Health care with a difference. Montgomery County Public Schools Employee and Retiree Health Benefits Program 2011 Group Policy Number

Transcription

1 Health care with a difference. Montgomery County Public Schools Employee and Retiree Health Benefits Program 2011 Group Policy Number

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3 One of a kind. We re delivering health care from a fresh - and even refreshing - perspective. Welcome to a benefits plan and a company that may help you improve your quality of life, even when all is well. Our high-value coverage, national network of doctors and in-depth wellness resources could help you and your family take charge of your total health and live healthier. Health care that s approachable. Surprisingly simple. Even supportive. Take a look at our health benefits, you ll see what we mean. Table of contents Page 2 New, more and better Page 5 Helpful tools Page 6-7 Coverage map and network Page 8-9 Wellness programs Page 11 Checklist Page Benefits at a glance 1

4 Fresh means new, more and better. New individualized programs and resources to improve your health. More choice of doctors and information on those doctors. A variety of resources to help improve your health and well-being. That s what UnitedHealthcare members receive practical, approachable health care. As a member, you will have access to the trusted network of 600,000 doctors and 5,000 hospitals, along with helpful tools for managing and improving your family s total health. Your UnitedHealthcare benefit plan choices: Select HMO Select Plus Point of Service No matter which plan you choose, both offer: no referrals -- direct access to specialists national network of doctors, hospitals and other health care facilities from coast-to-coast the same flat copayment whether you visit an in-network primary care doctor or specialist anytime access to caring, experienced nurses with NurseLine SM services health care tools at your fingertips 24/7 at myuhc.com wellness resources including health coaching, classes and diversity initiatives discounts on a variety of health-related products 2

5 Pulling together for kids in need Children with medical needs sometimes are not insured enough to cover all their treatments. UnitedHealthcare and its employees have helped provide funds to families through the UnitedHealthcare Children s Foundation. To learn more, visit www. uhccf.org. 3

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7 Power tools for the healthiest you. Your first stop toward better health: myuhc.com. It s loaded with details on your benefits plan including covered services and copayments. The Personal Health Record confidentially tracks doctor visits, shots, diagnoses, your health status and family medical history. myuhc.com is your convenient source for: a searchable directory of network doctors and hospitals near you, complete with maps of their locations printing a temporary ID card or requesting a new, permanent card nurses available to answer your questions via live online chat seeing a cost estimate for many different medical services View your medical history and access new wellness tools on your Personal Health Record. Check it out for yourself. Take a Quick Tour of myuhc.com. Track your account balances. 5

8 National Service Map 6 A really big network Our network is one of the largest in the nation, with more than 600,000 doctors and 5,000 hospitals. So chances are your regular doctor already participates with us. It also means that wherever you re at in the country, you ll be able to find a network hospital and get the same benefit coverage level you find at home. Whether you re in Maryland, Texas, Colorado or almost anywhere else in the nation, your benefits travel with you. Where you go for care is up to you We prefer to let you choose which network doctor or specialist is best for your care. While we give you tools to help you decide, you don t need our permission and you don t need a referral. Plus, your treatment is decided by you and your doctor, in most cases without having to get our approval. Strong regional network to serve you Maryland, Virginia and Washington D.C.* 29,984 physicians 53 hospitals

9 Your ally. Choosing a partner in care. When it comes to your health and the care of your family, a primary care physician is a trusted ally one who knows your family s health history, shares your concerns and walks along side you. With online tools at myuhc.com and other programs for specialized care, you and your family can partner with your primary care physician for better health. If you don t have a relationship with a health care partner, visit to choose one from our large national network of physicians and hospitals in all 50 states, including UnitedHealth Premium designation and NCQA-recognized doctors. UnitedHealth Premium designation: Finding the best for you. You want health care from the best. But how do you know who is the best? We can help. Our UnitedHealth Premium designation program evaluates most of the doctors in our network on their quality and efficiency of care by comparing them with widely accepted medical principles and published studies.* Those that meet these high standards for both receive two stars; those that provide excellent care receive one. Search our network at to see the doctors in your area who have been rated by the UnitedHealth Premium designation program. Rest assured, they re among the best. The National Committee for Quality Assurance (NCQA) is an independent, nonprofit organization that provides information on health care quality, helping *Designation is based on claims data from Choice, Choice Plus, Select, Select Plus and MAMSI Life and Health Insurance Company. UnitedHealth Premium is not available in all geographic locations. For a complete description of the UnitedHealth Premium designation program, including details on the methodology used, geographic availability and program limitation, please visit myhuc.com. consumers make better choices. 7

10 Wellness programs: Taking care before you need care. The best health care keeps you and your family well. Start by taking our free health assessment on myuhc.com to identify your problem areas. Then search our online libraries, where you ll find volumes of wellness articles from leading medical doctors, specialists and psychologists that may just inspire the lifestyle changes to improve your health. For more pressing questions, chat live online with a nurse. An online Health Coach can develop a plan for losing weight, exercising more or quitting smoking, and help you stick to it. If you ve struggled with these goals before, we ve got the tools and resources to help you succeed. We encourage your total well-being by extending discounts on products and health care services that may not be covered by your medical or dental plan. From nutrition supplements and fitness gear, to LASIK procedures and teeth whitening, you ll find valuable discounts at myuhc.com. Our Healthy Mind Healthy Body e-newsletter is another resource that can be tailored to your particular health concerns. Subscribe at and specify the content you d like whether it s articles on diet and exercise or fighting the flu. Moms-to-be: the special attention you get through our Healthy Pregnancy program will improve your odds for a healthy pregnancy, delivery and baby. Get more information and answers to your questions 24/7 at from knowledgeable maternity nurses. 8

11 Special help when it really counts When you become a member, call Customer Care at the toll-free telephone number on your member ID card to access these programs and services: * Disease management programs help you control chronic conditions such as asthma and diabetes. Specialized resources through our Centers of Excellence program can help if you are affected by a transplant, cancer or congenital heart disease from choosing the right medical center to finding a nearby hotel when you need treatment. * Care Coordination: We work with your doctor to see that your treatment plan is carried out effectively. And for certain chronic conditions, we call you with important care information, reinforce discharge instructions and support your journey from hospital to home. * United Behavioral Health: Confidential support on a wide range of personal issues. Our national network includes more than 60,000 licensed and certified professionals, including counselors, psychologists, psychiatrists and social workers. * United Resource Networks: If you have a serious medical need, specialized programs and nurse consulting are available to you. Get help deciding where to get care, coordinating care with your treatment team, scheduling appointments and finding support programs. 9

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13 Take a fresh look. We know that choosing your health care coverage is an important decision. You want to make the right choice for yourself or others if you have a spouse or family to consider. We want to help make that decision as easy and well-informed as possible. n review the benefits and programs outlined in this brochure n talk it over with your spouse or family n explore and get more details on all the benefits and services we offer for Montgomery County Public Schools The more you know about us, the more you ll see health care from a new perspective. 11

14 Montgomery County Public Schools - Summary of Benefits Select HMO Plan Benefits Physician Office Visits (illness) Primary Care Physician Specialist Hospitalization Inpatient Outpatient HMO Plan Benefits after $5 copayment after $5 copayment after $25 copayment Maternity Prenatal Care Delivery Newborn Care Infertility Treatments Artificial Insemination In-Vitro Fertilization after the first prenatal visit Diagnostic Laboratory and X-ray (Outpatient) Chemotherapy/Radiation Therapy Durable Medical Equipment/Diabetic Equipment/Prosthetic Devices 75% Acupuncture for Chronic Pain Management after $5 copayment (up to 20 visits per year) Plan pays 50% coinsurance of Eligible Charges (limited to $3,000 lifetime) Plan pays 50% coinsurance of Eligible Charges (limited to 3 attempts, not to exceed lifetime maximum of $100,000) Physical Therapy/Occupational Therapy/Speech Therapy (up to 60 combined visits per year) Chiropractic Services (up to 60 visits per year) Ambulance Emergency Health Services Urgent Care Mental Health and Substance Abuse Inpatient (Prior notification required) Outpatient (Prior notification required) after $5 copayment after $5 copayment for Medical Emergencies after $100 copayment (waived if admitted) for ER diagnosis after $15 copayment after $5 copayment Skilled Nursing Facility (up to 60 days per calendar year) Mammography Annual OB/GYN Checkup after $5 copayment for services of participating OB/GYN Well Child Care (8 visits to age 2; 1 per year ages 2-19) * Adult Routine Physical Exams * Hearing Aids for Children 50% for hearing aids per hearing impaired ear every 36 months up to $1,400 per ear (Under age 19) Allergy Testing Home Health Care (up to 60 visits per year) Annual Deductible Out-of-Pocket Maximum Lifetime Maximum after $5 copayment None $1,100 per person Unlimited *Preventive services covered with no copayment for those services described in the U.S. Preventive Services Task Force and/or the Centers for Disease Control and Prevention. - This outline is intended as a summary only. A more complete description of Benefits and terms is provided in the Evidence of Coverage (EOC) posted on - Prior Notification is required for some services. Refer to the Evidence of Coverage for more details. - The Select HMO plan lets you choose a primary care physician from our national network of providers to be your personal doctor. In addition to being your primary caregiver, the physician you select will serve as your guide in coordinating your care, including recommending other physicians and health care services. 12

15 Montgomery County Public Schools - Summary of Benefits Select Plus Open POS Plan Benefits POS In-Network Benefits POS Out-of-Network Benefit Physician Office Visits (illness) Primary Care Physician Specialist after $10 copayment after $10 copayment Hospitalization Inpatient Outpatient after $10 copayment up to 180 days Maternity Prenatal Care Delivery Newborn Care Infertility Treatments Artificial Insemination In-Vitro Fertilization (limited to 3 attempts, not to exceed lifetime maximum of $100,000) after the first prenatal visit after $10 copayment after $10 copayment Diagnostic Laboratory and X-ray (Outpatient) (excludes routine care) Chemotherapy/Radiation Therapy Durable Medical Equipment/Diabetic Equipment/Prosthetic Devices Acupuncture for Chronic Pain Management (Up to 20 visits per year) after $10 copayment Physical Therapy/Occupational Therapy/Speech Therapy (up to 90 visits per therapy per year) after $10 copayment Chiropractic Services after $10 copayment Ambulance for Medical Emergencies Paid in-network for Medical Emergencies Emergency Health Services after $100 copayment Paid in-network (waived if admitted) for ER diagnosis Urgent Care after $10 copayment 80% Mental Health and Substance Abuse Inpatient Outpatient (Prior notification required) after $10 copayment up to 180 days Skilled Nursing Facility (up to 60 days per year) Mammography Annual OB/GYN Checkup after $10 copayment for services of participating OB/GYN Well Child Care (8 visits to age 2; 1 per year ages 2-19) * 80% Adult Routine Physical Exams * Not covered by medical plan Hearing Aids for Children (Under age 19) for hearing aids per hearing impaired ear every 36 months up to $1,400 per ear Allergy Testing after $10 copayment Home Health Care (up to 60 visits per year) Annual Deductible Out-of-Pocket Maximum Lifetime Maximum None None Unlimited for hearing aids per hearing impaired ear every 36 months up to $1,400 per ear $300 Individual/$600 Family $1,000 Per Individual Unlimited *Preventive services covered with no copayment for those services described in the U.S. Preventive Services Task Force and/or the Centers for Disease Control and Prevention. - This outline is intended as a summary only. A more complete description of Benefits and terms is provided in the Evidence of Coverage (EOC) posted on - Prior Notification is required for some services. Refer to the Evidence of Coverage for more details. - The Select POS plan lets you choose a primary care physician from our national network of providers to be your personal doctor. In addition to being your primary caregiver, the physician you select will serve as your guide in coordinating your care, including recommending other physicians and health care services. - Where Benefits are subject to day, visit and/or dollar limits, such limits apply to the combined use of Benefits whether In-Network or Out-of-Network. 13

16 Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Insurance Company, United HealthCare Services, Inc. or their affiliates. The medical centers and programs in UnitedHealthcare s network and within United Resource Networks are independent contractors who render care and treatment to UnitedHealthcare members. UnitedHealthcare does not provide health services or practice medicine. The medical centers and programs are solely responsible for medical judgments and related treatments. UnitedHealthcare is not liable for any act or omission, including negligence, committed by any independent contracted health care professional, medical center or program. The UnitedHealth Premium designation program is intended as a resource for informational purposes only. Designations are displayed in UnitedHealthcare online physician directories at myuhc.com. You should always consult myuhc.com for the most current information. Premium designations are a guide to choosing a physician and may be used as one of many factors you consider when choosing the physicians from whom you receive care. If you already have a physician, you may also wish to confer with him or her for advice on selecting other physicians. Physician evaluations have a risk of error and should not be the sole basis for selecting a physician. Please see myuhc.com for detailed program information and methodologies. Only individual physicians and facilities that meet UnitedHealth Premium designation criteria, or physicians in designated specialties who are part of medical groups that meet UnitedHealth Premium criteria for group practices and who have sufficient claims data for analysis, may be designated. All physicians and facilities that contract with UnitedHealthcare have met credentialing requirements. Regardless of designation, plan enrollees have access to all physicians and facilities in the UnitedHealthcare network. Specialties for which there are no quality guidelines currently established in the program are excluded from evaluation and are noted as such. UnitedHealth Allies is a program that offers discounts on health products/services to UnitedHealthcare members. It is not an insurance product but is offered to existing members of certain products underwritten or provided by United HealthCare 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. UnitedHealthcare does not endorse or guarantee health products/services available through UnitedHealth Allies. This program may not be available in all states or for all groups. Components subject to change. The Healthy Pregnancy Program follows national practice standards from the Institute for Clinical Systems Improvement. The Healthy Pregnancy Program can not diagnose problems or recommend specific treatment. The information provided is not a substitute for your doctor s care. 14 Physician totals pulled from NDB UHN Reporting Database. Included medical professionals with a degree of MD, DO, DPM or POD with unique MPIN by Primary Address Market. Facility totals pulled from NDB UHN Reporting Database. Included hospitals with organization type 001-General Acute Care with unique MPIN by Primary Address Market. Quarter two Printed on paper containing recycled material. M /10 MCPS 2010 United HealthCare Services, Inc.