How to get the most from your UnitedHealthcare health care plan.

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1 How to get the most from your UnitedHealthcare health care plan. Your UnitedHealthcare health care plan includes many features and benefits that help you get the care you need and enjoy better overall health. Read on to learn how you can get the most out of your Medicare Advantage plan. Our plans are accredited by industry experts. Congratulations we re proud to tell you that you ve chosen a quality plan. UnitedHealthcare plans are accredited by the National Committee for Quality Assurance (NCQA), a private nonprofit organization that works to improve health care. NCQA accreditation is one of the most reliable and independent measures of excellence in health care today. 1 How to get the right care at the right place. With UnitedHealthcare plans, you have a lot of choice when it comes to where you get your health care. We have one of the largest provider networks in the country, and a network of more than 65,000 pharmacies that includes nearly all the major national and regional pharmacy chains, plus most independent local pharmacies. With such a large network, it s easier for you to get the care you need. How to find doctors, hospitals and medical groups in your community. 1. Go to our website. 2. Enter your ZIP code and click Continue. 3. Select your plan from the list and click Submit. 4. Enter your address. You can also pick the type of doctor or care you are looking for. Click Search. 5. A list of doctors providing primary care, specialty care and mental health care will be displayed. Hospitals and other health care facilities will also be listed. If you don t have access to a computer, call the Customer Service number on the back of your member ID card. Customer Service can give you information over the phone, or they can send you a list of doctors, pharmacies and hospitals in your area. OVMEX _000 Y0066_120412_ File & Use

2 How to decide what kind of care you need. At different times you need different types of care. Here are some guidelines for choosing the right type of care for your needs: For routine or primary/preventive care, start with a primary care provider. UnitedHealthcare has a large network of primary care doctors. To look up network doctors, see our online provider directory or call UnitedHealthcare Customer Service For hospital care, ask your doctor which hospital is best for your needs. Depending on your plan requirements, you or your doctor may need to notify UnitedHealthcare if you intend to go to the hospital For non-urgent or non-emergency care, start by calling your primary care doctor. Doctors in our network provide an answering service or an answering machine message that tells you how to get care after normal business hours For urgent care, go to an urgent care center near you. They usually reduce your wait time and offer care at a lower cost than the emergency room. Go to an urgent care center for problems like: Sprains and strains Broken bones Mild asthma attacks Minor infections Small cuts Sore throats Rashes For an emergency, go to the nearest emergency room. Are you in danger? Are your symptoms or injuries serious enough that you need immediate medical attention? Emergency conditions can include: Heavy bleeding Large open wounds Chest pain Sudden weakness or trouble talking Major burns Spinal injuries Severe head injuries Difficulty breathing If your medical situation is an emergency, no matter where you are at home or out of town call 911 or go to the nearest emergency room. Save money by choosing providers in our network. To get the most coverage from your health plan, select a doctor or health care facility from our network: With some plans, you can get care from a provider who is not in the network without a referral, but if it s not urgent or an emergency, you may pay more out of pocket In some cases, your plan may not cover care from a doctor or health care facility outside of the network unless it s an emergency Before you choose a doctor or hospital, check that they re covered by your plan 2

3 How to get primary care. What is a primary care doctor? Primary care doctors treat a wide range of health conditions and can help you maintain a healthy lifestyle. Primary care doctors may specialize in internal medicine (mostly adults), family practice (both adults and children), geriatric medicine (older adults) or gynecology (women). UnitedHealthcare has a large network of primary care doctors throughout the United States. How to find a primary care doctor who meets your needs. There are several ways to find a primary care doctor in your area: Visit our website at Call the Customer Service number on the back of your member ID card. Our Customer Service representatives can help you Tips for getting the most from your primary care visit. Most primary care doctors have a full schedule of appointments. They also need to make referrals, talk to other doctors about patient care and complete paperwork. However, this doesn t mean your doctor shouldn t take the time to listen to you and fully answer your questions. At the start of your appointment, tell the doctor about the issues you want to discuss. Then use the time to talk about the most important items. If your concerns are complex, your doctor might suggest you make another appointment It s important to be honest with your primary care doctor about your diet, smoking, alcohol use and other habits that may affect your health. This includes feeling sad or anxious. Be sure to mention things like this to your doctor Know your family medical history so your doctor can tailor his or her recommendations for you. If you have specific concerns or questions, write them down so you don t forget them Bring a list (or the bottles) of the medications you take, even if they were prescribed by a different doctor. Your primary care doctor needs to know about all your medications and how often you take them. List vitamins and supplements as well If you are experiencing any side effects from your medications, or if you have any other concerns about them, make sure to tell your doctor While talking to your doctor, take notes and make sure you fully understand the instructions. It may be helpful to bring a friend or family member with you so they can hear the instructions as well When you call to make an appointment, have all your information on hand to help the office set up an appointment that best meets your needs. Be sure to tell your doctor s office if you ll need a translator Arrive about 10 minutes early if you ve seen the doctor before. If this is your first appointment with the doctor, arrive 15 to 20 minutes early. Remember to bring your member ID card 3

4 Advice for becoming and staying healthy. Guidelines for preventive care. UnitedHealthcare has adopted guidelines for preventive care based on recommendations from the U.S. Preventive Services Task Force (USPSTF). 2 Your health care plan will often cover more preventive care services than the USPSTF recommends. If you have disease symptoms, have a family history for certain diseases or are otherwise at high risk for a certain disease, you may need to be checked more often. Talk to your doctor about how to best monitor your health. Vaccine recommendations for women and men. The Centers for Disease Control and Prevention has an Advisory Committee on Immunization Practices that recommends the following vaccines for both men and women: Influenza Get a flu shot every year during the flu season, which runs from October through March Pneumonia Get a pneumonia vaccine when you turn 65 years old. One shot is usually enough for your lifetime Screenings for women: What you need and when. Health experts from the U.S. Preventive Services Task Force recommend the following: Breast cancer Get a mammogram every year starting at age 40 Cervical cancer Colon cancer Depression Diabetes Eye exam High blood pressure Get a Pap smear every one to three years if you have ever been sexually active. If you are older than 65 and have had normal Pap test results for several years, or if you have had your cervix removed (had a hysterectomy), your doctor may say it s OK to stop getting regular Pap tests Get regular tests for colon cancer beginning at age 50. Your doctor can help you decide which test is right for you. Be sure to talk to your doctor about your family and personal medical history to see if you re at high risk. If you are, your doctor may recommend more frequent testing Your emotional health is as important as your physical health. If you have felt down, sad or hopeless over the last two weeks, if you don t feel like doing things, or if you no longer get pleasure from things you normally enjoy, you may be experiencing symptoms of depression. Talk to your doctor about being screened Get a blood test to screen for diabetes if you have high blood pressure or high cholesterol Get a complete eye exam for glaucoma every two years. If you have diabetes, get screened for diabetic eye disease. These eye diseases can lead to blindness Get your blood pressure checked at least once a year. High blood pressure means 140/90 or higher 4

5 High cholesterol HIV Obesity Osteoporosis (bone thinning) Sexually transmitted infections Have your cholesterol levels checked at least once a year, or more often if your doctor recommends it Talk with your doctor about HIV screening if any of these apply: You have had unprotected sex with more than one partner You have used or are using injection drugs You have exchanged sex for money or drugs, or you have had sex partners who do You have had sex or are having sex with partners who are HIV infected or bisexual, or who use injection drugs You are being treated for sexually transmitted diseases You had a blood transfusion between 1978 and 1985 Have your body mass index (BMI) calculated at least once a year. BMI is a measure of body fat based on your height and weight. The National Heart, Lung and Blood Institute has a BMI calculator at Have a bone density test at age 65. If you are younger than 65, ask your doctor if you should be tested. You may need to have this test again after two or more years Talk to your doctor about being tested for sexually transmitted infections Special health services for women. Medicare law requires that women be allowed to see a women s health specialist for women s routine and preventive health services, including: Breast exams Mammograms Pap smears You do not need a referral or preauthorization for these services. Women s Health and Cancer Rights Act. UnitedHealthcare provides benefits for services related to mastectomies (surgery to remove a breast). If you have a mastectomy and choose breast reconstruction in connection with it, you are entitled to coverage for: Prostheses (artificial breast inserts) Physical complications that occur at any stage of the mastectomy, including lymphedemas (fluid built up in the body) You and your doctor will discuss and make decisions about how these services will be provided. Reconstruction of the nipple/areola area after a mastectomy is covered regardless of how much time goes by between the mastectomy and the reconstruction. This coverage will have the same deductibles and copayments as other benefits described in your Evidence of Coverage or Summary of Benefits. Reconstruction of the breast on which the mastectomy is performed Surgery and reconstruction of the other breast so they are the same size and shape 5

6 Screenings for men: What you need and when. Health experts from the U.S. Preventive Services Task Force recommend the following: Abdominal aortic aneurysm Colon cancer Depression Diabetes Eye exam High blood pressure HIV Obesity Sexually transmitted infections If you are between the ages of 65 and 75 and have ever been a smoker, talk with your doctor about being screened Get regular tests for colon cancer beginning at age 50. Your doctor can help you decide which test is right for you. Be sure to talk to your doctor about your family and personal medical history to see if you re at high risk. If you are, your doctor may recommend more frequent testing Your emotional health is as important as your physical health. If you have felt down, sad or hopeless over the last two weeks, if you don t feel like doing things, or if you no longer get pleasure from things you normally enjoy, you may be experiencing symptoms of depression. Talk to your doctor about being screened Get a blood test to screen for diabetes if you have high blood pressure or high cholesterol Get a complete eye exam for glaucoma every two years. If you have diabetes, get screened for diabetic eye disease. These eye diseases can lead to blindness Get your blood pressure checked at least once a year. High blood pressure means 140/90 or higher Talk with your doctor about HIV screening if any of these apply: You have had sex with men since 1975 You have had unprotected sex with more than one partner You have used or are now using injection drugs You have exchanged sex for money or drugs, or you have had sex partners who do You have had sex or are having sex with partners who are HIV infected or bisexual, or who use injection drugs You are being treated for sexually transmitted diseases You had a blood transfusion between 1978 and 1985 Have your body mass index (BMI) calculated at least once a year. BMI is a measure of body fat based on your height and weight. The National Heart, Lung and Blood Institute has a BMI calculator at Talk to your doctor about being tested for sexually transmitted infections 6

7 Always feel free to ask about other health conditions. Everybody is different. Talk to your doctor about any health conditions you re concerned about. And always tell your doctor about any changes in your health, including changes to your vision or hearing. Coping with a chronic condition or complex health situation. If you develop a chronic condition or complex health situation, UnitedHealthcare Disease and Case Management programs offer support, help you get the care you need, and work to improve your overall health care experience. We help members with the following chronic conditions and complex health situations: Cancer Organ transplants Coronary artery disease Diabetes Heart failure Chronic conditions and trauma Pending hip or knee surgery Recent hospitalizations Our programs provide coaching, information and resources that help you: As a participant, you may receive detailed health risk assessments from registered nurses trained in care and disease management. Many of our programs also provide helpful mailings, newsletters and other tools so you can track your doctor visits and health status. How to take advantage of these programs. Your recent prescriptions, doctor visits or hospital stays may indicate when one of these programs might help you. Based on your health history: Your doctor may recommend you to a program You may receive a letter or phone call inviting you to participate in a program If you re referred to a program, a UnitedHealthcare team member may call to explain why you re eligible for the program and how to use it. Once you find out you re eligible, it s up to you to decide if you want to participate. If you need mental health or substance abuse help. You can get help anytime by calling the Behavioral Health number on the back of your member ID card. In the case of a life threatening emergency: Get emergency care immediately by dialing 911 Understand your condition and how it will affect you Reduce risk factors Maintain a healthy lifestyle Follow your doctor s treatment plan Take your medications correctly 7

8 Getting the most value from your prescription drug benefits. You can save money on prescription drugs by taking full advantage of your plan s prescription drug benefits. Here are three easy ways to learn about pharmacies and your prescription drug benefits: 1. Visit us at This site has information that can help you lower your out-of-pocket costs. You ll find drug lists (formularies), a pharmacy locator tool, information about our mail-order service and other money-saving programs such as Pharmacy Saver. 2. Review the Evidence of Coverage document that was mailed as part of your Annual Notice of Changes mailing or your Welcome Kit. 3. If you don t have Internet access, call the Customer Service number on the back of your member ID card. How to contact your plan. You can quickly get information about your health care benefits by going online or calling us. The UnitedHealthcare website has information about how to manage your health and your health care dollars. Visit to see: Health plan benefits and services Pharmacy benefits and how to use them Doctors in your area If you don t have Internet access, or to get more information, call the Customer Service number on the back of your member ID card. UnitedHealthcare Customer Service representatives will help you: Understand how and when to use your health care benefits Get answers about copays and how to submit a claim Find a provider or health care facility To tell us how we can improve your experience, or if you have any questions, simply call the Customer Service number on the back of your member ID card UnitedHealthcare Medicare Advantage plans are insured through UnitedHealthcare Insurance Company and its affiliated companies, a Medicare Advantage organization with a Medicare contract.

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