Good health happens together

Transcription

1 Good health happens together CITY OF BALTIMORE 2016 HEALTH CARE OPTIONS WHAT S INSIDE BENEFITS OVERVIEW WELLNESS RESOURCES ONLINE TOOLS

2 Thank you for considering UnitedHealthcare. We are proud to again have the opportunity to administer your City of Baltimore benefit plan options. Our goal is to give you the best experience possible, with tools and support to help you save time and find care when you need it. Choose from three health plans Each plan gives you access to our network of doctors and hospitals, 100% preventive care coverage and online tools and resources to help you manage the health care for you and your family. 1 UnitedHealthcare Choice HMO (lowest cost UnitedHealthcare plan) $5 co-pay for primary care physician (PCP) $5 co-pay for specialists No deductibles or co-insurance Preventive services covered at 100% in-network Emergency coverage anywhere in the world 2 UnitedHealthcare POS High Option $5 co-pay for primary care $5 co-pay for specialists No deductibles Preventive services covered at 100% 100% coverage in network National network No referrals required 3 UnitedHealthcare POS Standard Plan $25 co-pay for primary care $40 co-pay for specialists Preventive services covered at 100% 90% coverage (after deductible) in network National network No referrals required New plan features: Access to national network of more than 800,000 health care providers and 5,700 hospitals, including laboratory and radiology facilities You don t have to select a PCP No referrals required 2

3 Summary of Benefits: 2016 UnitedHealthcare Plan Options Plan Overview UnitedHealthcare Choice HMO UnitedHealthcare POS High Option UnitedHealthcare POS Standard Plan Network Network Non-network 1 Network Non-network Referrals No No No National Network Yes Yes Yes Deductible None None Out-of-Pocket Maximum $1,100 Individual $3,600 Family $1,000 Individual $2,000 Family Out-of-pocket maximum does not apply $250 Individual $500 Individual $500 Family $1,000 Family Salary < $45,000 $1,000 Individual $2,000 Family Salary > $44,999 $1,500 Individual $3,000 Family Lifetime Maximum Unlimited Unlimited Unlimited Medical Overview Physician Office Visits Salary < $45,000 $2,000 Individual $4,000 Family Salary > $44,999 $3,000 Individual $6,000 Family Primary Care Physician $5 co-pay $5 co-pay $5 co-pay; 100% allowed benefit $25 co-pay 80% after deductible Specialist $5 co-pay $5 co-pay $5 co-pay; 100% allowed benefit $40 co-pay 80% after deductible Inpatient Care 100% 100% 100% allowed benefit 90% after deductible 70% after deductible Inpatient Hospitalization 100% 100% 100% allowed benefit 90% after deductible 70% after deductible Outpatient Facility/Physician 100% 100% 100% allowed benefit 90% after deductible 70% after deductible Maternity 2 100% 100% 100% allowed benefit 100% 80% after deductible Diagnostic Lab and X-ray 100% 100% 100% allowed benefit 90% after deductible 70% after deductible Durable Medical Equipment 100% 100% 100% allowed benefit 90% after deductible 70% after deductible Emergency Room/ER Physician Services Behavioral Health $50 co-pay waived if admitted $50 co-pay waived if admitted $50 co-pay waived if admitted 90% after deductible 90% after deductible Inpatient 100% 100% 100% allowed benefit 90% after deductible 70% after deductible Outpatient $5 co-pay $5 co-pay $5 co-pay; 100% allowed benefit $25 co-pay 80% after deductible Urgent Care $5 co-pay $5 co-pay $5 co-pay; 100% allowed benefit $25 co-pay; 90% $25 co-pay; 90% Preventive Care Mammography 100% 100% $5 co-pay; 100% allowed benefit 100% 100% after deductible Immunizations, Including Annual Flu Shots 100% 100% $5 co-pay; 100% allowed benefit 100% 100% after deductible Well Child Care 100% 100% $5 co-pay; 100% allowed benefit 100% 100% after deductible Annual Physical Exams 100% 100% $5 co-pay; 100% allowed benefit 100% 100% after deductible Physical/Occupational/ Speech Therapy 3 $5 co-pay $5 co-pay $5 co-pay; 100% allowed benefit 90% after deductible 70% after deductible Acupuncture for Chronic Pain Management 3 $5 co-pay $5 co-pay $5 co-pay; 100% allowed benefit $40 co-pay 80% after deductible Chiropractic Services 3 $5 co-pay $5 co-pay $5 co-pay; 100% allowed benefit $25 co-pay 80% after deductible Hearing Aids 100% 100% 100% allowed benefit 90% after deductible 70% after deductible You also have the added option for discounted services on laser vision correction surgery through Laser Vision Network of America. This outline is intended as a summary only. For a detailed description of the benefits available, please refer to the Certificate of Coverage. 1 Allowed benefit is 50th percentile of Reasonable and Customary (R&C). When you receive services from a non-network provider, you are responsible for any amounts over the allowed benefit amount. 2 Routine maternity only. 3 Please call the Plan for number of visits. 3

4 Personalized resources Need support and help? We re on it. We know that managing your health plan benefits isn t always easy. That s why we have a team of people dedicated to helping you. City of Baltimore members have a dedicated Customer Care team who can help you with your concern. From questions about your benefits to finding a doctor near you, we re here to provide support and resources to help you and your family make confident health care decisions. Call a personal customer care professional who will help you get the answers and help you need to make the most of your health plan. Call Customer Care at We can also connect you to a nurse with mynurseline SM. If you have a health concern in the middle of the night, questions about your prescriptions, or you re curious about treatment options, our nurses can provide you with the information you need. You can call for 24/7 nurse support at Get behavioral health support Sometimes the challenges you face can feel like too much to handle. Your benefits include behavioral health support provided by United Behavioral Health. From everyday challenges to more serious issues, you can receive confidential help for: Depression, stress and anxiety Substance use and recovery Eating disorders Parenting and family problems To find out more, visit liveandworkwell.com. Disease Management Programs If you are dealing with a chronic condition, we offer a suite of complimentary Disease Management Programs to help you take charge and manage your condition. Our Disease Management Programs offer personalized support for the following conditions: Heart Failure Coronary Artery Disease (CAD) Diabetes Asthma Healthy Pregnancy Program At every stage of your pregnancy, benefit from: 24-hour access to experienced nurses Information to help identify risks and special needs Online Healthy Pregnancy Owner s Manual and other materials Learn more at healthy-pregnancy.com. 4

5 Resources on the go Access to care where you need it Whichever plan you choose, you ll have access to our nationwide network. You re covered when you travel. If you need to see a specialist, there s likely one close by. You have access to the best health care centers in the industry. More than 800,000 Health care More than providers 5,700 Hospitals and health care facilities Including every hospital in Maryland MD How to find a network doctor or hospital Go Online 1 Visit myuhcbaltimore.com 2 Select a plan 3 Click the network link under Find Your Doctor. You can search by distance, gender, language and more. Talk to a doctor 24/7 New for 2016: Access to care online at any time with a virtual visit When you don t feel well, or your child is sick, the last thing you want to do is leave the comfort of your home to sit in a waiting room. Now, you don t have to. A virtual visit lets you see and talk to a doctor from your computer or mobile device without an appointment. Information will be available on myuhc.com and through the UnitedHealthcare Health4Me app in

6 Visit your City of Baltimore support site for all your enrollment information As a City of Baltimore employee, you have access to a customized support site dedicated to giving you the information you need to choose the health plan that best fits you and your family. The site offers: Details on your plan options including a plan comparison grid Lists of wellness programs available through your health plan Links to learn about your digital tools and resources, such as myuhc.com, the Health4Me app, virtual visits and more To learn more about the benefits offered by UnitedHealthcare, visit myuhcbaltimore.com. myuhc.com: your member website for managing your health care Once you become a UnitedHealthcare member, myuhc.com puts all of your health benefits right at your fingertips. It s loaded with your plan information, including your deductible and out-of-pocket balances, and gives you tools to calculate health care costs, find a doctor and more. Need a new doctor or a specialist? You can search for doctors near you and even see which doctors have been recognized by the UnitedHealth Premium Designation program for having met national quality standards and local benchmarks for cost-efficiency. Want to get rid of that nagging pain, but worried about the cost? The health care cost estimator tool may help you get the best care for the best cost. Looking for an easier way to manage claims? You can track claims, mark claims you ve already paid, and review graphs to better understand what you owe. Subscribers can pay their health care providers online for any claim that there is an amount owed. Always on the go? We can help you there too. Health4Me Whether you need to find urgent care, pull up a copy of your health plan ID card, or contact us, the UnitedHealthcare Health4Me mobile app helps put your benefit information in the palm of your hand. 6

7 Where to go for care Helping you choose the right care center Care center Why would I use this care center? What type of care would they provide for example*? What are the cost** and time considerations?** Doctor s Office You need routine care or treatment for a current health issue. Your primary doctor knows you and your health history, can access your medical records, provide preventive and routine care, manage your medications and refer you to a specialist, if necessary. Routine checkups Immunizations Preventive services Manage your general health Often requires a co-pay and/or co-insurance Normally requires an appointment Little wait time with scheduled appointment Convenience Care Clinic You can t get to your doctor s office, but your condition is not urgent or an emergency. Convenience care clinics are often located in malls or retail stores offering services for minor health conditions. Staffed by nurse practitioners and physician assistants. Common infections (e.g., strep throat) Minor skin conditions (e.g., poison ivy) Flu shots Pregnancy tests Minor cuts Earaches Often requires a co-pay and/or co-insurance similar to office visit Walk in patients welcome with no appointments necessary, but wait times can vary Urgent Care Center You may need care quickly, but it is not an emergency, and your primary physician may not be available. Urgent care centers offer treatment for non-life threatening injuries or illnesses. Staffed by qualified physicians. Sprains Strains Minor broken bones (e.g., finger) Minor infections Minor burns Often requires a co-pay and/or co-insurance usually higher than an office visit Walk in patients welcome, but waiting periods may be longer as patients with more urgent needs will be treated first Emergency Room You need immediate treatment of a very serious or critical condition. The ER is for the treatment of life-threatening or very serious conditions that require immediate medical attention. Do not ignore an emergency. If a situation seems life threatening, take action. Call 911 or your local emergency number right away. Heavy bleeding Large open wounds Sudden change in vision Chest pain Sudden weakness or trouble talking Major burns Spinal injuries Severe head injury Difficulty breathing Major broken bones Often requires a much higher co-pay and/or co-insurance than an office visit or urgent care visit Open 24/7, but waiting periods may be longer because patients with life-threatening emergencies will be treated first If you have questions or need more information, you can speak to a customer care professional by calling the number on the back of your UnitedHealthcare health plan ID card. *This is a sample list of services and may not be all-inclusive. **Costs and time information represents averages only and is not tied to a specific condition, level of coverage or treatment. Your out-of-pocket costs will vary based on plan design. Not all treatment facilities are covered equally under all plan designs. Always refer to your specific Plan Documents for your coverage details. Some treatments may require preauthorization or a referral from your primary care physician. The information provided through these programs is for educational purposes only as a part of your health plan and is not a substitute for your doctor s care. Please discuss with your doctor how the information provided is right for you. Your personal health information is kept private in accordance with your plan s privacy policy. 7

8 Take the next step Before you enroll in a health plan, we encourage you to review all your options at your City of Baltimore pre-enrollment support site at myuhcbaltimore.com. You will find descriptions of each plan, information on personalized wellness programs and searches for doctors and hospitals. Visit baltimorecity.essbenefits.com to enroll in a plan. Once you re a member, you can take advantage of your member tools and resources by logging on to myuhc.com. Key contact information Customer Care mynurseline Healthy Pregnancy Pre-enrollment Website myuhcbaltimore.com Member Website myuhc.com Preventive Care uhcpreventivecare.com Please note: Under the Medicare Secondary Payer (MSP) Mandatory Reporting Provision and the Affordable Care Act (ACA) Individual Shared Responsibility Reporting Provision, the federal law requires the mandatory collection and reporting of social security numbers of all covered participants including employees, retirees and their dependents through employer group health plans. Noncompliance may be subject to a $50 penalty imposed by the IRS under Section 6723 of the Internal Revenue Code. Administrative services provided by United HealthCare Services, Inc. For a complete description of the UnitedHealth Premium designation program, including details on the methodology used, geographic availability, program limitations and medical specialties participating, please visit myuhc.com. The mynurseline SM, Care Coordination Nurse, and Cancer Nurse Advocate services are for informational purposes only, and should not be used for emergency or urgent care situations. In an emergency, call 911 or go to the nearest emergency room. Nurses cannot diagnose problems or recommend specific treatment and are not a substitute for your doctor s care. These services are not an insurance program and may be discontinued at any time. They are included as part of your health plan. Disease Management programs and services may vary on a location-by-location basis and are subject to change with written notice. UnitedHealthcare does not guarantee availability of programs in all service areas and provider participation may vary. Certain items may be excluded from health benefits plan and other requirements or restrictions may apply. If you select a new provider or are assigned to a provider who does not participate in the Disease Management program, your participation in the program will be terminated. Self-Funded or Self-Insured Plans (ASO) covered persons may have an additional premium cost. Please check with your employer. The information provided through these programs is for educational purposes only as a part of your health plan and is not a substitute for your doctor s care. Please discuss with your doctor how the information provided is right for you. Your personal health information is kept private in accordance with your plan s privacy policy. The Healthy Pregnancy Program follows national practice standards from the Institute for Clinical Systems Improvement. The Healthy Pregnancy Program cannot diagnose problems or recommend specific treatment. The information provided is not a substitute for your doctor s care. The hospital comparison program uses data from publicly available data sets, UnitedHealthcare claims and hospital data from Leapfrog and CMS, to create a multidimensional view of hospital performance. Not all facilities are eligible for evaluation for the program. All trademarks are the property of their respective owners. City of Baltimore Member Open Enrollment Guide CBMB2015 8/ United HealthCare Services, Inc.