Introducing UnitedHealthcare North Shore-LIJ Advantage When doctors connect, everyone benefits

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1 Introducing UnitedHealthcare North Shore-LIJ Advantage When doctors connect, everyone benefits For New York fully insured employers with 2-50 enrolled employees (Queens, Nassau, Suffolk counties)

2 UnitedHealthcare North Shore-LIJ Advantage the right choice for businesses like yours. Insurance coverage provided by or through UnitedHealthcare Insurance Company of New York United HealthCare Services, Inc.

3 A New Alliance At UnitedHealthcare, we understand how important it is to provide members with access to quality health care that s close to home. That s why we ve collaborated with the North Shore-LIJ Health System so we may offer a new product for New York fully insured employer groups with 2-50 enrolled employees in Nassau, Suffolk and Queens counties. UnitedHealthcare North Shore-LIJ Advantage encourages members to become more engaged in the health care process. This product offers tiered network benefits with different cost shares depending on the network chosen. The Tier 1 network comprises select North Shore-LIJ physicians and facilities and other health care professionals in Nassau, Suffolk and Queens counties, and offers members access to coordinated care with the lowest out-of-pocket expenses. The second network option, Tier 2, is available for members who prefer to visit physicians and facilities within our larger UnitedHealthcare national Choice Plus Network. This network provides members with more choice but at a higher out-of-pocket cost. TIER 1: Members can experience lower out-ofpocket costs when receiving care from the Tier 1 network 1 of more than 3,000 North Shore-LIJ physicians and other health care professionals in Nassau, Suffolk and Queens counties. This network also includes 13 North Shore-LIJ hospitals across the New York metropolitan area. Members receive assistance in care coordination and with obtaining authorizations by selecting a Tier 1 primary care physician (PCP) to guide them through their health care process. There are 1,000 PCPs in Tier 1. TIER 2: Members have the ability to access the UnitedHealthcare Choice Plus Network of 704,966 physicians and other health care professionals and 5,580 hospitals nationwide 2 at a higher out-of-pocket cost through our Tier 2 network. In New York alone, this provides access to more than 56,000 physicians and over 200 hospitals. 3 We know how important flexibility is when selecting a physician, which is why we are providing members with access to this larger network tier. These benefit plan designs, the first of their kind in the New York metropolitan area, are a way for health care insurers, medical care providers and companies like yours to work together to promote healthier communities where our members live and work. Note: Non-network coverage is not available. 2

4 Product Overview UnitedHealthcare North Shore-LIJ Advantage Tiered Network Benefits Non-network Benefits Pharmacy Benefits Health Savings Account a Not applicable a Optional UnitedHealthcare North Shore-LIJ Advantage plans come in three designs with tiered benefit choices that members to minimize their out-of-pocket expenses while maximizing their benefits. There is no coverage for non-network care, except for in an emergency. Highlights include: North Shore-LIJ physicians and other health care professionals in Nassau, Suffolk and Queens counties specifically chosen to participate in the Tier 1 network Coordination of member s care, including assistance obtaining authorizations and guidance to specialty care, through Tier 1 PCPs Local and national access to other physicians, facilities and health care professionals through the Tier 2 network No referral required No charge for wellness visits under the preventive care benefit Ability to earn a credit of $20 per month up to $240 per member per year 4 through the fitness reimbursement program Easy-to-understand health information, wellness tools and trackers available to members through myuhc.com Here s how it works. See the benefit plan design highlights charts on the next page for more details. Optimal Path for Maximizing Benefits (selecting a Tier 1 PCP) Member selects Tier 1 PCP for enhanced care coordination Member receives a more holistic approach to care Member experiences lower out-of-pocket costs Paths with More Flexibility Member selects any Tier 1 or Tier 2 physician from provider network Member receives care from a local or national network physician Member experiences lower out-of-pocket costs when receiving care from a Tier 1 physician Adding a Health Savings Account * UnitedHealthcare North Shore-LIJ Advantage also offers plan designs that are qualified to be paired with a Health Savings Account (HSA). This is a bank account funded by employees with pre-tax dollars (employers can also contribute to this account). Unused HSA funds belong to the employee, and will carry over year after year. Members may use their HSA funds to pay for their qualified medical expenses or they can use other personal funds to pay provider(s) until reaching their deductible. *Plans may not be paired with a Health Reimbursement Account (HRA). 3

5 Product Overview These charts provide plan design highlights only. The deductible and maximum out-of-pocket costs shown below represent the cost shares for a single person. The family multiplier for these cost shares is two times (2x) the amount shown. You may contact your UnitedHealthcare sales representative for more details on plan designs. UnitedHealthcare North Shore-LIJ Advantage plan design highlights Plan 1 PCP Specialist Urgent Care Inpatient Services $30 Tier 1 $60 Tier 2 Emergency Room $50 Tier 1 $100 Tier 2 $50 Tier 1 $100 Tier 2 $500/day, 2 day max/admit Tier 1 $1,000/day, 5 day max/admit Tier 2 Outpatient Services $150 Tier 1 $450 Tier 2 Deductible Coinsurance Maximum Out-of-Pocket Pharmacy Coverage $200 $250 Tier 1 $500 Tier 2 10% Tier 1 30% Tier 2 $1,000 Tier 1 $2,000 Tier 2 $10/$35/$60 $100 deductible Deductible does not apply to services with a copayment. UnitedHealthcare North Shore-LIJ Advantage with an HSA plan design highlights Plan Deductible PCP Specialist Urgent Care Inpatient Services $1,500 $15 Tier 1 $30 Tier 2 $30 Tier 1 $60 Tier 2 $75 Tier 1 $125 Tier 2 Deductible then 15% Tier 1 Deductible then 40% Tier 2 2 Outpatient Services Deductible then 15% Tier 1 Deductible then 40% Tier 2 Emergency Room $300 15% Tier 1 40% Tier 2 Coinsurance Maximum Out-of-Pocket Pharmacy Coverage $4,000 $10/$35/$60 UnitedHealthcare North Shore-LIJ Advantage with an HSA plan design highlights Plan Deductible PCP Specialist Urgent Care Inpatient Services $2,000 $20 Tier 1 $50 Tier 2 $40 Tier 1 $100 Tier 2 $100 Tier 1 $150 Tier 2 Deductible then 20% Tier 1 Deductible then 50% Tier 2 3 Outpatient Services Deductible then 20% Tier 1 Deductible then 50% Tier 2 Emergency Room $400 20% Tier 1 50% Tier 2 Coinsurance Maximum Out-of-Pocket Pharmacy Coverage $6,000 $10/$35/$60 4

6 Navigating Your Network Options Finding a Physician Members have access to the Tier 1 network of select North Shore-LIJ network physicians and other health care professionals in Nassau, Suffolk or Queens counties. The Tier 1 network is a subset of the UnitedHealthcare national Choice Plus Network. Members can locate a Tier 1 physician by visiting our dedicated website at Members may also seek care from a physician in the Tier 2 network of UnitedHealthcare Choice Plus physicians and other health care professionals. To search for Tier 2 physicians, members can visit myuhc.com, select Choice Plus Network from the pull down menu and search by the appropriate criteria. ** Members without Internet access can contact their dedicated Customer Care team to request a copy of the printed provider directory as well as to confirm whether a provider participates in our network and in which tier. When searching for a specialty care provider we encourage members to consult their PCP. Members who select a PCP from our Tier 1 network will receive assistance in the coordination of their medical care, including locating other Tier 1 providers and obtaining authorizations. 5

7 Navigating Your Network Options Finding a Facility Members enrolled in UnitedHealthcare North Shore-LIJ Advantage plans have access to our network facilities across the United States. The Tier 1 network comprises North Shore-LIJ hospitals and other facilities, including Urgent and Immediate Care centers, Imaging centers, Ambulatory Surgery centers, laboratories, sports therapy, behavioral health facilities and rehabilitation centers. A Tier 1 PCP can guide members to the most appropriate facility based on the member s particular medical condition. Please refer to the map below, which highlights Tier 1 North Shore-LIJ hospitals. Indicates counties where UnitedHealthcare North Shore-LIJ Advantage is available. Members who are interested in obtaining information about facilities included in UnitedHealthcare s Tier 2 national network should visit myuhc.com, select Choice Plus Network from the pull down menu and search by the appropriate criteria. ** ** The UnitedHealthcare Choice Plus network includes all Tier 1 and Tier 2 providers. Please remember to confirm Tier 1 status using the Tier 1 directory. 6

8 Our Commitment to Care Management Seeing the Whole Picture Means Treating the Whole Patient Our disease and care management programs focus on the whole person, not just the condition, and are tailored to the member s needs. Many of these programs are enhanced by the care and coordination our Tier 1 physicians provide. By working together to provide hands-on case management and by educating members on how to manage their condition, we can minimize the physical and financial impact of chronic conditions that require complex medical treatment. Care Management and Wellness Programs Chronic Case Management Identifies high-risk individuals with chronic conditions and applies personalized case management services to help improve their quality of care. High Risk Management Advanced analytics and predictive modeling identify at-risk members and educate them about their condition. Specialized networks for complex medical conditions Leading health care facilities and services are available to support safe, cost-effective care for complex, unusual or rare medical conditions. NurseLine sm Offers toll-free 24-hour access to registered nurses who can assist with health related concerns. Healthy Pregnancy program Every expectant mother is automatically enrolled and provided with educational resources about pregnancy, childbirth and child rearing. Reminder mailings Remind members to get recommended preventive screenings. myuhc.com A personalized online gateway with easy-to-understand health information, tools and trackers. At myuhc.com members can find the following: Online health assessment: helps members understand their lifestyle and health risks while showing preventive changes that may improve their health and reduce their risks. Online health improvement programs and coaching: helps members reduce stress, stop smoking, eat healthier and develop an exercise regime, as well as understand and reduce the impact of diabetes and heart-related conditions on their lifestyle. Personal health record: allows members to securely record their medical history. Online nurse chat: members can chat in real time with a nurse about a variety of general health topics. 7

9 Wellness Resources Promoting Employee Wellness When members learn how to make good decisions for their health everyone wins. Members may stay healthier and employers may see increased productivity and less absenteeism. Our integrated wellness offering provides programs and services to help members achieve their health and wellness goals. What the program 5 offers: At-Home Biometric Screening Kit that members 6 can use to learn the numbers that may help them manage and improve their health, such as blood glucose and cholesterol levels. One-on-one telephonic wellness coaching from a personal health coach to address certain health conditions. 7 Earn a credit of $20 per month up to $240 per member per year 4 through the fitness reimbursement program by accessing the participating fitness center of their choice from one of our contracted network fitness centers, at least 12 times per month. A health discount program (administered by UnitedHealth Allies ) that can help make a healthy lifestyle more affordable with discounts on fitness, nutrition, acupuncture, chiropractic care and more. 8 More information on these wellness offerings, including promotional tools for employers, is available at uhctogether.com/uhcwellness. 8

10 Online Tools Information When and How You Want It At UnitedHealthcare, we re constantly developing innovative ways for people to get faster access to the health information they need. We ve created many different websites, online tools and mobile applications designed to provide our employers and members with the information they need. Employer Sites Member Sites Mobile Apps Employer eservices ( Gives employers immediate and secure self-service access to health benefits information such as eligibility maintenance, customer reporting and billing solutions. Communication Resource Center (uhc.com/crc): Resources, programs and services to help promote wellness to employees, including an easy-to-build newsletter. UnitedHealthcare Pharmacy (uhc.com/pharmacy.htm): Information and tools regarding our pharmacy benefits and services. Preventive care resources (uhcpreventivecare.com): Preventive care toolkits that provide up-to-date guidelines on preventive screenings specific to age and gender. myuhc.com: Provides secure information about the member s account and health topics. Healthy Mind Healthy Body Newsletter (uhc.com/myhealthnews.com): Personalized health e-newsletter that provides wellness information tailored to our members. Source4women.com: Designed to help women make informed health care decisions, manage their family s health care spending and keep themselves and their families as healthy as possible. uhc.tv: An online television network that presents educational and entertaining video programs about good health and living well. Healthcarelane.com: A virtual community that makes learning about health care easy and fun. Dozens of topics, including health insurance basics, tips on saving money and ways to get healthy are covered. UnitedHealthcare Health4Me TM : Provides instant access to critical health information. Users can find a physician, check claims status or speak directly with a health care professional by using a smartphone. (Available for iphone and Android TM devices.) DocGPS : Combines a search function with GPS mapping to help users find local care. (Available for iphone, certain Blackberry devices and Android devices powered by operating system v1.5 and later.) OptumizeMe : An interactive, motivational app that allows users to create health challenges or join existing ones. This app can be integrated with existing social networks to create fitness challenges with friends and family. (Available for iphone and Android devices.) 9

11 Customer Care Whether you are calling with a simple question, to check the status of a claim or need more help understanding your benefits, we want to respond quickly and accurately. Rest assured, members enrolled in UnitedHealthcare North Shore-LIJ Advantage plan designs will have access to a dedicated Customer Care team that will help guide them through their network options and answer any other questions they may have. When members call, they will talk to someone who is trained to handle their concerns. The result is greater accountability and greater response times. All of our Service Associates undergo ongoing training. Members also have access to personalized information online at myuhc.com. Employers can get answers to their questions by contacting their broker or UnitedHealthcare sales representative. Contact UnitedHealthcare today to find out why the UnitedHealthcare North Shore-LIJ Advantage plan is the right choice for your business. 10

12 1 UnitedHealth Networks, October UnitedHealth Networks, September Count as of August Provider totals and hospital totals pulled from NDB UHN Reporting Database. Includes physicians (degree of MD, DO, DPM, or POD) and Allied Health individuals. Includes hospitals with organization types: General Acute Care, Osteopathic and Christian Science Hospitals. Counts are based on Unique MPIN by Primary Address State. 4 Fitness reimbursement available to eligible employees and spouses only who are actively enrolled on a UnitedHealthcare medical insurance plan. Fitness reimbursements may be taxable. Please consult your own tax advisor to determine the tax implications of receiving fitness reimbursements under the program. 5 This UnitedHealthcare wellness program is available to New York employers with 2-50 enrolled employees. 6 Available to covered employees and spouses only. 7 Available for covered employees only. 8 Disclosure: The UnitedHealth Allies health discount program is administered by HealthAllies, Inc., a discount medical plan organization located at P.O. Box 10340, Glendale, CA 91209, 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. Source4Women content and materials are for informational purposes only, are not intended to be used for diagnosing problems and/or recommending treatment options, and are not a substitute for your doctor s care. Lists of potential treatment options and/or symptoms may not be all inclusive. NurseLine sm is for informational purposes only. Nurses cannot diagnose problems or recommend specific treatment and are not a substitute for your doctor s care. NurseLine services are not an insurance program and may be discontinued at any time. The Healthy Pregnancy Program follows national practice standards from the Institute for Clinical Systems Improvement. The Healthy Pregnancy Program cannot diagnose problems or recommend specific treatment. The information provided is not a substitute for your doctor s care.. Insurance coverage provided by or through UnitedHealthcare Insurance Company of New York Small Group (2-50) Brochure 2012 United Healthcare Services, Inc UHCNY

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