DENTAL VISION WORK & LIFE SERVICES HEALTH DISCOUNTS

Transcription

1 DENTAL VISION WORK & LIFE SERVICES HEALTH DISCOUNTS Please Note: Oxford Benefit Management, Inc. acts as the distribution company for products by third-party vendors including UnitedHealthcare Dental, Spectera, LifeEra and UnitedHealth Allies. The UnitedHealthcare Dental PPO Plan, the UnitedHealthcare Dental Trust Plan and Spectera, Inc. are underwritten by United Healthcare Insurance Company, Hartford, Connecticut (except in New York), United Healthcare Insurance Company of New York, Hauppauge New York (New York only). OBM does not underwrite or administer these products and bears no risk on any product offered. All information within this document is subject to change. OBM SM ELITE SPECIALTY OPTION MEMBER EDITION MS

2 WELCOME WELCOME TO OXFORD BENEFIT MANAGEMENT (OBM) Thank you for selecting Oxford Benefit Management SM (OBM). Our goal is to simplify specialty benefits by providing you with a unique selection of products offered by third-party vendors, that include dental coverage, vision coverage, work & life services and health discounts. When you look through this Welcome Brochure, you ll see that your four specialty benefit options offer complementary benefits that you can use together to save even more money. With the OBM SM Elite Specialty Option, your plan includes insured dental and vision coverage, in addition to work & life services and a health discount program. TABLE OF CONTENTS Understanding Your OBM Member ID Card How To Access Your Benefits at oxfordbenefitmanagement.com.. 3 OBM Member Services DENTAL Understanding Your Dental Coverage How To Access Your In-network Dental Benefits How To Access Your Out-of-network Dental Benefits VISION Understanding Your Oxford Benefit Management Benefits Understanding Your Vision Coverage How To Access Your In-network Vision Benefits How To Access Your Out-of-network Vision Benefits DENTAL In addition to your insured dental coverage through UnitedHealthcare Dental, you can also take advantage of UnitedHealth Allies dental discounts for services: Beyond the limits of your covered care, or For services not covered by your dental coverage, such as cosmetic dentistry. VISION In addition to your insured vision coverage through Spectera, you can also save with UnitedHealth Allies vision discounts for products and services: Beyond the limits of your covered care, or For services not covered by your vision coverage, such as LASIK eye surgery. WORK & LIFE SERVICES Child/Parenting Support Services Adult/Elder Support Services Life Learning Chronic Condition Support Services Liveandworkwell.com How to Access Your Work & Life Services Benefits HEALTH DISCOUNTS Understanding When to Use UnitedHealth Allies How UnitedHealth Allies Discounts Work How to Access Your Health Discounts Benefit WORK & LIFE SERVICES In addition to receiving timesaving information and referrals from LifeEra on services such as long-term care, weight management and smoking cessation programs, you can get also get discounts on many of these services through UnitedHealth Allies. HEALTH DISCOUNTS UnitedHealth Allies not only offers discounts on dental, vision, and work & life services, but it also offers significant savings on chiropractic care, acupuncture, massage therapy, vitamins, nutritional counseling, hearing aids, infertility therapies, and more. NOTES

3 ACCESS YOUR PERSONALIZED OBM MEMBER IDENTIFICATION (ID) CARD Use your personalized OBM Member ID Card at thousands of participating provider locations and retail locations nationwide. At the time of service or product purchase just present your OBM Member ID Card with any required payment to get the savings offered by your OBM plan. Understanding Your OBM Member ID Card Your OBM Member Identification Card can be used at thousands of participating provider locations and retail locations nationwide. The OBM Member ID Card indicates the OBM plan that was selected by your employer. Front of Card 1. Name of Member 2. Type of Plan 3. OBM Member ID Number 4. OBM Member Services Number 5. Web Site Address Jane Doe Plan: OBM Elite Specialty Option Member ID: All OBM products are offered by third-party vendors. All of the packages include dental, vision, work & life services and health discounts. For a complete summary of these benefits, visit 1 Back of Card 1. Third-Party Vendor Logos 2. Claims Information 3. Disclaimer 2 3 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, Claims Unit Spectera Claim Department PO Box P.O. Box Salt Lake City, UT Baltimore, MD Electronic Payer ID# Fax: By the use of this card, I hereby consent to the release of any information needed by Oxford Benefit Management, Inc. or third-party vendors. This plan is underwritten by United Healthcare Insurance Company. OXFORDBENEFITMANAGEMENT.COM The OBM web site, is the easiest way to find out about your benefits and locate participating providers. 1. Visit 2. Select the Member Site along the top navigation bar. 3. Then select OBM Prepackaged Benefits. 4. Next, select 2005 OBM Prepackaged Benefits. From this page, you can find everything you need. Use the Services Locator to conduct online searches for: Dental Service Locations Vision Service Locations Work & Life Services Health Discounts Select OBM Vendors to find out more about the third-party vendors that provide your specialty benefits. Click on OBM Plans to find out the specific benefits of the OBM plan selected by your employer. Go to the Online Forms section to download Member Enrollment Forms or a Dental Claim Form. OXFORD BENEFIT MANAGEMENT MEMBER SERVICES If you have questions related to your OBM plan, you can contact OBM Member Services at (8:00 AM to 8:00 PM EST) to get assistance with: Questions on claims and claims payments Understanding your benefits Locating a participating provider Ordering a duplicate Member ID card Answering any other questions you have related to your OBM benefits We re continually working to find new ways to help OBM members save money. To find out about the newest OBM plan updates, product additions and discounts, send an to obm@oxfordhealth.com and we ll add you to our mailing list. If you have questions related to your OBM plan, 2 3

4 DENTAL HIGHLIGHTS OF YOUR DENTAL BENEFITS With the OBM SM Elite Specialty Option, Your Dental Benefits Include: 100%/80%/50% coinsurance coverage on preventive, basic and major care on an in- and out-of-network basis. Access to a network of over 10,000 dental providers in the tri-state area. Flexibility to see a dental provider outside of the network. Substantial cost savings when visiting an in-network provider. Understanding Your Dental Coverage In-network Out-of-network 1 Coinsurance Preventive/Basic/Major 100%/80%/50% 100%/80%/50% Annual Maximum 2 $1000 ($1500 Option) $1000 ($1500 Option) Deductible Single/Family $50/$150 $50/$150 Preventive Care Teeth Cleaning, X-Rays 100% 100% Basic Care Fillings, Restorations, Root Canals, 80% 80% Endodontics, Periodontics, Oral Surgery Major Care Crowns, Bridges, Dentures 50% 50% Orthodontia 2 (Optional) 50%; $1000 Lifetime Maximum 50%; $1000 Lifetime Maximum Waiting Periods 3 (Major Care, Orthodontia) 12 Months for Connecticut & New Jersey 12 Months for Connecticut & New Jersey 6 Months for New York 6 Months for New York IN-NETWORK DENTAL BENEFITS 1. Select a provider from the UnitedHealthcare Dental network. Visit Select the Member Site along the top navigation bar. Then select OBM Prepackaged Benefits. Next, select 2005 OBM Prepackaged Benefits. Under the Service Locator to the right, 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. 4. Remember, preventive care is covered 100%, basic care is covered 80%, and major care is covered 50%. There are no claim forms to submit when seeking services from an in-network provider. OUT-OF-NETWORK DENTAL BENEFITS 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: Visit Select the Member Site along the top navigation bar. Then select OBM Prepackaged Benefits. Next, select 2005 OBM Prepackaged Benefits. Under the Online Forms, click on the UnitedHealthcare Dental Claim Form to download and print a copy. See pages to find out how to take advantage of great discounts available through UnitedHealth Allies on dental expenses not covered by your insured dental coverage, including: Orthodontia & Cosmetic Dentistry If you have any questions about your dental benefits or need help locating a participating provider, Up to 35% Off This is only a summary of covered services. Please refer to your contract for complete terms, limitations and conditions of coverage. 1 Out-of-network benefits are paid based on UnitedHealthcare Dental s Maximum Allowable Charge (MAC) schedule. 2 The $1500 annual maximum buy-up option and orthodontia options are available for purchase at the discretion of your employer. Please check with your employer to see if your group elected these coverage options. 3 There is no waiting period for preventive or basic care. For major care and orthodontia a 12-month waiting period applies for members in Connecticut and New Jersey; a 6-month waiting period applies for members in New York. Annual Deductibles, Coinsurance and Annual Plan Maximums: Your dental coverage includes an annual deductible of $50 for single, and an annual deductible of $150 for family coverage. You will need to pay that yearly amount before UnitedHealthcare Dental will pay benefits on your behalf. Coinsurance is the percentage of dental charges you are responsible for paying at the time of service. The amount of coinsurance you pay varies based on the procedure performed and whether the dentist is participating in the network. UnitedHealthcare Dental has negotiated discounted fees with network dentists. So, if you seek care from an in-network provider, you will benefit from potentially lower out-of-pocket costs and no claim forms to submit. The annual maximum benefit is the total amount that UnitedHealthcare Dental pays for your treatment in a year. Each claim reimbursement accumulates towards your annual maximum. 4 5

5 VISION HIGHLIGHTS OF YOUR VISION BENEFITS With the OBM SM Elite Specialty Option, Your Vision Benefits Include: An annual routine in-network vision exam paid in full after a $20 copayment. Covered-in-full frames and lenses, or contacts in lieu of eyeglasses, after a materials copayment. An extensive network of over 1,800 providers in the tri-state area. No claim forms or referrals are necessary for covered services when obtained from a Spectera participating provider. Understanding Your Vision Coverage In-network Out-of-network Vision Exam You will pay a $20 copayment at the time of service. Up to a $20 reimbursement Once every 12 months Materials You will pay a $50 materials copayment at the time of service. This copayment covers both frames and/or lenses; or contacts. Frames If You Choose a Covered-in-full Frame Your frame benefit applies to Up to a $25 reimbursement Once every 24 months virtually all of the frames on the market today. You are entitled up to $25 wholesale frame allowance (private practice providers) or $70 retail frame allowance (retail chain providers). Lenses Standard single vision, lined bifocal, lined trifocal and lentricular lenses Single Vision Lenses Once every 12 months are included in your $50 materials copayment. Standard scratch resistant Up to a $20 reimbursement coating is covered in full. Bifocal Lenses Progressive lenses, polycarbonate lenses, tints, UV and anti-reflective Up to a $30 reimbursement coating may be available at a discount. Trifocal and Lentricular Lenses Up to a $40 reimbursement Contacts Covered-in-full Contact Lenses If covered disposable contact lenses Elective Contacts Once every 12 months are chosen, up to four boxes (depending on prescription) are included when Up to a $55 reimbursement (In lieu of lenses and obtained from a network provider. The benefit includes the evaluation/fitting Medically Necessary Contacts a frame) fees, contacts and up to 2 follow-up visits. Up to a $105 reimbursement Contacts Outside the Covered-in-full Selection You are entitled up to a $105 allowance towards the fitting/evaluation fee and purchase of contacts outside of the covered-in-full selection (materials copayment does not apply). IN-NETWORK VISION BENEFITS 1. Select a provider from the Spectera network. Visit Select the Member Site along the top navigation bar. Then select OBM Prepackaged Benefits. Next, select 2005 OBM Prepackaged Benefits. Under the Service Locator to the right, click on Vision Service Locations to search for an in-network provider. You will then need to enter the 10-digit Member ID number found on the front of your OBM Member ID card, as well as the patient s date of birth. 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 Spectera 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: 1 Just show your OBM Member ID card. You are only responsible for your copayments and non-selection patient options such as tints and coatings. There are no claim forms to submit and no referral forms are necessary for covered services when obtained from a Spectra participating provider. OUT-OF-NETWORK VISION BENEFITS 1. You can visit the vision provider of your choice. 2. You will be responsible for paying full payment at the time of service and submitting your receipts to be reimbursed up to your out-of-network reimbursement. 3. To receive reimbursement, you should send your itemized receipt(s), with the subscriber s Member ID number and the patient s name and date of birth, to: Spectera Claims Department P.O. Box Baltimore, MD Receipts for services and materials purchased on different dates must be submitted at the same time to receive reimbursement. You will be reimbursed according to the out-ofnetwork allowance. See pages to find out how to take advantage of great discounts, available through UnitedHealth Allies on vision expenses not covered by your insured vision coverage, including: LASIK, PRK & New Custom LASIK Up to 50% Off If you have any questions about your vision benefits or need help locating a participating provider, This is only a summary of covered services. Please refer to your contract for complete terms, limitations and conditions of coverage. 6 7

6 WORK & LIFE HIGHLIGHTS OF YOUR WORK & LIFE SERVICES BENEFITS ADULT/ELDER SUPPORT SERVICES CHRONIC CONDITION SUPPORT SERVICES WORK & LIFE SERVICES BENEFITS Now you can reduce the stress involved with handling personal and family matters through the assistance of LifeEra. LifeEra offers consultation and referrals, online services and educational resources on a wide variety of subjects, including Child/Parenting Support Services, Adult/Elder Support Services, Chronic Condition Support Services and much more. There is no charge to speak with a LifeEra counselor or to obtain educational materials, referrals or references. If you are caring for an older family member, LifeEra can help you. LifeEra is available around the clock to help you deal with any immediate eldercare crisis and plan for secondary and long-term needs including: Housing concerns In-home nursing care Behavioral health services Managing your own chronic condition or that of a loved one is one of life s toughest challenges. LifeEra counselors are always available with information about: Assistive technology Food service Support groups Advocacy Whenever you need help with any of life s challenges, simply call LifeEra. LifeEra counselors are available 24 hours a day, 7 days a week, including on holidays. To get in touch with LifeEra counselors and resources: 1. Visit 2. Select the Member Site along the top navigation bar. 3. Then select OBM Prepackaged Benefits. All services are completely confidential. Transportation Affordable housing 4. Next, select 2005 OBM Prepackaged Benefits. LifeEra counselors are available 24 hours a day, 7 days a week, 365 days a year. LifeEra has direct access to translators in over 140 languages and a dedicated TTY/TDD line for speech- or hearing-impaired individuals. Community resources Food/nutrition programs Travel opportunities Homemaker services Work-related concerns Remodeling for accessibility Transportation issues 5. Under the Service Locator to the right, click on the Work & Life Services link that will take you to the web site. 6. Log in using the access code Oxford. LIVEANDWORKWELL.COM CHILD/PARENTING SUPPORT SERVICES Finding warm, attentive, and age-appropriate care for your children at every stage of their lives is a continual challenge. Let LifeEra counselors assist you with information and referrals on: When it comes to personal and family matters, sometimes you d rather do your own research privately and on your own time. LifeEra s interactive web site, gives you access to the best work & life resources, including: Financial calculators Retirement planning tools See pages to find out how to take advantage of great discounts, available through UnitedHealth Allies, beyond your LifeEra benefit, including: Long-Term Care Up to 30% Off Childcare centers Smoking cessation Nanny and au pair services Home day care LIFE LEARNING Searchable databases Interactive programs If you have questions about your LifeEra benefits or would like to speak with a counselor, Teen programs Preschools Programs for children with special needs The homework involved in researching a school whether it s for your child or for yourself can be a project in itself. LifeEra can cut hours out of your search with the following services: School selection: Pre K through 12th grade Clinician search Preventive health programs Health quizzes Day and residential camps Personalized college searches including financial aid/scholarship Health and work & life balance content Emergency or sick childcare Assistance with academic problems Spanish content Adult education and community education programs Comprehensive article library Career consulting Electronic intake forms Chat and message boards 8 9

7 DISCOUNTS HIGHLIGHTS OF YOUR HEALTH DISCOUNTS BENEFIT Now you can take advantage of great discounts through UnitedHealth Allies on health-related products and services not covered by your insurance. Savings of 5% to 50% on health-related products and services: Vision (eye exams, LASIK eye surgery) 5% to 50% Dental (cosmetic dentistry, orthodontia) 10% to 35% Wellness (fitness, smoking cessation, nutrition) 10% to 50% Long-Term Care (DME, hospice) 5% to 30% Hearing (testing and hearing devices) 10% to 20% Infertility (in vitro, reproductive endocrinology) 5% to 20% Complementary & Alternative Medicine 20% (chiropractic, massage therapy, acupuncture) Understanding When To Use Your UnitedHealth Allies Discounts Is the Health Product, Service or Treatment Covered by Insurance? HOW UNITEDHEALTH ALLIES DISCOUNTS WORK Healthcare providers in the UnitedHealth Allies network may display either discount percentages or actual prices. Actual prices are usually given for services that are defined in scope. For example, you can save $10 on ediets.com for weight management. Discount percentages are given for services that require evaluation for pricing, such as chiropractic care. Discounted percentages indicate the average discount you can expect to receive from that individual or facility. On some services, you may save more than the average; on others, you may save less. Your total savings for the visit should be within the stated discount range. If not, call OBM Member Services, and the difference will be refunded. USING UNITEDHEALTH ALLIES Keep in mind that UnitedHealth Allies is not insurance and you should always use your insurance for covered services. Instead, rely on UnitedHealth Allies to help you save on healthcare products and services not covered by insurance. See the chart to the left for more information. HEALTH DISCOUNTS BENEFIT 1. Visit Select the Member Site along the top navigation bar. Then select OBM Prepackaged Benefits. Next, select 2005 OBM Prepackaged Benefits. Under the Service Locator to the right, click on the Health Discounts link to go to the UnitedHealth Allies web site. You will need to register for a username and password using the 10-digit Member ID number found on the front of your OBM Member ID card. You ll be able to search for a provider by ZIP code. For each provider, you will be able to review their: Specialties Full Biography Credentials Estimated Savings 2. When you have selected the healthcare provider you would like to visit, be sure to confirm the discounted rate. Confirming a rate does not mean you must visit that healthcare provider. It only means that if you DO visit that healthcare provider, you are guaranteed the discounted rate. The rate confirmation also contains the providers contact information so you can call to make an appointment. YES YES, but only to a certain point NO Always use your medical, vision, or dental insurance for covered services. You can use UnitedHealth Allies 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 UnitedHealth Allies to save on additional visits to a participating UnitedHealth Allies chiropractor. You can also use UnitedHealth Allies to save on services once you have met your annual maximum. Then you can use UnitedHealth Allies to save on health-related products and services. Always use your dental and vision insurance for covered services. See pages 4 and 6 to find out about the insured dental and vision services covered by the UnitedHealthcare Dental coverage and Spectera vision coverage available to you through OBM. For more information on each category of discounts, please visit 3. Make an appointment with the provider, if you wish. Be sure to bring your rate confirmation and your OBM Member ID card with you to your visit. 4. At your appointment, pay the discounted rate directly to the provider. Remember, UnitedHealth Allies is not insurance and you are responsible for paying the UnitedHealth Allies discounted cost, at the time of your visit. If you have questions related to your health discounts benefit, * You are responsible for paying the discounted cost, at the time of service

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