UnitedHealthcare EDGESM

Transcription

1 UnitedHealthcare EDGESM

2 100 percent preventive care coverage and that s just the beginning As a leading health and wellness company, UnitedHealthcare is committed to improving the health care system for everyone especially you, your employees, and their physicians. This starts by providing more choices for health coverage, and then the information you and your employees need to make the most out of your plan. Our EDGE plans were designed with this in mind. EDGE plans give your employees more: starting with preventive care covered at 100 percent, which encourages employees to take the first steps to getting the care the need. And the tiered benefits design enables employees to choose health care professionals based on quality and the value they need. It s easy to use, and helps engage employees in their own good health.

3 UnitedHealthcare EDGE plans provide lower office visit copayments and greater plan coinsurance coverage when employees find care provided by UnitedHealth Premium designation program quality and cost-efficiency designated specialty physicians. These physicians designations are displayed on the member website, myuhc.com, with two stars (HH). The stars mean a physician has met national industry standards for quality care established by medical organizations and governmental agencies such as the Ambulatory Care Quality Alliance, the National Committee for Quality Assurance (NCQA) and the American College of Cardiology, plus guidelines for cost efficiency using local market benchmarks. EDGE features: Lower office copayments with UnitedHealth Premium designated physicians Higher plan coinsurance with UnitedHealth Premium designated physicians Primary care covered at the highest benefit level (Family Medicine, Internal Medicine, Obstetrics/ Gynecology, Pediatrics) Network hospital inpatient stays covered at the plan s highest benefit level (includes service and supplies provided during the stay, plus room and board) Physician services during hospital stay, including anesthesiologists, emergency room physicians, pathologists, radiologists and consulting physicians are covered at the plan s highest benefit level regardless of designation status Ability to pair with a Definity Health Savings Account, which allows employees even more control of their health care spending UnitedHealth Premium quality and cost-efficiency designated specialties Allergy Cardiology Cardiology Electrophysiology Cardiology Interventional Endocrinology Family Medicine Infectious Disease* Internal Medicine Nephrology Neurology Neurosurgery Spine Obstetrics and Gynecology Orthopaedics General Orthopaedics Hand Orthopaedics Foot/Ankle Orthopaedics Hip/Knee Orthopaedics Shoulder/ Elbow Orthopaedics Spine Pediatrics Your employees also have access to the national UnitedHealthcare network for primary care services, including over 659,000 physicians and other health care professionals, 5,158 hospitals and 64,000 pharmacies Pulmonology Rheumatology *Not Available in Minnesota, North Dakota, South Dakota and Western Wisconsin

4 Getting the most out of your UnitedHealthcare EDGE plan UnitedHealthcare provides a variety of tools and resources to your employees to make sure they are maximizing their benefits. Since most members will not see specialists frequently, it is critical to keep the UnitedHealth Premium designation program top of mind. This will help ensure that your employees minimize out-of-pocket costs. Employer eservices suite of tools and resources Using the resources in the Communication Resource Center, you can provide employees with information on UnitedHealth Premium, plus other health topics in ready-to-use print and electronic formats. To get started, log on to employereservices.com and click the Communication Resource Center link. myuhc.com Our member website, myuhc.com, makes it easier for employees to find designated specialty physicians in the online physician directory. It also explains the value of quality and cost-efficiency measures, plus each specialist s location and accessibility. Our member site also offers a wide range of member tools, including: Benefit details Health assessment and personalized report Health improvement tools Online programs Resource libraries Personal health record Personal health information Health statements Healthy Mind Healthy Body e-newsletter Treatment cost estimators Health discount program Printed materials We provide additional employee education campaigns specific to UnitedHealth Premium, using online tools, s and printed materials. Plus, these specific materials are targeted to employees on EDGE plans: Enrollment and welcome brochure Health plan ID card sleeves UnitedHealth Premium information materials

5 Additional resources For members who have additional questions, or for those who prefer to use the phone, our NurseLine SM and Care24 assistance lines are open 24 hours to assist with provider selection, treatment and follow-up decision support. And, for members who have specific chronic conditions, we offer disease management programs. Example of how a basic EDGE plan works using Plan Y3-A* $1,000 Deductible $50 Urgent Care copayment $30 Copayment for primary care physicians and HH (two-star) Premium designated specialists $60 Copayment for H (one-star) or non-premium specialists not designated under the Premium Program 100% Network preventive care coverage 100% Plan coinsurance coverage for network inpatient services and HH (two-star) Premium designated professional fees/ major diagnostic and outpatient diagnostics 70% Plan coinsurance coverage for H (one-star) or non-premium specialists/professional fees Member Responsibility for Specialist Services using Plan Y3-A* HH (two-star) Premium Designated H (one-star) or Non-Premium Designated Primary care physician $30 copayment $30 Specialist office visit $30 copayment $60 Specialist professional fees 2 After deductible no member copayment, plan covers at 100% 30% * Plan shown is for example purposes only. Benefit levels in the example are for network services only. Actual plan benefits are subject to state requirements and may not be available in all states. Refer to the Certificate of Coverage and corresponding Schedule of Benefits issued with your Group Policy for actual benefit or coverage levels. The Certificate of Coverage, Group Policy, Schedule of Benefits, Summary Plan Description and any amendments or riders govern the terms of coverage provided and take precedence over any other source of information. 1 Refer to the Certificate of Coverage and corresponding Schedule of Benefits issued with your Group Policy for actual benefit or coverage levels. The Certificate of Coverage, Group Policy, Schedule of Benefits, and any amendments or riders govern the terms of coverage provided and take precedence over any other sources of information. 2 Specialist professional fees include the professional physician fees for surgical and medical services.

6 What is the UnitedHealth Premium designation program? Not all health care is created equal. We developed the UnitedHealth Premium designation program to evaluate and recognize physicians who meet national industry standards for quality care and local market benchmarks for cost efficiency. All your employees need to do is look for the stars, which indicate that a physician is designated. H Quality of Care A doctor has met quality of care guidelines by following evidence-based medical standards and practices. HH Quality of Care and Cost Efficiency A doctor has met quality of care guidelines by following evidence-based medical standards and practices, and has met guidelines for providing cost efficient care. Visit MyChoiceNotChance.com for more information.

7

8 Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc. or their affiliates. UnitedHealthcare EDGE SM plans are only available in states that have implemented the 2007 Certificate of Coverage and have the UnitedHealth Premium designation program. The UnitedHealthcare Health Savings Account (HSA) high deductible health plan (HDHP) is designed to comply with IRS requirements so eligible enrollees may open a Health Savings Account with a bank of their choice or through OptumHealth Bank, Member of FDIC. UnitedHealthcare HSA refers generally to the UnitedHealthcare HSA product, which includes a HDHP, although at times UnitedHealthcare HSA may refer only and specifically to the UnitedHealthcare Health Savings Account, provided in conjunction with OptumHealth Bank and not to the associated HDHP. The UnitedHealth Premium designation program is an information resource to help our members choose a physician. It may be used as one of many factors members consider when choosing the physicians from whom they receive care. As with any performance assessment program, physician evaluations have a risk of error. Please see myuhc.com for detailed program information and methodologies. The Care24 program integrates elements of traditional employee assistance and work-life programs with health information lines for a comprehensive set of resources. It is not a substitute for a doctor s or professional s care. Due to the potential for a conflict of interest, legal consultation will not be provided on issues that may involve legal action against UnitedHealthcare or its affiliates, or any entity through which the caller is receiving these services directly or indirectly (e.g., employer or health plan). This program and its components may not be available in all states or for all group sizes and are subject to change. Coverage exclusions and limitations may apply. For informational purposes only. NurseLine SM 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. 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 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. UnitedHealth Wellness is a collection of programs and services offered to UnitedHealthcare enrollees to help them stay healthy. It is not intended to be medical advice or a substitute for your doctor s care. It is not an insurance product but is offered to existing enrollees of certain products underwritten or provided by UnitedHealthcare Insurance Company or its affiliates to encourage their 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. Some UnitedHealth Wellness programs and services may not be available in all states or for all group sizes. Components subject to change / United HealthCare Services, Inc. UHCEW