Oxford Benefit Management (OBM) Member Benefi ts Guide

Transcription

1 Oxford Benefit Management (OBM) Member Benefi ts Guide 84269_M52327.indd 1

2 Table of contents Welcome to Oxford Benefi t Management (OBM) Accessing Info Understanding your OBM ID card Dental Vision Optional Life Employee Assistance Program (EAP) with WorkLife Services Health Discounts _M52327.indd Sec1:1

3 Welcome to Oxford Benefit Management Thank you for selecting this Oxford Benefit Management (OBM) plan. Our goal is to provide you with a well-balanced package of benefits that include dental coverage, vision coverage, employee assistance program (EAP) with WorkLife services and heath discounts. When you look through this Welcome Brochure, you ll see that this convenient benefits package provides you with a valuable combination of services that you can use to manage the health and well-being for you and your family. Accessing Info For more information about your benefits, try our Web site, It s the easiest way to find out about your benefits and locate participating providers. Then, select links in the center, or resources and links along the right side of the member page Or, if you have questions related to your OBM plan, you can contact OBM Member Services at (8:00 AM to 5:00 PM EST) for assistance with: Questions on claims and claims payments Understanding your benefits Locating a participating provider Ordering a duplicate member ID card Accessing EAP with WorkLife services representatives Questions about the health discounts Answering any other questions you have related to your OBM benefits Understanding your OBM ID Card Your personal Member ID card contains valuable information for utilizing your OBM benefits. On the front of the card, you will find your Member ID number. Refer to this number when you call Member Services and when you access Web site tools, such as those for the discount program. If you choose to visit an out-of-network dentist or eye care provider, you will find the claims mailing address on the back of your Member ID card. You can print the Claim form from the OBM Website and mail it to that address for processing. 1 Oxford Benefi t Management Employee Name Plan: OBM Premier Specialty Option Member ID: Member/Provider Service: tmanagement.com Not an Insurance Product It is the provider s responsibility to verify eligibility before providing treatment. Submit Dental claims to: Submit Vision claims to: UnitedHealthcare Dental UnitedHealthcare Vision Attention: Claims Department Attention: Claims Department PO Box PO Box Salt Lake City, UT Salt Lake City, UT Electronic Payer ID # Fax: By use of this card, I hereby consent to the release of any information needed by Oxford Benefi t Management, Inc. or third-party vendors. This plan is underwritten by UnitedHealthcare Insurance Company 84269_M52327.indd Sec2:1

4 Your dental benefits include: Fully insured dental coverage: Coverage for preventive and diagnostic procedures such as cleanings, X-rays and routine examinations Innovative preventive care programs with coverage for prenatal dental care for women in their second and third trimester, for additional preventive and periodontal services with no out-of-pocket costs, and coverage for oral cancer screening Access to large national network of more than 185,000 participating dentists and specialists Dental How to access your in-network dental benefi ts: 1. Select a provider from the UnitedHealthcare Dental network. Visit Then, go to the Helpful Links section on the right side of the Member page Click on Dental Service Locations to search for an in-network provider 2. Call to schedule an appointment, and be sure to verify the provider s participation in the UnitedHealthcare Dental network. 3. At the time of your appointment just show your OBM ID card. How to access your out-of-network dental benefi ts: 1. You can visit the dental provider of your choice. 2. You will be responsible for paying all costs at the time of service and filling out a dental claim form to be reimbursed. 3. To download a dental claim form: Then go to the Online Forms section on the right side of the Member page Click on the UnitedHealthcare Dental Claim Form to download and print a copy If you have any questions about your dental benefits or need help locating a participating provider, call OBM Member Services at , and follow the instructions for Dental Benefits. How to access dental benefi t and claims information: Once enrolled in our dental program, you can access information about your dental benefits any time, day or night, through our state-of-the-art Web site. For specific plan or claims information, simply go to the OBM Web site Member page. On the right side of the page you will see a Helpful Links section. Click on the link called My Dental Plan. The first time you visit My Dental Plan you will be asked to register as a member. You do this by using a unique ID number. This number is the last 5 digits of your member ID with 4 preceding zeros. For example, if your member ID is you would enter the subscriber ID of Once you have registered, you can log in and select the tools on the site that meet your needs _M52327.indd Sec2:2

5 Vision How to access your vision benefi ts 1. Select a provider from the UnitedHealthcare Vision network. Click on Vision Service Locations, on the right side of the Member page under Helpful Links to search for an in-network provider. You ll be able to search for a network provider by your ZIP code. Next to each provider listing you will find symbols that indicate whether the provider offers eye exams only, dispenses vision care products only, or does both. You can also print directions to the provider location. 2. Call to schedule an appointment and be sure to identify yourself as having UnitedHealthcare Vision coverage. Doing so will better assist the provider in verifying eligibility and obtaining authorization prior to your appointment. 3. At the time of your appointment: Just show your OBM Member ID card You are only responsible for your copayments and certain patient options such as tints and coatings or choosing non-selection frames There are no claim forms to submit and no referral forms are necessary for covered services when obtained from a participating provider If you have any questions about your vision benefits or need help locating a participating provider, call OBM Member Services at , and follow the instructions for Vision Benefits. Your Vision benefits include: Comprehensive annual eye exams Allowances toward frames and lenses, or contacts in lieu of eyeglasses National network of more than 34,000 private practice and retail chain providers conveniently located near work or home Discounts on many popular services Optional Life OBM offers an optional basic employee life insurance offering that includes a modest life insurance benefit amount. Your employer may or may not have included this option in your benefit plan. In addition, a beneficiary service, which offers greif consultation and financial/legal assistance services for beneficiaries, is automatically included in the Life benefit at no additional cost. If you have any questions about your Optional Life insurance benefits, call OBM member services at _M52327.indd Sec2:3

6 Employee Assistance Program (EAP) with WorkLife Services EAP with WorkLife services is a benefit that helps reduce stress involved with managing a wide variety of personal and family matters. And, because your needs change over time, not only are our consultations and referrals available but you can also have access to an abundance of online resources 24/7! Your EAP with WorkLife Services benefit includes: Child/Parenting Support Services Adult/Elder Support Services Chronic Condition Support Services In addition to the consultative and referral services, you also have 24/7 access to an abundance of online resources How to access your EAP with WorkLife service benefi ts: To reach a counselor and resources call or: Click on the EAP with WorkLife services link on the right side of the page and log on using the access code: Oxford If you have questions about your EAP with WorkLife services benefit or would like to speak with a counselor, call OBM Member Services at and follow instructions for EAP with WorkLife services _M52327.indd Sec2:4

7 Health Discounts Now you can take advantage of great discounts for services and products not paid for by your insurance. Through the OBM health discount program, powered by UnitedHealth Allies, you will enjoy savings of 5 to 50 percent on hundreds of health care products and services, such as: Lasik eye surgery Cosmetic dentistry Alternative care, including acupuncture, chiropractic and massage therapy Smoking cessation Weight management from Jenny Craig, NutriSystem and others Fitness clubs, including locations of many popular chains Infertility treatment You ll also get special member discounts on products from dozens of brand-name retailers in the online Marketplace. Save on fitness apparel, vitamins, exercise equipment, home medical supplies and many more family health and wellness needs. Using the discount program Keep in mind that the discount program is not insurance and you should always use your insurance for covered services. Instead, rely on the discount program to help you save on many health care products and services not paid for by insurance. How to find participating providers and use your health discounts benefits In the Service Locator section on the right of the member page, click on the Heatlh Discounts link. First-time users should follow the New Member/Create Account instructions, inputting the member ID number from your OBM ID card. Select a category (such as Alternative Care) and a specialty, such as Massage Therapy, to search for providers by ZIP code. Click Details to learn more about a participating provider. When you have selected the health care provider you would like to visit, click Select Provider to get a discount confirmation. The discount confirmation introduces you to the provider or facility and helps ensure yo get your discount. It also contains the provider s telephone number so you can call to make an appointment. If you choose to make an appointment with the provider, be sure to bring your discount confirmation and your OBM member ID card with you to your visit. At your appointment, pay the discounted rate directly to the provider. Remember, the discount program is not insurance and you are responsible for paying the discounted cost at the time of your visit. To purchase health- and wellness-related products from the online Marketplace, no confirmation is necessary. Simply follow the on-screen instructions to get your discount. You may need to input a discount code; or the discount may be automatically applied at checkout. If you have questions related to your health discounts benefit, call OBM member Services at When to use your health discount program Is the health product or service paid for by insurance? If the answer is yes, use your medical, vision or dental insurance to pay for the product service. If the answer is yes, but you have reached the limits of your insurance, you can use the discount program to save on products and services above or beyond the limits of your insurance*. For example, if your medical insurance covers only a limited number of chiropractic visits, you can use the discount program to save on additional visits to a participating chiropractor. If the answer is no, use the discount program to save on the product or service. Remember: You must choose provider from the discount network in order to get the discount. Always use your dental and vision insurance for covered services _M52327.indd Sec2:5

8 Disclosure: 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 at certain providers for 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. Oxford Benefi t Management packages are not available in all states and state-specifi c requirements may cause limitations or variations to the plans. Packaged Savings is not available for this product. Benefi t options may vary by group size. Components subject to change. Oxford Benefi t Management products are provided through the following partners: UnitedHealthcare Dental coverage provided by or through United HealthCare Insurance Company, United HealthCare Insurance Company of New York, or its affi liates. Administrative services provided by Dental Benefi t Providers, Inc., Dental Benefi t Administrative Services, United HealthCare Services, Inc. or their affi liates. UnitedHealthcare VisionSM coverage provided by or through United HealthCare Insurance Company, United HealthCare Insurance Company of New York, or its affi liates. Administrative services provided byspectera, Inc.., United Healthcare Services, Inc. or their affi liates. UnitedHealthcare Life products are provided by or through Unimerica Life Insurance Company of New York, United HealthCare Insurance Company or their affi liates. M / Oxford Health Plans LLC. All rights reserved rev _M52327.indd Sec2:6