UnitedHealthcare Group Medicare Advantage (PPO) See providers in or out-of-network at the same cost share. Your Plan Option Explained

Transcription

1 Your Plan Option Explained UnitedHealthcare Group Medicare Advantage (PPO) See providers in or out-of-network at the same cost share. UHEX12PP _000 H1509_110720_100830

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3 Your Medicare. This brochure explains the Medicare Advantage (PPO) plan option available to you through Alcatel-Lucent for Medicare Advantage plans, also known as Medicare Part C plans, combine your Medicare Part A (hospital) and Medicare Part B (doctor and out-patient) coverage with additional benefits that contribute to improving your health and wellness. No physicals or health questions are required to enroll, and pre-existing conditions do not affect your eligibility. All Medicare Advantage plans are offered by private insurance companies, like UnitedHealthcare, who are required to provide coverage that is as good as Original Medicare or better. The government pays the private insurers a fixed fee for your care, who in turn, handle the payments to doctors and hospitals. You must be enrolled in Medicare Part A and purchase Medicare Part B to be eligible to enroll in this plan. If you are not sure if you are enrolled, check with your local Social Security office. You must continue paying your Medicare Part B premium to keep your coverage under this group-sponsored plan. If you stop your payments, you will be disenrolled from this plan. Your UnitedHealthcare. Hospital Doctors Additional Benefits Choosing the right health care plan is a big decision. It involves looking at the costs, benefits, access to doctors and other health care services and so much more. We want to help you get the most out of your health care dollar so you can feel good about your health plan choice. Five reasons to choose a UnitedHealthcare plan. Receive coverage from a National Leader With over 25 years of experience, UnitedHealthcare is one of the nation s largest providers of health care coverage for older adults. Nationally, we serve one in five people eligible for Medicare Helping to control your care costs The plan helps limit your out-of-pocket expenses by providing an annual limit and affordable copays. Flexibility We understand that your choice of doctors, hospitals and other health care providers is important. With this plan option, you will have access to a national contracted network through UnitedHealthcare. Plus, you can see non-contracted providers as long as they participate in Medicare. Additional health and wellness programs that make a difference This plan offers the same benefits as Medicare Parts A and B, plus other services that contribute to your health and wellness. Dedicated Customer Service We provide a helpful customer service team that has been trained on your specific group-sponsored plan. With one simple phone call, you can get answers to all your health plan benefit questions. 3

4 Your Plan Option. This plan option is a Preferred Provider Organization (PPO) plan. This type of plan helps keep health care decisions in your hands. You can see any provider who participates in Medicare. You can take advantage of our large group of in-network doctors. If a doctor is in-network, that means they have a contract with UnitedHealthcare for this plan. You also have the flexibility to see doctors that are out-of-network. These doctors do not have a contract with UnitedHealthcare for this plan. However, unlike most PPO plans, with this plan you pay the same costs in and out-of-network. Plan highlights: The plan covers services provided to you by any doctor or medical professional who participates in Medicare and accepts the plan. You can enjoy predictable copays (a flat dollar amount) or coinsurance (a percentage) so you can predict your share of the cost. You can take advantage of a $0 copay for some Medicare-covered preventive services including an Annual Wellness Visit. There is a limit on your out-of-pocket spending for the year. Worldwide Emergency and Urgently Needed Services are covered and never require prior authorization. Frequently asked questions. Will the doctor or hospital accept my plan? In-Network Yes Out-of-Network Has the choice to accept plan (except for emergencies) What is my copay or coinsurance? You pay the same copay or coinsurance whether you see an in or out-of-network provider* Do I need to choose a Primary Care Physician (PCP)? Do I need a referral to see a specialist? No No No No * For more information about your plan details including copays and plan benefits refer to the Benefit Highlights brochure or Summary of Benefits. 4

5 Your Doctor. Seeing a doctor is easy. Plan members have access to a broad network of doctors and hospitals. So it is likely your doctor is already part of the plan. However, even if your doctor is not part of our network, we have made it easy for your doctor to accept this plan. PPO plans have been around a long time, doctors are familiar with them and how they work. We pay as Medicare pays so your doctor will receive the same payment as under Medicare. If your doctor does not accept Medicare assignment, we will pay the excess charges. To find doctors or hospitals in our network, see the online Provider Directory at This directory is updated regularly to provide you with the current listing of network providers. If you would like help finding a network doctor or to request a written copy of the Provider Directory, please call Customer Service at , TTY 711, 8 a.m. 8 p.m. local time, 7 days a week. 5

6 Your Additional Benefits and Programs. Your plan provides the same coverage as Medicare Parts A and B, plus additional benefits and programs that contribute to your health and wellness. They include: NurseLine SM Services Speak with a registered nurse, 24 hours a day, 7 days a week. Discuss your health and diet. Review or discuss your medications. Receive information about illnesses and injuries. Get tips on working with your doctor. SilverSneakers Fitness Program Stay physically fit and active with the SilverSneakers Fitness Program. This fitness program is available to you at no additional cost. With the SilverSneakers Fitness Program you ll receive: A basic fitness center membership at more than 11,000 participating locations. Access to all amenities, programs and services that are standard with a basic fitness center membership. Nationwide access to any participating fitness location (find locations at Many women-only locations, including Curves, are available nationwide. If the nearest participating location is 15 miles or more away from your home, you can register for the SilverSneakers Steps program. This is a personalized program that provides tools such as resistance bands, exercise DVDs and how-to material to help you measure, track and increase your daily activity. 6

7 Next Steps. 1. UnitedHealthcare will make sure you are eligible for the plan. 2. In about 4-6 weeks, you will receive your new member ID card. 3. Once you are officially enrolled in the plan, you will receive a Welcome Kit. 4. Begin using your new member ID card on your effective date. 5. If you drop your group-sponsored retiree health coverage in the future, you may not be able to re-enroll until the next annual open enrollment period or unless you have a qualified status change Important Notes. Providing you with new and updated plan information can help you understand your plan better, so you can take advantage of all the benefits available to you. The Centers for Medicare and Medicaid Services, (CMS) requires that we provide our members with new or updated plan materials. Evidence of Coverage (EOC) included in your Welcome Kit, provides complete details about the benefits and services included with your new plan. Annual Notice of Changes (ANOC) mailed every year in late fall, describes changes to your benefits for the next plan year. Updated Provider Directories mailed every 1-3 years or upon request. Questions? Call Customer Service toll-free: , TTY a.m. 8 p.m. local time, 7 days a week When calling Customer Service, let the representative know that you are calling about a group-sponsored plan. Your group number can be found on the Benefit Highlights brochure or Summary of Benefits. 7

8 UnitedHealth Group Annual Report OptumHealth SM is a health and well-being company that provides information and support as part of your health plan. NurseLine SM nurses cannot diagnose problems or recommend specific treatment and are not a substitute for your doctor s care. NurseLine SM services are not an insurance program and may be discontinued at any time. SilverSneakers is a registered mark of Healthways, Inc. The SilverSneakers program is made available as part of this plan s benefits to those insured through this plan. UnitedHealthcare does not endorse and is not responsible for the services or information provided by this program. Always consult your physician before you begin SilverSneakers or any physical fitness program. UnitedHealthcare Medicare Advantage plans are insured through UnitedHealthcare Insurance Company and its affiliated companies, a Medicare Advantage organization with a Medicare contract. Members may enroll in the plan only during specific times of the year. Contact UnitedHealthcare for more information. You must have both Medicare Parts A and B to enroll in the plan. Retiree plan prospects must meet the eligibility requirements to enroll for group coverage. The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party. Limitations, copayments, and restrictions may apply. Reimbursement is provided for all covered benefits regardless of whether they are received in or out-of-network. For some PPO plans out-of-network services may cost more than in-network services.