Certificate of Coverage documents for any copayments that may not apply to the out-of-pocket maximum. 8

11 Accessing your health benefit plan What laboratory should you use? UnitedHealthcare continually evaluates its laboratory network to ensure the best combination of quality, affordability, access and convenience. We encourage you to take an active role in your health care and learn which laboratories participate in our network, so you can minimize expenses that may come with using out-of-network providers. Non-participating laboratories may be significantly more expensive than network laboratories. Please ask your doctor to verify that a participating laboratory will be used for your laboratory work. The chart below illustrates the average unit costs for some of the most common laboratory tests and is not meant to represent all laboratory test costs or tests that a laboratory may provide. Laboratory Test Description Average Unit Cost Non-Participating Laboratory Average Unit Cost Participating Laboratory Cholesterol $36.69 $11.23 Strep Throat $30.24 $7.84 CBC $18.68 $6.54 Hemoglobin A1C (Diabetes) $27.98 $8.50 Pap Smear $47.39 $19.14 Bacterial Culture $23.04 $6.90 PSA $49.22 $15.57 For a current listing of network laboratories in your area, please go to myuhc.com or call the toll-free, member phone number on the back of your ID card. This wallet card is a great way to remember what to bring and ask your doctor, pharmacist or other provider during an appointment. Simply cut along the dotted lines and fold on the solid line to create your wallet card. Keep it with your member ID card. You can also share it with your doctor or other medical provider. See back for details. 9 cut here For eligibility and benefit verification, please call the toll-free member number on the back of your ID card. 8 a.m. to 8 p.m. Monday through Friday

12 Accessing your health benefit plan Help yourself to service, whenever you want it From time to time, you ll receive letters or postcards about changes in your provider network or covered services. Take the time to read these notices. Also, make sure you let your employer know of any updates on your end, such as a new address or new phone number. Get easy access to details about your benefits, doctors, eligibility, hospital quality and more by visiting myuhc.com. On myuhc.com, you can: Find a doctor, specialist or other health care professional who s right for you, plus urgent care and hospital locations. View detailed information about your coverage, including any applicable copayments and deductibles. Print a temporary ID card or order a replacement. Estimate your medical expenses with our health care cost calculator. View your claim history and payments. Read hospital performance reviews. Take advantage of wellness tools and information. Learn more about your pharmacy benefit and costs associated with your prescription medications.* Locate a pharmacy close to your work or home. Tips to make your doctor s visit worthwhile 1 Prior to visiting with the doctor, ask the nurse routine questions you may have. 2 Mention all medications you are taking. Make a list if needed. When you register at myuhc.com, you can find resources, discounts, programs and services that can help you get even more out of your plan. Best of all, these programs are available to you as part of your benefit plan. 3 Mention if a family member has recently been diagnosed with a serious disease or condition. 4 If you travel outside of the country, be sure to let your doctor know. 5 Bring along a family member or friend if you have a hard time remembering what the doctor tells you. 6 Ask your doctor at every visit to send any laboratory tests to an in-network facility. 7 Before you leave, make sure you can read or understand your doctor s or pharmacist s instructions. If you don t, it s okay to ask them to explain until you do understand. * You must have UnitedHealthcare pharmacy benefits to see pharmacy information on myuhc.com. 10

13 Accessing your health benefit plan Know where to go when you don t feel well Your benefit plan is an important part of your daily life, even if you don t need services every day. It protects you and helps you better manage your health. Right now is the perfect time to find out all you can about your coverage before you need it, especially how it works and where to go for care. You also should know that we make sure medical technology is safe for you including new tests and treatments, as well as what s currently available. We continually review scientific evidence about the safety of care. Always carry your health plan ID card. Your ID card has key information about you and your coverage. Put your card in your wallet or your pocketbook so you won t forget it. When you re at doctors offices, drugstores and hospitals, show it to make sure you receive quick service and that you re not billed unnecessarily. Make the time to take care of yourself. When you see a network doctor for preventive care services, you usually don t need to pay a copayment. This includes routine checkups, screenings, immunizations and prenatal care. See your Certificate of Coverage for details. When calling the member number on the back of your ID card, you ll need these numbers. Health plan ID card Call the number located here on your ID card to reach a customer care professional. Printed 10/20/08 Health Plan (80840) Member ID: Member: Dependents: SUBSCRIBER I BROWN SPOUSE I BROWN CHILD A BROWN CHILD B BROWN CHILD C BROWN Group Number: SPONSOR OR COMPANY NAME SECOND LINE OF SPONSOR NAME Payor ID Rx Bin: Rx Grp: UHEALTH Copay: Office / Spec / ER / URG $### / $###/ $###/ $#### UnitedHealthcare Choice DOI Underwritten by UnitedHealthcare Insurance Company Standard Family Card - F05 What you pay at a medical visit. This card does not guarantee coverage. To verify benefits, view claims, find a provider, provide notification or seek preauthorization, visit the website or call For Members: (XXX) XXX-XXXX For Providers: (XXX) XXX-XXXX Medical Claim Address: P.O. Box ######, City, ST #####-#### Pharmacy Claims: PBM Address City, ST #####-#### For Pharmacist: (XXX) XXX-XXXX Members: (XXX) XXX-XXXX Standard Back - B01 You can find claim status online. 11

14 Better health services Health Statement A health statement will be mailed to you each month you use your benefit plan. You can see all claims processed for that period, plus remaining balances for your in-network and out-of-network balance information and deductibles. If there are no claims in a month, no statement will be mailed. You ll have one easy-to-read record of your claims for a more complete view of your health care expenses. And less paperwork means fewer headaches for you and less impact on the environment. If you d like to go paperless and just receive health statements online, go to myuhc.com and select Account Settings, then Mailing Preferences. You can view your past health statements, individual Explanation of Benefits or current claims activity at any time of the day or night by logging on to myuhc.com. SPRINGFIELD SERVICE CENTER P O BOX SALT LAKE CITY, UT Address change? Please contact your employer s benefit department. UNITED HEALTHCARE INSURANCE COMPANY Subscriber Number Statement Period 07/01/07-07/26/07 JOLENE PETTERSON 8332 CEDAR LANE ANYTOWN, USA Your recent health benefit plan activity Statement Period 07/01/07-07/26/07 Date of Service: 07/12/07 Member: JOLENE Provider: JOHN STORK, MD Claim Number: Type of Service: MEDICAL Date of Service: 07/20/07 Member: JOLENE Provider: JOHN STORK, MD Claim Number: Type of Service: MEDICAL Date of Service: 07/15/07 Member: AMY Provider: DARCY CHILDRESS Claim Number: Type of Service: MEDICAL Date of Service: 07/21/07 Member: AMY Provider: Suppressed for Member s Privacy Claim Number: Type of Service: PHARMACY This is not a bill. Stop the flu before it stops you! Now, before flu season begins, is the time to protect yourself. According to the Centers for Disease Control and Prevention, the best way to protect against the flu is to get vaccinated. Under some health plans, flu vaccine is considered preventative care and might be provided at no cost. The vaccine is available through your doctor, and may also be available at some quick service clinics. Call your doctor today to schedule an appointment. Customer Care Your provider will bill you for the following health care services: Pay your provider when they bill you $92.00 $44.00 $ $20.00 TOTAL $ Please see the next page for more information Page 1 of 7 This is not a bill. Your provider will bill you directly unless you have already paid them. Please check your records. These charges represent your responsibility as defined by your health benefit plan. They may include your deductible, coinsurance, or a product or service that is not an eligible expense. Please see your coverage documents for more information. 12

15 Better health services A pharmacy benefit that gives you a lot of choices We believe that more options creates more choices for you. Whether you re at home or traveling, you will have the convenience of a participating pharmacy nearby. Or, you can always save some money with your ongoing medications and have them delivered straight to your mailbox with our mail-order pharmacy program. Log on to myuhc.com or call the toll-free, member phone number on the back of your ID card to see if you re eligible. Log on to myuhc.com and learn more about your pharmacy benefit. } Medication pricing } Benefit and coverage information } Copayment amounts } Lower-cost medication alternatives } Participating retail pharmacies } Mail-order refills } Prescription history *Check your Certificate of Coverage to see whether UnitedHealthcare pharmacy benefits are available to you. 13

16 Better health services Primary care, urgent care or emergency care: how to tell the difference Consider going to an urgent care center for: } Sprains } Strains } Minor broken bones } Mild asthma attacks } Minor infections } Small cuts } Sore throats } Rashes Consider going to the emergency room for: } Heavy bleeding } Large open wounds } Sudden change in vision } Chest pain } Sudden weakness or trouble talking } Major burns } Spinal injuries } Severe head injuries } Difficulty breathing OK, it s not an emergency or even urgent In this case, it s best to go to your own doctor s office for medical care. Your doctor knows you and your health history, and has access to your medical records. You also pay the least amount when you receive care in a doctor s office. I can t wait for my regular doctor Sometimes, you need medical care fast. But a trip to the emergency room may not be necessary. A great alternative is an urgent care center, where you can get treated for many minor problems faster than at an emergency room. Even better, you probably will pay a lot less, too. Head to the emergency room When you or a loved one is hurt, your first instinct may be the emergency room. But this may not be the best choice. True emergencies are treated first, which may leave you hanging out in the waiting room for hours. You also may have to pay a lot more for emergency care than if you were to go to urgent care instead. A true emergency medical condition is when symptoms are severe enough that you could reasonably expect serious jeopardy to your health. In an emergency, no matter if you re at home or out of town, call 911 or go to the nearest emergency room. If you end up going to the emergency room, after you re back at home, it s a good idea to call your doctor within two days so he or she can provide any follow-up care you may need. 14

17 Better health services Need help making smart health care decisions? Let Care24 services point you in the right direction. Call Care24 services and speak with a registered nurse to: } Find resources to better manage an illness or injury. } Recognize urgent and emergency symptoms. } Locate doctors and hospitals in your area that meet criteria for quality and efficiency of care. } Understand medication interactions and how to reduce your prescription costs. } Connect with resources for pregnancy, cancer, diabetes, asthma, heart disease and more. Treatment Decision Support connects you with a specially trained registered nurse to get more information about a diagnosis, learn what questions to ask your doctor and understand your treatment options. Appointment Scheduling can help save you time and hassle by arranging doctor appointments for you and assisting with coordinating your medical records. Emotional support also is available from master s-level specialists when you need help dealing with life s challenges. Get help with stress, anxiety, depression, grief, marriage difficulties and much more. Best of all, Care24 services are included as part of your benefit plan. Call the number on your member ID card any time 24 hours a day, every day. 15

18 Better health services When you re in the hospital If you need hospital care, UnitedHealthcare s Care Coordination SM can help you with a successful recovery. We work with your doctor to see that your treatment plan is carried out effectively. And for certain chronic conditions, we call you with important care information, reinforce discharge instructions and support your journey from hospital to home. How to find mental health and substance abuse services* By 2020, it s estimated that disability from mental illness will increase by 50 percent globally. Of the U.S. population, 23 percent experience a mental disorder in any given year but less than half of these people seek treatment.** Your benefits include confidential support on a wide range of personal issues from everyday challenges to more serious problems. The national network includes more than 57,000 licensed and certified professionals, including counselors, psychologists, psychiatrists and social workers. You also have access to for information on conditions, self-help programs and work/life balance. * Each health plan offers different benefit levels for substance abuse services. The network of practitioners available to you depends on your location and benefit plan. To determine your coverage, refer to your Certificate of Coverage. For you to qualify for maximum reimbursement, some benefit plans require you to call for prior authorization on some or all mental health and substance abuse services. Pre-authorization means calling (at the Member number listed on your ID card) before you receive services. You should always contact us before seeking inpatient care. ** 2 Kaiser Family Foundation, Women s Health Survey, July 2005; 3 APA national poll, 2005;4 16

19 Better health services Specialized programs when you need it most Specialized programs and nurse consulting is available to help you and your family deal with certain conditions such as: } Cancer } Chronic kidney disease } Obesity } Transplants } Women s health Congenital heart disease Infertility Neonatal care Pregnancy Through our Centers of Excellence network programs, you have access to leading health care facilities and nurse consultants who can give you the information you need to make informed decisions. Get help deciding where to get care, coordinating care with your treatment team, scheduling appointments and finding support programs. Depending on the benefit plan provided to you by your employer, program offerings will vary.* Call the toll-free, member phone number on the back of your ID card to access these UnitedHealthcare programs and services: } Care Coordination SM } Behavioral Health Services } Centers of Excellence * Check your Certificate of Coverage documents to verify your coverage levels. 17

20 Create your health Five ways to invest in yourself Whether you want to eat right, exercise more, stop smoking or just relax, you have a wide range of resources to help you stay healthy. Even better, these are already included in your benefit plan. These are fun tools to get you motivated to make changes in your health and wellness. Get started today by visiting myuhc.com. Health assessment and personalized report Complete an online questionnaire to help assess your overall state of health. You ll then receive immediate and confidential results from an online personalized report, plus suggestions to help you improve your health. Health improvement tools and programs Choose from many online, personal Take Action guides to help you develop skills to improve your health and well-being. Plus, you can enroll in an online, six-week Healthy Living Program. These programs focus on helping you make lifestyle changes. Online personal health record Makes it easy to organize and store all the information about your health conditions, medication, medical procedures and laboratory results in one place. Discounts Save five to 60 percent on thousands of wellness products and services, including certain health care services not covered by your benefit plan. These include alternative medicine, cosmetic dentistry, laser eye vision correction, hearing services, long-term care services and more. Wellness tools and educational resources Find information on a wide range of health and wellness topics, plus quizzes, calculators and charts. Topics include: addiction, family, fitness and nutrition, healthy aging, pregnancy, preventive medicine, relationships and more. Before you have an appointment, research your health issues, jot down your questions and concerns and bring them with you to your appointment. At the appointment, write down your doctor s answers and instructions. Be sure to take advantage of routine checkups and preventive screenings. 18

21 Create your health Wellness e-news the way you want it Our Healthy Mind, Healthy Body e-newsletter allows you to choose the wellness information that best fits your daily life. We also feature members like you who have improved their health through lifestyle changes and with care provided through our network. Each month we ll send you an with the newsletter. Information contained in the newsletters have been found helpful by 90 percent of members surveyed. Another survey found that 60 percent of the members said they made more informed decisions by using myuhc.com. Sign up today by visiting Baby on the way? The Healthy Pregnancy program helps expectant mothers find help through all pregnancy stages. To enroll, call between 8 a.m. and 11 p.m. Central Time, Monday through Friday, or visit for more information. It s best to enroll within the first 12 weeks of your pregnancy, but you can enroll through week 33 of your pregnancy. The program is provided to you at no extra charge. Lead a healthy lifestyle, which can help you reduce your chance of developing the types of serious health problems that are expensive to deal with even when you do have health care insurance. Eating a healthy diet, maintaining a healthy weight, exercising regularly, getting enough sleep, and avoiding smoking and excessive alcohol intake can all help to improve your health. 19

22 Create your health What does that word mean? Certificate of Coverage: The most complete description of what is covered and not covered by your benefit plan. Your Certificate of Coverage explains your level of benefits, share of costs and other important information. Copays: Fixed-dollar payments that you must pay directly to your doctor at the time services are received. For example, the contract for a certain network of doctors may require that patients pay a $10 copay. Coinsurance: A percentage you are required to pay out-of-pocket (the remaining percentage of eligible expenses are paid by the medical plan). Deductible: The amount you are required to pay before we begin paying benefits. For example, if you have bills amounting to $400 and your benefit plan coverage has a $100 deductible amount, you re responsible for paying the first $100 and your benefit plan will begin paying after that, subject to any applicable copayments or coinsurance. Health statement: A statement shows all claims processed in a month for all covered members, plus remaining balances for deductibles and out-ofpocket expenses. If there are no claims, you will not receive a health statement for that month. Medical claim form: A form you will need to fill out if you receive care from a doctor who does not participate in our network. Our network doctors normally take care of claim forms for you. Network: All doctors, specialists, hospitals, pharmacies and other health care professionals who agree to provide medical care to our members, under the terms of a contract. Out-of-pocket maximum: A dollar limit on the portion of covered medical expense that you must pay during a benefit period (usually a calendar year). When the out-of-pocket maximum is met, you will not have to pay further deductibles, copayments or coinsurance for that year. Prescription claim form: A form you will need to fill out if you fill a prescription with a pharmacy that does not participate in our network. Our network pharmacies normally take care of claim forms for you. Technology terms A system for sending and receiving messages electronically over computer networks and personal computers. Web site: A set of Web pages that are maintained as a collection of information by a person, group or organization. Online: When you are connected to the Internet or computer network. 20

23 Your responsibilities as a UnitedHealthcare member Know and confirm your benefits before receiving treatment. Contact an appropriate health care professional when you have a medical need or concern. Access myuhc.com or call Customer Care before receiving services to verify that your doctor or health care professional participates in the UnitedHealthcare network. Show your ID card before receiving health care services. Pay any necessary copayment at the time you receive treatment. Participate in understanding your health problems and developing mutually agreed-upon treatment goals. Use emergency room services only for injuries and illnesses that, in the judgment of a reasonable person, require immediate treatment to avoid jeopardy to life or health. Keep scheduled appointments. Provide information needed for your care. Follow the agreed-upon instructions and guidelines of doctors and health care professionals. Visit myuhc.com or call Customer Care when you have a question about your eligibility, benefits, claims and more. Notify your employer of any changes in your address or family status. The UnitedHealthcare Bill of Rights You have the right to be treated with respect and dignity by UnitedHealthcare personnel, network doctors and health care professionals. You have the right to privacy and confidentiality for treatments, tests and procedures you receive.* You have the right to voice your concerns about the service and care you receive. You have the right to register complaints and appeals concerning your health plan and the care provided to you. You have the right to receive timely responses to your concerns. You have the right to candidly discuss with your doctor the appropriate and medically necessary treatment options for your conditions, regardless of cost or benefit coverage. You have the right to participate in decisions about your care with your doctor and other health care professionals. You have the right to receive information about UnitedHealthcare, our services, network doctors and health care professionals. You have the right to access to doctors, health care professionals and other health care facilities. You have the right to be informed about, and refuse to participate in, any experimental treatment. You have the right to have coverage decisions and claims processed according to regulatory standards, when applicable. You have the right to choose an Advance Directive to designate the kind of care you wish to receive should you become unable to express your wishes. * See Notice of Privacy Practices in your Certificate of Coverage for description of how UnitedHealthcare protects your personal health information. 21

24 Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by UnitedHealthcare Insurance Company, United HealthCare Services, Inc. or their affiliates. Health Plan coverage provided by or through a UnitedHealthcare company. The medical centers and programs in UnitedHealthcare s network and within OptumHealth SM Care Solutions are independent contractors who render care and treatment to UnitedHealthcare members. UnitedHealthcare does not provide health services or practice medicine. The medical centers and programs are solely responsible for medical judgments and related treatments. UnitedHealthcare is not liable for any act or omission, including negligence, committed by any independent contracted health care professional, medical center or program. The Care24 program integrates elements of traditional employee assistance and work-like programs with health information lines for a comprehensive set of resources. Program components may not be available in all states or for all groups. Care24 is a registered trademark of UnitedHealth Group, Inc., used by permission. Due to the potential for a conflict of interest, legal consultation will not be provided on issues that may involve legal action against OptumHealth or its affiliates, including UnitedHealthcare, or any entity through which the caller is receiving OptumHealth services directly or indirectly. Care24 may not be available in all states or for all group sizes. Components subject to change. The Healthy Pregnancy Program follows national practice standards from the Institute for Clinical Systems Improvement. The Healthy Pregnancy Program can not diagnose problems or recommend specific treatment. The information provided is not a substitute for your doctor s care. The UnitedHealth Premium designation program is intended as a resource for informational purposes only. Designations are displayed in UnitedHealthcare online physician directories at myuhc.com. You should always consult myuhc.com for the most current information. Premium designations are a guide to choosing a physician and may be used as one of many factors you consider when choosing the physicians from whom you receive care. If you already have a physician, you may also wish to confer with him or her for advice on selecting other physicians. Physician evaluations have a risk of error and should not be the sole basis for selecting a physician. Please see myuhc.com for detailed program information and methodologies. Only individual physicians and facilities that meet UnitedHealth Premium designation criteria, or physicians in designated specialties who are part of medical groups that meet UnitedHealth Premium criteria for group practices and who have sufficient claims data for analysis, may be designated. All physicians and facilities that contract with UnitedHealthcare have met credentialing requirements. Regardless of designation, plan enrollees have access to all physicians and facilities in the UnitedHealthcare network. Specialties for which there are no quality guidelines currently established in the program are excluded from evaluation and are noted as such. The UnitedHealth Allies health discount program is administered by HealthAllies, Inc., a discount medical plan organization located at 505 N. Brand Blvd., Suite 850, Glendale, CA, 91203, The health discount program is NOT insurance. The health discount program provides discounts for certain health products and services. The health discount program does not make payments directly to the providers of health products and services. The program member is obligated to pay for all health products and services but will receive a discount from those providers who have contracted with the discount plan organization. The health discount program is offered to existing members of certain products underwritten or provided by UnitedHealthcare Insurance Company or its affiliates to provide specific discounts and to encourage participation in wellness programs. Health care professional availability for certain services may be dependent on licensure, scope of practice restrictions or other requirements in the state. UnitedHealthcare does not endorse or guarantee health products/services available through the discount program. This program may not be available in all states or for all groups. Components subject to change. Insurance coverage provided by or through PacifiCare Life and Health Insurance Company, PacifiCare Life Assurance Company or their affiliates. Administrative services provided by PacifiCare Health Plan Administrators, Inc., UnitedHealthcare Insurance Company, United HealthCare Services, Inc., ACN Group, or United Resource Networks. Behavioral health products are provided by PacifiCare Behavioral Health, Inc. (PBHI) or United Behavioral Health (UBH) /09 Member (FI) 2009 United HealthCare Services, Inc.