Product Catalog. Plans designed with the needs of employers mind

Transcription

1 Product Cataog Pans designed with the needs of empoyers mind Caifornia Sma Business Empoyees Effective January 1, 2015

2 About UnitedHeathcare Better Information. Better Decisions. Better Heath The Power of the Network UnitedHeathcare Product Continuum UnitedHeathcare Pans and Programs... 5 Seect Pus 6 Consumer-Driven Heath 8 Non-Differentia PPO 10 Pharmacy for Seect Pus, Consumer-Driven Heath, and Non-Differentia PPO 11 Signature*, Advantage*, and Aiance* 12 Pharmacy for Signature, Advantage, and Aiance 14 eservices for Seect Pus, Consumer-Driven Heath, and Non-Differentia PPO 15 Vaue-Added Programs for Seect Pus, Consumer-Driven Heath, and Non-Differentia PPO 16 Vaue-Added Programs for Signature, Advantage, and Aiance 18 Vaue-Added Programs Avaiabe with Every Pan 19 Speciaty Pans Denta 24 UnitedHeathcare is a division of UnitedHeath Group, a Fortune 50 company and one of the argest heath coverage carriers in the country, offering a wide range of heath care pans to fit sma business needs. As a recognized eader in the industry, we work to enhance the heath care experience for the 25 miion members we serve. This incudes working with providers and physicians to improve the quaity and efficiency of heath care services, providing greater access to heath care for our members and the underserved, deveoping and impementing pans and programs that hep our members manage heath care costs, and using technoogy to hep our members better navigate the heath care system. Our nationwide network incudes more than 774,000 physicians and heath care professionas, 5,600 hospitas and 64,000 pharmacies. We are committed to enhancing the heath and we-being of individuas and communities and ensuring the continuing improvement of the quaity of heath care in the United States. Vision 26 Underwriting Guideines * Forma HMO product names: Signature = UnitedHeathcare SignatureVaue Advantage = UnitedHeathcare SignatureVaue Advantage Aiance = UnitedHeathcare SignatureVaue Aiance

3 Better Information. Better Decisions. Better Heath. UnitedHeathcare is a division of UnitedHeath Group, a Fortune 50 company and one of the singe argest heath coverage carriers in the country. We offer a diverse range of heath coverage pans and a nationa network of more than 774,000 physicians and heath care professionas, 5,600 hospitas and 64,000 pharmacies. Serving neary 25 miion members nationwide, we re committed to enhancing the heath care experience through: Better information We aert individuas and their doctors to potentia heath risks or opportunities to take charge of their heath. We give empoyers access to information to pan and impement worksite weness programs to boost productivity and morae. Better decisions When we give empoyers, individuas and doctors access to reevant information, they can be empowered to make betterinformed decisions. Better heath Our shared focus is: heping peope ive heathier ives, which contributes to a heathier and more productive, costefficient workpace. 1

4 We asked our customers what to improve and they tod us Do something about the costs Make it easy You be gad to know that we re doing just that. Affordabiity Good Heath. We hear and read every day that the best way to get contro over heath care costs is to get heathy. It s been we-documented: Poor heath costs money. And unheathy empoyees cost their empoyers in ost productivity as we as heath care costs. UnitedHeathcare pans incude 100 percent coverage for preventive care and weness benefits, such as weness coaching, fitness memberships and biometric screenings, with buit-in incentives to encourage members to adopt heathy behaviors, and other vaue-added programs at no additiona premium cost. And we reach out to our members to get that preventive care or take action on persona heath risks when the need arises. Education. We re making it easier for our customers to understand and manage their heath care costs with toos ike our easy-to-use Heath Care Cost Estimator and easiy accessibe heath advisors and professionas who offer guidance as needed through the compex heath care system. Pan Design. Pans ike the Seect Pus, Consumer-Driven Heath and Aiance pans feature fexibiity in choice of benefits and financia responsibiity, as we as give the member more contro over managing heath-reated expenses. And the increasing avaiabiity of ower-cost generic drugs is making a significant dent in the high cost of prescription medication. 2

5 The Power of the Network Our commitment to providing you with heath coverage soutions incudes offering an expansive network, both nationay and ocay. Our Caifornia HMO network incudes over: 52,000 physicians and heath care professionas, and 220 hospitas Advantage pan: More than 30,000 physicians and speciaists, and 140 hospitas Aiance pan: More than 21,000 physicians and speciaists, and 120 hospitas Our Seect Pus network incudes over: 100,000 physicians and heath care professionas, and 340 hospitas Our nationa network incudes over: 774,000 physicians and heath care professionas, and 5,600 hospitas Network coverage Empoyees have nationwide access to 83 percent of a avaiabe U.S. hospita beds and two out of three avaiabe doctors and heath care professionas. Seamess and easy to use Fuy integrated Stabe 3

6 UnitedHeathcare Product Continuum Chart Caifornia Sma Business (51-99 empoyees) UnitedHeathcare offers a broad range of heath pans that are designed to be affordabe and fexibe for empoyers of various sizes. To hep determine the pans that best suit their empoyees need for affordabiity, we ve created a product continuum chart. The pans are arranged from owest to highest premium and ist key features. ow PREMIUM COST FOCUS Deivers quaity care with owest cost network access Aiance Cost-effective pans with a network of highy effective medica groups focused on providing patientcentered care PCP Referra Network ony PCP Referra Network ony Non-referra No copayment High deductibe HSA-quaified Network and non-network Patinum, god, siver, bronze pans avaiabe Advantage Strives for ow-cost network access HSA Vaues federa income-tax-free savings for future heath care costs PCP Referra Network ony PCP Referra Network ony Signature Wants a arge network access and fexibe benefits Core Customized network of physicians and hospitas Open access Network and non-network coverage options Incentives to use preferred providers and pace of service Non-referra Network and non-network coverage options Incentives to use preferred providers or pace of service Seect Pus Seeks a nationa network with non-network fexibiity Non-Differentia PPO Seeks utimate provider fexibiity Non-referra Network and non-network high PREMIUM COST 4

7 UnitedHeathcare Pans and Programs We offer an array of pans designed to hep empoyers and their empoyees get access to the heath care coverage they need at an affordabe price. 5

8 Seect Pus Fexibe Pans with Network Advantages UnitedHeathcare provides network and out-of-network benefits; pans for singe-site, muti-site and mutistate businesses; and variabe options for deductibes, coinsurance and pharmacy pans that hep meet empoyers needs. Our new Seect Pus pan designs incude a peroccurrence deductibe, which is appied to inpatient hospita and certain outpatient services such as outpatient surgery, standard ab/x-ray, and compex imaging (e.g., MRI, CT, PET). Members have the option to avoid the per-occurrence deductibe when accessing these benefits by receiving services from an independent, non-hospitaaffiiated provider. These benefit pan designs offer empoyers: Affordabiity Low-cost aternatives for premiums Choice Popuar combinations of benefits and pricing These benefit pan designs offer consumers: Choice Choice of any network physician or heath care professiona and no referra or primary physician required Freedom Nationa reciprocity for visiting physicians and speciaists in participating networks across the country and no referras for speciaists required Network Access to more than 774,000 physicians, 5,600 hospitas, and 64,000 pharmacies across the country Compete benefits for hospita, cinic, physician and prescription drugs Preventive care and office visits Compete physica exams, Pap smears and mammograms, routine vision exam, we-baby/chid, incuding immunizations, routine office visits, obstetrica office visits, pre/ postnata care Pharmacy A wide seection of pharmacy pan options avaiabe with the medica pans Notification Participating physicians and heath care professionas are responsibe for Care Coordination SM notification requirements 6

9 Seect Pus Network Deductibe Out of Network Network2 Out-of-Pocket Maximum 1 Coinsurance Deductibe Type 4 Network Out of Network Network Out of Network PCP Spec ER Inpatient Hospita IP Per Occurence Deductibe 3 OP Per Occurence Deductibe 3 Combined Med/Rx Ded 5 Pan Code Seect Pus $250 $500 $2,500 $5,000 90% 70% $10 $20 $250 90% N/A N/A Embedded No AA-IP $500 $1,000 $5,350 $10,700 80% 60% $20 $40 $250 80% N/A N/A Embedded No AA-IQ $750 $1,500 $5,350 $10,700 80% 60% $20 $40 $250 80% N/A N/A Embedded No AA-IR $1,000 $2,000 $4,000 $8,000 80% 60% $30 $50 $250 80% N/A N/A Embedded No AA-IS Seect Pus Direct $250 $500 $3,500 $7,000 90% 70% $10 $20 $250 90% $500 $250 Embedded No RZ-K $250 $500 $4,000 $8,000 90% 70% $15 $30 $250 90% $500 $250 Embedded No RZ-L $250 $500 $4,500 $9,000 90% 70% $20 $40 $250 90% $500 $250 Embedded No RZ-M $250 $500 $4,000 $8,000 80% 60% $15 $30 $250 80% $500 $250 Embedded No RZ-N $250 $500 $4,500 $9,000 80% 60% $20 $40 $250 80% $500 $250 Embedded No RZ-O $500 $1,000 $4,500 $9,000 90% 70% $15 $30 $250 90% $500 $250 Embedded No RZ-P $500 $1,000 $5,500 $11,000 90% 70% $20 $40 $250 90% $500 $250 Embedded No RZ-Q $500 $1,000 $6,350 $12,700 80% 60% $15 $30 $250 80% $500 $250 Embedded No RZ-R $500 $1,000 $6,350 $12,700 80% 60% $20 $40 $250 80% $500 $250 Embedded No RZ-S $750 $1,500 $4,500 $9,000 90% 70% $15 $30 $250 90% $500 $250 Embedded No AA-IT $750 $1,500 $5,500 $11,000 90% 70% $20 $40 $250 90% $500 $250 Embedded No AA-IU $750 $1,500 $6,350 $12,700 80% 60% $15 $30 $250 80% $500 $250 Embedded No AA-IV $750 $1,500 $6,350 $12,700 80% 60% $20 $40 $250 80% $500 $250 Embedded No AA-IW $1,000 $2,000 $5,000 $10,000 80% 60% $30 $50 $250 80% $500 $250 Embedded No RZ-T $1,000 $2,000 $5,500 $11,000 70% 50% $30 $50 $250 70% $500 $250 Embedded No RZ-U $1,500 $3,000 $5,500 $11,000 70% 50% $30 $50 $250 70% $500 $250 Embedded No RZ-V $1,500 $3,000 $6,000 $12,000 70% 50% $40 $60 $250 70% $500 $250 Embedded No RZ-W $2,000 $4,000 $6,350 $12,700 70% 50% $40 $60 $250 70% $500 $250 Embedded No RZ-X $3,000 $3,000 $6,350 $12,700 80% 60% $30 $50 $250 80% $500 $250 Embedded No RZ-Y $4,000 $4,000 $6,350 $12,700 80% 60% $40 $60 $250 80% $500 $250 Embedded No RZ-Z $5,000 $5,000 $6,350 $12,700 80% 60% $50 $70 $250 80% $500 $250 Embedded No RZ-1 1 Famiy Out-of-Pocket Maximum is 2x Individua. Member cost share, incuding Office Visits, deductibe, coinsurance and pharmacy, appy to the Out-of-Pocket Maximum. 2 Benefits with coinsurance (%) responsibiity are subject to the Deductibe. 3 The Per Occurrence Deductibe is separate from the Annua Deductibe and accrues toward the Out-of-Pocket Maximum. The Outpatient Per Occurrence Deductibe may be waived for outpatient services received at an in-network independent, non-hospita affiiated provider. 4 Famiy Deductibe is 2x Individua. For pans with a Non-Embedded deductibe, one or more eigibe members of a famiy unit may satisfy the entire Famiy Deductibe. No one in the famiy wi be eigibe for benefits unti the Famiy Deductibe has been met. 5 HSA-eigibe pans may ony be offered with pharmacy pans with a combined medica and drug annua deductibe. This benefit grid is intended ony to highight pan benefits and shoud not be reied upon to fuy determine coverage. These pans may not cover a heath care expenses. This poicy has excusions, imitations and terms under which the poicy may be continued in force or discontinued. For costs and compete detais of the coverage, contact your saes representative. 7

10 Consumer-Driven Heath UnitedHeathcare Heath Savings Account (HSA) and Heath Reimbursement Account (HRA) UnitedHeathcare s HSA and HRA pans are designed with the new heath care consumer in mind. Our HSA and HRA pans offer a medica pan, coverage for preventive care and a heath care account that members contro and access themseves to cover some of the costs of quaified medica expenses outside network preventive care. With these accounts, members shift from being passive heath care users to vaue-conscious, engaged consumers. HSA features Members can manage their medica caims and HSA together onine or with a customer care professiona. Three account types offer baance of interest, account fees and spending. Non-proprietary mutua fund investing is avaiabe. For greater member convenience, HSAs incude a debit card and onine bi payment. Accounts are administered by Optum Bank ȘM Member FDIC. OptumHeath Financia Services SM provides educationa toos that hep both empoyers and individuas successfuy engage in their financia heath. UnitedHeathcare HSA pans hep members become more informed and active heath care consumers. By taking ownership of their heath and heath care spending, empoyees can aso hep their empoyers have more contro of their heath care costs. Recent studies support the vaue of HSA-eigibe pans in reducing costs and promoting a heathier workpace. HSA-eigibe pans have shown 20% to 30% owercostthan-average premiums, heping U.S. businesses save money. 1 Premium savings for empoyees with an HSA-eigibe pan amount to an average $ HSA pan members are two to three times more ikey to participate in weness programs than those in nonconsumer-driven heath pans. 3 Our weness offerings incude worksite weness programs, a confidentia,* personaized heath assessment, onine and teephonic coaching and persona support. HRA features Empoyers and empoyees get tax savings with an HRA. The distributions from the empoyer-funded HRA are tax-deductibe to the empoyer; empoyee reimbursements from the HRA are tax-exempt. UnitedHeathcare offers a First Doar Shared- Deductibe HRA: An empoyer-defined percentage of each eigibe expense is paid out of the HRA and the rest is the member s responsibiity. Empoyers set the contribution amount and covered expenses Empoyees are automaticay enroed in the HRAeigibe medica pan Accounts are not funded unti a request for reimbursement is fied UnitedHeathcare caims are paid to the member automaticay and member is responsibe for providing payment to the provider Empoyers get reports to hep track account use HRAs can work with Fexibe Spending Accounts (FSAs) 1 HSA Insider, HSA Road Rues for Empoyers, Seventh Edition, May th Annua Nationa Business Group on Heath/Watson Wyatt Survey Report 2009, The Effect of the Economic Crisis on Heath Care Programs survey of 212,000 UnitedHeathcare members enroed in UnitedHeathcare Heath Savings Accounts for the fu year of * Confidentia to the fuest extent permitted by aw. 8

11 Consumer-Driven Heath Network Deductibe Out of Network Network2 Out-of-Pocket Maximum 1 Coinsurance Deductibe Type 4 Network Out of Network Network Out of Network PCP Spec ER Inpatient Hospita IP Per Occurence Deductibe 3 OP Per Occurence Deductibe 3 Combined Med/Rx Ded 5 Pan Code Seect Pus Direct HRA $2,000 $4,000 $6,350 $12,700 70% 50% 70% 70% 70% 70% $500 $250 Embedded No RZ-2 $3,000 $6,000 $6,350 $12,700 70% 50% 70% 70% 70% 70% $500 $250 Embedded No RZ-3 $4,000 $8,000 $6,350 $12,700 70% 50% 70% 70% 70% 70% $500 $250 Embedded No RZ-4 Seect Pus HSA $2,000 $4,000 $4,000 $8,000 90% 60% 90% 90% 90% 90% N/A N/A Non-Embedded Yes LX-W $2,000 $4,000 $5,000 $8,000 80% 50% 80% 80% 80% 80% N/A N/A Non-Embedded Yes RY-M $3,000 $6,000 $4,000 $12,000 90% 60% 90% 90% 90% 90% N/A N/A Non-Embedded Yes RY-N $3,000 $6,000 $5,000 $12,000 80% 50% 80% 80% 80% 80% N/A N/A Non-Embedded Yes RY-O $4,000 $8,000 $5,000 $16,000 80% 50% 80% 80% 80% 80% N/A N/A Non-Embedded Yes RY-P 1 Famiy Out-of-Pocket Maximum is 2x Individua. Member cost share, incuding Office Visits, deductibe, coinsurance and pharmacy, appy to the Out-of-Pocket Maximum. 2 Benefits with coinsurance (%) responsibiity are subject to the Deductibe. 3 The Per Occurrence Deductibe is separate from the Annua Deductibe and accrues toward the Out-of-Pocket Maximum. The Outpatient Per Occurrence Deductibe may be waived for outpatient services received at an in-network independent, non-hospita affiiated provider. 4 Famiy Deductibe is 2x Individua. For pans with a Non-Embedded deductibe, one or more eigibe members of a famiy unit may satisfy the entire Famiy Deductibe. No one in the famiy wi be eigibe for benefits unti the Famiy Deductibe has been met. 5 HSA-eigibe pans may ony be offered with pharmacy pans with a combined medica and drug annua deductibe. This benefit grid is intended ony to highight pan benefits and shoud not be reied upon to fuy determine coverage. These pans may not cover a heath care expenses. This poicy has excusions, imitations and terms under which the poicy may be continued in force or discontinued. For costs and compete detais of the coverage, contact your saes representative. 9

12 Non-Differentia PPO The UnitedHeathcare Non-Differentia PPO product provides maximum freedom for deaing with any heath care situation. This fexibe product provides a broader-based coverage to incude more doctors and speciaists to visit without referras. With this version of heath insurance, benefits are provided for covered heath services received from any physician or other icensed heath care professiona. Non-Differentia PPO Network Deductibe Out of Network Network2 Out-of-Pocket Maximum 1 Coinsurance Deductibe Type 4 Network Out of Network Network Out of Network PCP Spec ER Inpatient Hospita IP Per Occurence Deductibe 3 OP Per Occurence Deductibe 3 Combined Med/Rx Ded 5 Pan Code $500 $3,000 80% 80% 80% 80% 80% N/A N/A Embedded No LX-V 1 Famiy Out-of-Pocket Maximum is 2x Individua. Member cost share, incuding Office Visits, deductibe, coinsurance and pharmacy, appy to the Outof-Pocket Maximum. 2 Benefits with coinsurance (%) responsibiity are subject to the Deductibe. 3 The Per Occurrence Deductibe is separate from the Annua Deductibe and accrues toward the Out-of-Pocket Maximum. The Outpatient Per Occurrence Deductibe may be waived for outpatient services received at an in-network independent, non-hospita affiiated provider. 4 Famiy Deductibe is 2x Individua. For pans with a Non-Embedded deductibe, one or more eigibe members of a famiy unit may satisfy the entire Famiy Deductibe. No one in the famiy wi be eigibe for benefits unti the Famiy Deductibe has been met. 5 HSA-eigibe pans may ony be offered with pharmacy pans with a combined medica and drug annua deductibe. This benefit grid is intended ony to highight pan benefits and shoud not be reied upon to fuy determine coverage. These pans may not cover a heath care expenses. This poicy has excusions, imitations and terms under which the poicy may be continued in force or discontinued. For costs and compete detais of the coverage, contact your saes representative. 10

13 Pharmacy for Seect Pus, Consumer-Driven Heath, and Non-Differentia PPO UnitedHeathcare Pharmacy Designed to meet empoyers financia goas, as we as the heath and weness needs of their empoyees and their famiies, our pharmacy management program is incuded in a fuy insured pans. Here are the reasons to offer UnitedHeathcare Pharmacy: 1. We are aigned with empoyers goas: Focusing on tota heath care costs Emphasizing owering net costs, not rebate maximization Buiding and executing a consistent overa medica and pharmacy strategy This approach is based on the fact that we manage risk for tota heath care spending for approximatey 8 miion fuy insured members. 2. Our pharmacy management program focuses on a the components to hep ensure optima performance through: Benefit design that engages and motivates members to choose higher-vaue drugs A Prescription Drug List (PDL) based on evidence of tota heath care vaue and managed with fexibiity to quicky respond to new information and changing market conditions Demonstrated abiity to drive market share, motivating pharmaceutica companies to provide greater rebates, resuting in ower net costs for entire therapeutic categories Support toos and programs to hep consumers fuy understand their options and costs Compete physician-directed cinica programs to improve quaity of care and to support high heath care vaue options Deductibe 1 Member Copay Non-Speciaty Medications Member Copay Speciaty Medications Mai Order (90-Day Pan Code Individua Famiy Tier 1 Tier 2 Tier 3 Tier 4 Tier 1 Tier 2 Tier 3 Tier 4 Suppy) N/A N/A $10 $25 $40 N/A $10 20% 30% N/A 2.5x YN N/A N/A $10 $25 $50 N/A $10 20% 30% N/A 2.5x YO N/A N/A $10 $25 $60 N/A $10 20% 30% N/A 2.5x YS N/A N/A $10 $35 $50 N/A $10 20% 30% N/A 2.5x YP N/A N/A $10 $35 $60 N/A $10 20% 30% N/A 2.5x YT N/A N/A $15 $35 $50 N/A $15 20% 30% N/A 2.5x YR N/A N/A $15 $35 $60 N/A $15 20% 30% N/A 2.5x YQ N/A N/A $15 $35 $60 N/A $15 25% 30% N/A 2.5x IV N/A N/A $15 $45 $85 N/A $15 N/A N/A N/A 3x RU2 2 N/A N/A $10 $25 $40 25% $10 $25 $40 25% 2.5x 26 N/A N/A $10 $25 $50 25% $10 $25 $50 25% 2.5x 28 N/A N/A $10 $35 $50 25% $10 $35 $50 25% 2.5x 3P N/A N/A $10 $35 $60 25% $10 $35 $60 25% 2.5x 3T N/A N/A $15 $35 $50 25% $15 $35 $50 25% 2.5x 3V N/A N/A $15 $35 $60 25% $15 $35 $60 25% 2.5x 3X $150 $450 $15 $35 $60 N/A $15 25% 30% N/A 2.5x IW $200 $600 $10 $25 $40 N/A $10 20% 30% N/A 2.5x YU $200 $600 $10 $25 $50 N/A $10 20% 30% N/A 2.5x YV $200 $600 $10 $25 $60 N/A $10 20% 30% N/A 2.5x YW $200 $600 $10 $35 $50 N/A $10 20% 30% N/A 2.5x YX $200 $600 $10 $35 $60 N/A $10 20% 30% N/A 2.5x YY $200 $600 $15 $35 $50 N/A $15 20% 30% N/A 2.5x YZ $250 $750 $15 $35 $60 N/A $15 25% 30% N/A 2.5x IY $250 $750 $20 $40 $60 N/A $20 25% 30% N/A 2.5x IZ Combined Medica/Pharmacy Deductibe Pans Medica Deductibe Appies $10 $25 $40 N/A $10 20% 30% N/A 2.5x YN $10 $25 $60 N/A $10 20% 30% N/A 2.5x YS $10 $35 $60 N/A $10 20% 30% N/A 2.5x YT $15 $35 $50 N/A $15 20% 30% N/A 2.5x YR $15 $35 $60 N/A $15 25% 30% N/A 2.5x IV $10 $35 $60 25% $10 $35 $60 25% 2.5x 3U $15 $35 $50 25% $15 $35 $50 25% 2.5x 3W $15 $35 $60 25% $15 $35 $60 25% 2.5x 33 1 Does not appy to Tier 1, except for pan IZ and pharmacy pans subject to the Medica Deductibe. 2 This pharmacy pan may ony be paired with medica pans with a $1,000 or greater deductibe. It is not eigibe to be paired with HSA pans or any other pans with a combined medica/pharmacy deductibe. Ony generic drugs are covered with this pan under Tier 1. State-mandated brand-name drugs, if any, are covered under Tier 2 and Tier 3. 11

14 Signature,* Advantage* and Aiance* The Signature pan incudes our fu network of contracted providers. With this HMO pan, members simpy choose a Primary Care Physician (PCP) from our network to coordinate a their medica care. They can then visit their PCP for routine checkups, and when they need to see a speciaist, their PCP can provide a referra. Members are charged ony a copayment for each doctor s visit. Preventive care, incuding checkups, is covered. The Advantage pan offers the same eve of benefit coverage as a traditiona HMO pan at a ower premium. The difference is in the network. The Advantage pan offers a narrower network of contracted providers. Members must choose a PCP from the Advantage network to coordinate a their medica care. The Aiance pan requires members to choose a PCP from network medica groups that were seected based on their outstanding reputations and cinicay proven abiities to deiver the kind of care that keeps heath care costs down. The focus of these pans is on patientcentered care the PCP coordinates the member s care with other physicians and speciaists in their chosen medica group s network to ensure that the member wi receive outstanding care. As with our other pans, members get the toos they need to do their own evauations, so they can seect the right physician to meet their unique needs and preferences. To make these pans fexibe enough to meet the needs of empoyers and their empoyees, they can be paired with either an HSA or an HRA. These options each provide a unique set of features, benefits and requirements. For exampe, the empoyee is the owner of the HSA, whie HRAs give the empoyer much more contro over which expenses to cover. With both types of account, funds can ro over from year to year to aow members to save for bigger expenses, and significant tax benefits can be reaized, with proper use. * Forma HMO product names: Signature = UnitedHeathcare SignatureVaue Advantage = UnitedHeathcare SignatureVaue Advantage Aiance = UnitedHeathcare SignatureVaue Aiance 12

15 Signature, Advantage and Aiance Deductibe 1 Out-of- Pocket PCP Spec ER Maximum 2 Inpatient Hospita IP Copay Max IP Copay Type Outpatient Surgery Deductibe Combined Type Med/Rx Deductibe HMO Pan Codes Signature Advantage Aiance N/A $1,500 $10 $20 $ % 100% N/A 100% N/A N/A L0A LHP LJ7 N/A $1,500 $15 $30 $ % 100% N/A 100% N/A N/A LB1 LHS L5J N/A $1,500 $20 $40 $ % 100% N/A 100% N/A N/A LB8 LHW L90 N/A $1,500 $10 $20 $150 $250 $250 Admit $125 N/A N/A LCA L5H L94 N/A $1,500 $15 $30 $150 $250 $250 Admit $125 N/A N/A LC2 L0G LKE N/A $1,500 $20 $40 $150 $250 $250 Admit $125 N/A N/A LC6 LOV LKR N/A $1,500 $10 $20 $150 $500 $500 Admit $250 N/A N/A LD8 L5N LKW N/A $1,500 $15 $30 $150 $500 $500 Admit $250 N/A N/A LE1 LOM L5K N/A $1,500 $20 $40 $150 $500 $500 Admit $250 N/A N/A L0D LI1 L8K N/A $2,000 $15 $30 $150 80% 80% N/A 80% N/A N/A LFE LI6 LLM N/A $2,000 $20 $40 $150 80% 80% N/A 80% N/A N/A LFR L2I LLT N/A $2,000 $30 $50 $150 80% 80% N/A 80% N/A N/A LFV L5I LL6 N/A $3,000 $15 $30 $150 70% 70% N/A 70% N/A N/A L1P L8I LLX N/A $3,000 $20 $40 $150 70% 70% N/A 70% N/A N/A LF6 L80 L5L N/A $3,000 $30 $50 $150 70% 70% N/A 70% N/A N/A LC9 L83 LMM N/A $3,000 $15 $30 $150 60% 60% N/A 60% N/A N/A LC0 L86 LMQ N/A $3,000 $20 $40 $150 60% 60% N/A 60% N/A N/A LGR LO9 LMU N/A $3,000 $30 $50 $150 60% 60% N/A 60% N/A N/A LGV LJP LM6 N/A $3,000 $40 $60 $150 70% 70% N/A 70% N/A N/A LEY LJS L1M $1,000 $3,000 $40 $60 $150 70% 70% N/A 70% Emb No LG1 LJW L7M $2,000 $3,000 $40 $60 $150 70% 70% N/A 70% Emb No LOS LJ1 LM9 HRA-Eigibe $1,500 $4,000 90% 90% N/A 90% 90% N/A 90% Emb No N/A N/A LN1 $2,000 $5,000 80% 80% N/A 80% 80% N/A 80% Emb No N/A N/A LN7 $3,000 $6,000 70% 70% N/A 70% 70% N/A 70% Emb No N/A N/A L1N HSA-Eigibe 3 $1,500 $3,000 90% 90% N/A 90% 90% N/A 90% Non-Emb Yes N/A N/A LNH $2,000 $4,000 80% 80% N/A 80% 80% N/A 80% Non-Emb Yes N/A N/A LNQ $3,000 $6,000 80% 80% N/A 80% 80% N/A 80% Emb Yes N/A N/A LNT 1 Famiy Deductibe is 2x Individua. For pans with a Non-Embedded deductibe, one or more eigibe members of a famiy unit may satisfy the entire Famiy Deductibe. No one in the famiy wi be eigibe for benefits unti the Famiy Deductibe has been met. 2 Famiy Out-of-Pocket Maximum is 2x Individua. Member cost share, incuding Office Visits, deductibe, coinsurance and pharmacy, appy to the Out-of- Pocket Maximum. 3 Ony pharmacy pans 3DW, 3DY and 3EO are avaiabe with Aiance HSA-eigibe pans. 13

16 Pharmacy for Signature, Advantage, and Aiance OptumRx As a eading pharmacy benefit manager serving more than 11 miion members, OptumRx is committed to offering quaity pharmacy benefits at a reasonabe price. We reaize that peope are more than their prescriptions. That s why our integrated medica and pharmacy mode considers the whoe person. Combined data is used to make decisions and deiver the best possibe heath outcomes. Through a partnership approach, we work to: Deiver a simpe, high-touch service mode. Our pharmacy experts hep empoyers get the most from their benefits. Administration is easier with one contact, one bi and integrated reporting. Members get a singe ID card, customer care number and website. Drive prescriber coaboration. Through on-site visits and educationa materias, we work to increase generic utiization, mai service use and formuary compiance. Pus, manage speciaty drug trend. Improve quaity and safety through formuary and cinica program management. We aso monitor fraud, waste and abuse through rea-time audit and reguatory coaboration. Maximize savings through better trend and cost management. We achieve this through formuary management, product design and utiization strategies. Empowering members to take charge of their heath can hep contro costs. Members using medications as prescribed may have fewer doctor visits and hospitaizations, which can ead to ower medica expenses. And that heps empoyers, too. Members can fi prescriptions through mai service and enjoy convenient door-to-door deivery. Or, they can choose one of our 64,000 network retai pharmacies. Pharmacy for Signature, Advantage, and Aiance Deductibe 1 Member Copay Mai Order Individua Famiy Generic Brand-Name (90-Day Suppy) Formuary Formuary Non-Formuary Speciaty Medications Pan Code N/A N/A $10 $25 $40 N/A 2x 3AI N/A N/A $10 $25 $50 N/A 2x 3EI N/A N/A $10 $25 $60 N/A 2x 3KH N/A N/A $10 $35 $50 N/A 2x 3MH N/A N/A $10 $35 $60 N/A 2x 3OI N/A N/A $15 $35 $50 N/A 2x 3QI N/A N/A $15 $35 $60 N/A 2x 3WI N/A N/A $20 $35 $50 N/A 2x 3XI N/A N/A $10 $25 $40 25% (max $300) 2x 4MS N/A N/A $10 $25 $50 25% (max $300) 2x 4MU N/A N/A $15 $35 $50 25% (max $300) 2x 4MP N/A N/A $15 $35 $60 25% (max $300) 2x 4MQ N/A N/A $20 $35 $50 25% (max $300) 2x 4MR $100 $300 $20 $60 N/A N/A 2x 2OA $100 $300 $20 $80 N/A N/A 2x 2OD $200 $600 $10 $25 $40 N/A 2x 3YI $200 $600 $10 $25 $50 N/A 2x 3ZI $200 $600 $10 $35 $50 N/A 2x 3NF $200 $600 $15 $35 $50 N/A 2x 3OF $200 $600 $20 $35 $50 N/A 2x 3QF Deductibe Member Copay Mai Order (90-Day Pan Code Offered with 2 Individua Famiy Generic Brand-Name Suppy) Medica Pan Formuary Formuary Non-Formuary Speciaty Medications Combined Medica/Pharmacy Deductibe Pans $10 $30 $50 N/A 2x 3Y5 LNH Medica Deductibe Appies $10 $30 $50 N/A 2x 3Y6 LNQ $10 $30 $50 N/A 2x 3Y7 LNT 1 Does not appy to Generic drugs. 2 Ony pharmacy pans 3Y5, 3Y6 and 3Y7 are avaiabe with Aiance HSA-eigibe pans. 14 For more information about by OptumRx, visit

17 eservices for Seect Pus, Consumer-Driven Heath, and Non-Differentia PPO Avaiabe with Seect Pus, Consumer-Driven Heath and Non-Differentia PPO pans. Programs subject to change. Soutions for Empoyers Empoyer eservices provides streamined administration for empoyers Empoyer eservices is UnitedHeathcare s secure website that provides immediate and secure sef-service access to heath benefits information. Sef-service efficiency eads to: Increased member satisfaction members have access to their benefits immediatey and experience ess hasse at the time of service with updated eigibiity information Increased accuracy empoyers benefit from accuracy through rea-time processing and more accurate biing statements From eigibiity maintenance to customer reporting and biing soutions, Empoyer eservices is a gateway to toos that make heath benefits administration more efficient. Onine eigibiity maintenance Add new empoyees Verify and change eigibiity Request heath pan ID cards Verify or change status of empoyees and dependents Onine biing Check caims status (sef-funded customers ony) View invoices Authorize payment Downoad invoices into spreadsheets View, sort and search current and prior month s invoices Request adjusted invoices after changing/adding eigibiity information Rea-time reporting* View benefit pan cost and use information Access free standard reports and optiona customized reports Downoad free empoyee communication toos Onine enroment UnitedHeathcare s OninEnro offers a quick, easy and accurate way for presenting, coecting and managing empoyee benefit enroment data with one integrated soution. Communication Resource Center (CRC) The Communication Resource Center on or makes it easy for empoyers to communicate with their empoyees and hep them get the most from their benefit pan. Access fiers, posters, brochures and artices that empoyers can emai, print, use in company newsetters or any other form of empoyee communication Buid a customized newsetter with artices provided Use communication toos that hep empoyers pan a workpace weness campaign Soutions for Brokers United eservices United eservices makes administration simper for brokers who are appointed to se UnitedHeathcare pans. We deveoped the United eservices website to hep appointed brokers and consutants streamine their administrative tasks and provide better service to empoyers. Brokers can access an array of onine toos and information: Network information Onine commission statements and bonus schedues Saes support materias Reward program information Forms United eservices aso provides a gateway to the Empoyer eservices site for those brokers who manage benefits administration on behaf of their cients. Register with United eservices onine. Visit unitedeservices.com and cick on the registration button. We provide the most current Sma Business pan information and toos right at the fingertips at With our new expanded sma business product portfoio that incudes new and improved pans, you can view and downoad PDFs by a cick of a button. This incudes: Product cataogs Forms Weness toos Brochures and fyers for speciaty pans, such as denta and vision, no-fee administrative services and more Brokers aso can send a request for a quote. Visit today. *Avaiabiity based on group size and funding arrangements 15

18 Vaue-Added Programs for Seect Pus, Consumer-Driven Heath, and Non-Differentia PPO Our goa is to hep empoyers and empoyees manage costs by heping peope improve their tota heath and productivity. That s why we offer these additiona heath and weness programs with a our Seect Pus, Consumer-Driven Heath and Non-Differentia PPO pans at no additiona charge. UnitedHeath Premium designation program The UnitedHeath Premium program evauates physicians using nationa evidence-based guideines for quaity and oca market benchmarks for cost efficiency. The Premium designation can hep members choose the care that s right for them. UnitedHeath Premium Tier 1 physicians have received the Premium designation for either Quaity & Cost Efficiency or Cost Efficiency & Not Enough Data to Assess Quaity. Physicians have aready received notification of their Premium designation status. The designation resuts are avaiabe on myuhc.com and in other provider directories. For more information, visit UnitedHeathPremium.com. myheathcare Cost Estimator myheathcare Cost Estimator is your empoyees personaized onine too that wi empower them to make more informed heath care decisions. myheathcare Cost Estimator is avaiabe to UnitedHeathcare members at no additiona cost. When members are abe to get information based on their pan, they have the knowedge to better understand their choices and be in greater contro of heath care. United Resource Networks Through our affiiate company, United Resource Networks (U.R.N.), we provide access to Centers of Exceence networks comprising medica centers that U.R.N. identifies as speciaists in the treatment of specific conditions and that meet strict evauation requirements. U.R.N. aso provides cinica consuting services to manage treatment programs and costs to maximize empoyee benefits. United Behaviora Heath Our goa is to hep empoyers manage costs by heping peope improve their tota heath and productivity. That s why we offer compete behaviora heath and substance abuse services, ranging from counseing to acute inpatient care. We do this through behaviora heath benefits deivered by our affiiate, United Behaviora Heath (UBH). Features Support and treatment for menta heath and substance use issues Integration with medica benefits for streamined administration Indirect and direct cost-savings Care24 Our Care24 assists empoyees with heath, persona or famiy-reated concerns via a to-free phone number 24 hours a day, seven days a week. One to-free number puts them in touch with nurses, counseors, financia consutants and attorneys. For situations where in-person resources are needed, Care24 contracts with more than 9,000 professionas nationwide who provide oca support. In addition, our database of more than 60,000 unique community resources, representing 400,000 points of expertise, adds to Care24 s depth of service. Care24 aso offers empoyers access to audio messages on more than 1,100 heath and we-being topics. Most audio tapes are avaiabe in Spanish, and we provide transation services for more than 140 anguages. esync Patform Technoogy UnitedHeathcare s sophisticated esync patform takes a big-picture ook at a member s heath, and, using proprietary technoogy, aerts the member and his or her physician to a potentiay serious condition so that intervention can occur at the diagnostic stage. 16

19 Care Coordination SM Coordinates and customizes services where gaps in care may exist. Education and prevention programs incude pre-admission counseing, inpatient care advocacy and readmission prevention. Disease Management Identifies high-risk individuas with chronic conditions, such as asthma, diabetes and coronary artery disease, who may benefit from a focused intervention program. Individuas are paced on one of three eves of intervention to improve quaity of ife and keep cost trends in check. Reminders Program Encourages individuas to get recommended preventive care and screenings, incuding mammograms, diabetic eye exams, pediatric immunizations and fu shots. Evidence-Based Medicine Improves consistent cinica outcomes and reduces inefficient deivery of care. We offer Cinica Evidence (a compiation of thousands of recent research studies); faciitate peer-to-peer, data-sharing consutations; and provide physicians and hospitas with reevant data regarding their performance compared to nationay accepted, evidence-based practices. myuhc.com Gives members with Seect Pus, Consumer-Driven Heath and Non-Differentia PPO pans onine, sefservice access to benefit and network information. myuhc.com aso provides customized information and artices on hundreds of heath-reated topics. Compex Medica Conditions The Compex Medica Conditions program provides access to Centers of Exceence networks comprising medica centers that are identified as speciaists in the treatment of specific conditions and that meet strict evauation requirements. The Compex Medica Conditions program aso provides cinica consuting services to manage treatment programs and costs to maximize empoyee benefits. 17

20 Vaue-Added Programs for Signature, Advantage, and Aiance 18 Disease Management and Heath Management Programs Managing a disease is never easy. But with the right support and information, it can be made more toerabe. Catastrophic Care Management Compex case management Specia Popuation Care Frai members, ER frequent users, pre-catastrophic care, terminay i members Chronic Disease Management CHF, CAD/stroke, COPD, ESRD Diabetes, Depression, AMI We offer case-based disease management programs for: Asthma Cancer Chronic Obstructive Pumonary Disease Congestive Heart Faiure Coronary Artery Disease/Stroke Depression Diabetes End-Stage Rena Disease Neonata Care Management Heathy Pregnancy Program We aso offer Heath Management programs that are over and above the traditiona heath care coverage. These extended services provide education and sef-care information that can hep members ive heathier ives. Our Heath Management programs incude: Taking Charge of Asthma Taking Charge of Diabetes Taking Charge of Your Heart Heath StopSmoking TM Heath discount program Acute Episode Management In-/Out-pt. Medica Management Transitiona, Continuity of Care Preventive Heath Management HeathCredits, preventive care/ risk reduction, heath improvement, member education The heath discount program offers members savings of between 5-50 percent on a variety of products, programs and services, ranging from aternative and compementary therapy discounts, to nationa weight oss programs ike Jenny Craig. Denta, Vision, aternative care and infertiity treatment savings Fitness equipment and appare discounts Reduced rates on fitness cubs, incuding 24 Hour Fitness, LA Fitness, Anytime Fitness, Bay Tota Fitness, Curves, God s Gym and Snap Fitness HMO members can og on to and search through the Heath and Weness tab to find providers and discounts, and start taking advantage of this program. Heathy Pregnancy program This program is ike a fairy godmother for any momto-be. In addition to an information resource center that provides vauabe tips, advice, screening and immunization schedues, and what mothers need to know for pre- and post-baby heath, Heathy Pregnancy program aso incudes: Pregnancy consutation to identify a new mother s risks and specia care needs 24-hour to-free access to experienced maternity nurses Compimentary book: Your Journey Through Pregnancy The Heathy Pregnancy program is a competey new program for HMO members. 24-Hour Information If members need answers to genera heath questions, they no onger need to wait unti Monday morning. For those who prefer to pick up the phone, they may ca PHS-HEALTH to speak to a icensed registered nurse about genera heath issues. They aso have the option of istening to prerecorded information on a variety of heath topics. Onine Sef-Service At HMO members may order ID cards and change their provider, pus get access to interactive heath information, heath benefits, doctor directories, information on the Mai Service Pharmacy, heath tips, resource inks and more. NurseLine SM Efficient use of heath care resources can hep contain empoyers medica costs. NurseLine nurses provide heath information, discuss treatment options and assist individuas in finding an appropriate eve of care. Maintaining good heath starts with asking questions and understanding the answers. NurseLine services empower peope with information, support and guidance. From heping prepare questions for an upcoming doctor visit to determining the appropriate use of medica resources, NurseLine heps individuas make educated decisions about their persona heath. NurseLine provides immediate access to experienced registered nurses for neary any heath or medica concern 24 hours a day, seven days a week.

21 Vaue-Added Programs Avaiabe with Every Pan Sma Business Weness Programs As more companies ook for ways to ower their heath care costs, we beieve that weness programs in the workpace coud potentiay save empoyers money. When empoyees earn how to make good decisions for their heath, everyone wins. UnitedHeath Weness UnitedHeath Weness is a group of programs and services designed to hep members make heathy ifestye decisions that coud affect their ong-term quaity of ife. Among the toos and resources offered are a persona heath record, onine heath coaching, an onine heath assessment, a Heathy Pregnancy program, and heath and weness pubications. Fitness reimbursement program The fitness reimbursement program offers money back to members who on a reguar basis go to a participating fitness center, incuding 24 Hour Fitness, LA Fitness, Anytime Fitness, Curves, Life Time Fitness, Snap Fitness, the Y and more. Biometric screenings and coaching Biometric heath screenings and weness coaching can hep make a measurabe difference for empoyers and their empoyees. Home-screening kits for both the member and spouse are sent and received by mai to check their choestero, gucose and body-mass index. In addition, teephone weness coaching is avaiabe on diabetes, exercise, heart heath, nutrition, stress, tobacco cessation and weight. Heath discount program Our heath discount program heps members and their famiies save 10 to 25 percent on non-covered heath and weness purchases from participating providers. Even with medica, denta and vision coverage, enroed heath pan members can save even more money by using the heath discount program for denta care, hearing devices, vision care, ong-term care services, infertiity treatment and aternative care such as acupuncture, chiropractic care, massage therapy and natura medicine. Preventive care services Preventing disease or detecting disease eary is important to iving a heathy ife. The better an individua s heath, the ower heath care costs are ikey to be. UnitedHeathcare provides information about guideines for maintaining heath, incuding heath screenings and recommended immunization schedues for chidren up to 18 years of age as we as preventive care guideines for aduts 18 and oder. Member onine porta UnitedHeathcare has set up a website on heath and weness information at uhctogether.com/uhcweness. Designed to hep members understand their heath care choices and get the most out of their coverage, it offers easy-to-use onine toos and personaized information. Aso, UnitedHeathcare wi provide a promotiona too kit to hep spread the news to members about these new programs and the new website. CaféWe It is a fun, a in one weness program that s easy for empoyers to impement, and fun and rewarding enough to keep empoyees engaged and motivated. The program combines heath and fitness chaenges and socia networking. CaféWe connects members with the toos they need to make meaningfu ifestye changes and giving them the chance to win prizes. 19

22 Vaue-Added Programs Avaiabe with Every Pan (continued) Market-Specific Soutions and Resources Muticutura Soutions Latino Heath Soutions SM Latinos have specific heath care and cutura preferences and many prefer Spanish, especiay when deaing with such compicated or persona subjects as heath care coverage. We understand these cutura preferences and have designed a broad range of services to assist empoyers needs within the Latino community, incuding: A Spanish-anguage website, offers interactive, easy-to-use, Web-based heath and educationa resources. Schedues of benefits and enroment materias in Spanish. Onine provider directory of Spanish-speaking physicians. Customer service in Spanish, with biingua customer care professionas. Asian American Markets UnitedHeathcare has worked to deveop aternative pans, heath education and in-anguage communications to better serve our Asian American customers and members. Asian American Markets features: an educationa website that offers genera heath care topics and terms in Engish, Chinese, Korean, Vietnamese and Japanese. Asian-anguage provider directories that won the 2007 Recognizing Innovation in Muticutura Heath Care Award from the Nationa Committee of Quaity Assurance. Sponsored community events for traditiona Asian hoidays, incuding Lunar New Year. Generations of Weness When it comes to good heath, peope need to have options that take into account their individua needs not ony their background and history, but their cutura preferences and even where they ive and work. That s why UnitedHeathcare created Generations of Weness, an initiative designed to address heath issues specific to African Americans. By providing more reevant options and choices, we re working to create a better heath care experience. Generations of Weness heps members: Create their own personaized road maps to good heath by using innovative, interactive heath toos, such as our Famiy Heath History Tree and heath tip fiers, found on Become more engaged in their own heath, and their community, by participating in UnitedHeathcare-sponsored heath and weness events. Prevent or manage diabetes, stroke and other conditions that affect a disproportionatey high number of African Americans by referencing our heath tip fiers utiizing our Onine Heath Coach. Resources for Women Source4Women Source4Women, our women s website at uhc.com/source4women.htm offers an onine space for women to share their insights about heath and improve their abiity to manage their heath care. Our femae members and their friends and famiy members can register to participate in the Source4Women communities by going to uhc.com/source4women/community. There women wi find four core communities, discussions and advice, emai notifications and bogs about managing their, and their famiies, heath and more. The site aso offers onine seminars so that they wi be abe to hear from eading women s heath experts on key topics. 20

23 Packaged Savings Buy medica pan and speciaty benefits together and save. UnitedHeathcare and our affiiated companies give the empoyers one-stop shopping for quaity, comprehensive heath care benefits. Empoyers can combine our innovative medica pans with comprehensive speciaty benefits denta, ife, disabiity and vision. When they bunde the benefits, they can expect proven knowedge and service from a eading speciaty carrier pus the simpicity and convenience of just one team to administer benefits. The savings empoyers reaize through Packaged Savings are based upon medica enroment and the number of active ines of speciaty coverage they have with the UnitedHeathcare famiy. The more they bunde, the more they save. Packaged Savings means: Bunded UnitedHeathcare medica and speciaty benefits for administrative credit Savings based on medica enroment and the number of eigibe empoyer paid or contributory speciaty coverages chosen One account team from UnitedHeathcare to serve a of your benefits needs Streamined administration State-of-the-art onine toos UnitedHeathcare Benefit Services SM UnitedHeathcare Benefit Services comes at no additiona cost when empoyers purchase medica coverage through UnitedHeathcare, to hep empoyers and their empoyees save both time and money. Pre-Tax Premium Pans. These pans aow empoyers and their empoyees to pay your premiums on a pre-tax basis, which owers their taxabe income under Section 125. Empoyees can reduce their payro-reated taxes, and they can decrease their taxabe income and increase their take-home pay. COBRA Administration. We offer streamined administration and efficient record-keeping, so empoyers can focus on managing and growing their business, not on the administrative responsibiities required by COBRA. Fexibe Spending Accounts (FSA). Our FSA services incude panning, impementation, communication, administration, compiance and maintenance. When your group purchases medica and: Receive the foowing potentia savings cacuated per empoyee per month: Denta $3.00 Vision $2.00 Life 1 $1.00 Short-term disabiity 2 $1.00 Life 1 and short-term disabiity 2 $2.00 Life 1 and ong-term disabiity 2 $2.00 Denta and vision $5.00 Denta and ife 1 $4.00 Vision and ife 1 $3.00 Denta, vision and ife 1 $6.00 Denta, vision, ife 1 and short-term disabiity 2 $ Any combination of ife products counts as one product for the purpose of the program. 2 Any combination of disabiity products counts as one product for the purposes of the program. Long-term disabiity must be bunded in conjunction with ife or short-term disabiity coverage to quaify for the program and be eigibe for credit. Per-empoyee per-month savings is given as a monthy credit based on the number of enroed UnitedHeathcare medica subscribers. 21