You re one step closer to simple health care.

Transcription

1 welcometouhc.com You re one step closer to simple health care. SIMPLE - A GUIDE TO YOUR 2016 UNITEDHEALTHCARE BENEFITS

2 Health care can be hard. We re here to help you through it. You can count on us to help protect you financially and guide you through your health care needs. We ll help make your health experience easier by giving you tools and support designed to help you save time, save money and find care when you need it. Your benefits MEDICAL PLAN Visit the website or call us. welcometouhc.com Search for network providers. Learn more about your benefits. Watch helpful videos and much more. Toll-Free , TTY 711 Habla Español? Podemos ayudar. Health Plan Information 4 The City of Tampa Health Plans 6 MORE BENEFITS Prescription Benefits 7 BENEFIT EXTRAS myuhc.com 8 Wellness 9 Personal Support 10 Preventive Care 11 2

3 We start by helping to make it easier to get care and stay healthy. Preventive care is covered 100% in our network.* Immunizations Preventive exams and health screenings VIEW BENEFITS on page 4. Help is a call, or web chat away. Contact us for help and answers. Talk or chat online with a registered nurse, 24/7. Using the network may help you save on covered services. 1 Doctor office visits Prescription drugs Emergency services Hospital care Lab services Pregnancy care services Outpatient care services Rehabilitative services and devices Wellness services Mental health and substance use disorder services and more 1 If you re wondering, this is not the complete list of covered services. See your official health plan documents for more details. VIEW BENEFITS on page 4. Manage your health and your plan online and on the go. * Certain preventive care services are provided as specified by the Patient Protection and Affordable Care Act (ACA), with no cost-sharing to you. These services are based on your age, gender and other health factors. UnitedHealthcare also covers other routine services that may require a co-pay, co-insurance or deductible. 3

4 HEALTH PLAN DETAILS Questions to help you choose DEDUCTIBLE FOUNDATIONS PLAN IN NETWORK OUT OF THE NETWORK Employee $2,000 $4,000 Family $4,000 $8,000 COVERED SERVICES Doctors and Specialists Primary Care Physician $40 Co-pay+ 30%* Specialist $55 Co-pay 30%* What do I pay for covered services? CO-PAYMENT OR CO-PAY You ll pay a fixed amount of money for each covered doctor visit or prescription. DEDUCTIBLE This is the amount you will need to pay for covered services before your plan begins to pay. CO-INSURANCE This is your share of the costs of a covered service, calculated as a percent. FIND INSURANCE TERMS CONFUSING? Visit justplainclear.com. OB/GYN $40 Co-pay 30% Preventive Care Adult Annual Physical $0 30%* Well Child Care $0 30%* Emergency Care Urgent Care Visit $55 Co-pay 30%* Emergency Room Hospital Care Inpatient Services $300 Co-pay $300/day Co-pay (4 Day Max)* $300 Co-pay 30%* Outpatient Surgery-Hospital $175 Co-pay* 30%* Outpatient Services- Free Standing Facility $125 Co-pay 30%* MRI, MRA, CT and PET Scans $175 Co-pay* 30%* Xray/Labs $0* 30%* Additional Services Allowance (Per Member) $0 None Allergy Injections $5 Co-pay 30%* Vision Exam (every year) $0 30%* Infertility Treatment 50%* up to $5,000 Maximum 50%* up to $5,000 Maximum OUT-OF-POCKET LIMIT Employee $3,500 $7,000 Family $7,000 $14,000 What is the most I may have to pay? OUT-OF-POCKET LIMIT You ll never pay more than your out-of-pocket limit in costs during your plan year. PRESCRIPTIONS IN THE NETWORK Retail (30-day supply) Tier1 Co-pay $30 Co-pay Tier2 Co-pay $60 Co-pay Tier3 Co-pay $90 Co-pay Tier4 Co-pay 25% Home Delivery (90-day supply) Tier1 Co-pay $60 Co-pay Tier2 Co-pay $120 Co-pay Tier3 Co-pay $180 Co-pay Tier4 Co-pay 25% 4 * After Annual Deductible has been met. ** If you purchase a Prescription Drug from a Non-Network Pharmacy, you are responsible for any difference beween what the Non-Network Pharmacy charges and the amount we would have paid for the same Prescription Drug dispensed by a Network Pharmacy. *** UnitedHealth Premium Tier 1 Providers + $0 Co-pay at the Employee Wellness Center This information does not replace your official health plan documents. Please see your official health plan documents for all coverage details, which includes limitations and exclusions.

5 SELECT PLAN TOBACCO FREE SELECT PLAN PHA CHOICE PLAN IN NETWORK OUT OF THE NETWORK IN NETWORK OUT OF THE NETWORK IN NETWORK OUT OF THE NETWORK $1,500 $3,000 $1,500 $3,000 $1,000 $3,000 $3,000 $6,000 $3,000 $6,000 $2,000 $6,000 $40 Co-pay+ 30%* $40 Co-pay+ 30%* $30 Co-pay+ 30%* $55 Co-pay 30%* $55 Co-pay 30%* $30 for Tier 1*** $45 all others 30%* $40 Co-pay 30% $40 Co-pay+ 30%* $30 for Tier 1*** $40 all others 30%* $0 30%* $0 30%* $0 30%* $0 30%* $0 30%* $0 30%* $55 Co-pay 30%* $55 Co-pay 30%* $45 Co-pay 30%* $300 Co-pay $300/day Co-pay (4 Day Max)* $300 Co-pay 30%* $300 Co-pay $300/day Co-pay (4 Day Max)* $300 Co-pay 30%* $250 Co-pay $300/day Co-pay (4 Day Max)* $250 Co-pay 30%* $150 Co-pay* 30%* $150 Co-pay* 30%* $100 Co-pay 30%* $100 Co-pay 30%* $100 Co-pay 30%* $75 Co-pay 30%* $150 Co-pay* 30%* $150 Co-pay* 30%* $100 Co-pay 30%* $0* 30%* $0* 30%* $0* 30%* What will it cost to see providers in and out of the network? Providers in our network have agreed to charge lower prices. If you use out-of-network providers, your costs may be higher. $250 None $500 None $1000 None $5 Co-pay 30%* $5 Co-pay 30%* $5 Co-pay 30%* $0 30%* $0 30%* $0 30%* 50%* up to $5,000 Maximum 50%* up to $5,000 Maximum 50%* up to $5,000 Maximum 50%* up to $5,000 Maximum 50%* up to 50%* up to $5,000 Maximum $5,000 Maximum $3,000 $7,000 $3,000 $7,000 $2,500 $7,000 $6,000 $14,000 $6,000 $14,000 $5,000 $14,000 OUT OF THE NETWORK How much will it cost to fill a prescription? This is what you ll pay when you need a prescription. You may save by choosing prescriptions from the lower tiers and signing up for home delivery. Talk to your pharmacist or doctor to learn ways you may be able to save. 5

6 The City of Tampa MEDICAL Health Plans + National Network and Out-of-network Coverage 800,000+ doctors and health care professionals (clinics, labs, care centers, etc.) 5,700+ hospitals 67,000+ pharmacies Get more protection with a national network and out-of-network coverage. A network is a group of health care providers and facilities that have a contract with UnitedHealthcare. You can receive care and services from anyone in or out of our network, but you save money when you use the national network. There s coverage if you need to go out of the network. Out-of-network means that a provider does not have a contract with us. Choose what s best for you. Just remember, out-of-network providers will likely charge you more. There s no need to choose a primary care provider (PCP) or get referrals to see a specialist. Consider a PCP; they can be helpful in managing your care. Preventive care is covered 100% in our network. DETAILED BENEFITS on page 4. Look for care in our network first. Specialists within 10 miles To help you save money, we make it easy for you to find network providers. Search the NETWORK at welcometouhc.com. GO * You won t need to worry about these costs for preventive care if you stay in the network. You may be required to receive approval for some services before they can be covered. + + Paying for network care Co-payment (co-pay)* You ll pay a fixed amount of money for each covered doctor visit or prescription. Deductible* This is the amount you will need to pay for covered services before your plan begins to pay. Co-insurance* After you ve paid your deductible, you only pay a percentage of the cost for each covered service. Out-of-pocket limit You ll never pay more than your out-of-pocket limit during the plan year. The out-of-pocket limit includes all of your co-payment, deductible and co-insurance payments. If you go out of the network, your costs may be higher. Out-of-network providers can even bill you for amounts higher than what your plan will cover. For all of the COVERAGE DETAILS, see your official health plan documents. 6

7 Prescription Benefits PRESCRIPTION Easily fill and save on your medications. You ll be covered for a wide variety of medications from UnitedHealthcare. Best of all, we ve made it easy for you to get your prescriptions filled and save money. Access thousands of retail pharmacies. Save when you use a network pharmacy. Get 24/7 phone support, refill reminders and more. Take advantage of no-cost home delivery. With Mail Service Member Select SM from OptumRx, you can get your long-term medications delivered to your door at no charge, often for less than they cost at retail. You can cancel home delivery service at any time and fill prescriptions at a retail pharmacy for your standard copay or cost. However, canceling this service may increase your medication costs. UnitedHealthcare and OptumRx are partners in making your health plan work better. OptumRx makes prescription medications more accessible and affordable and focuses on improving your overall health outcomes. How we cover prescriptions. The UnitedHealthcare Prescription Drug List (PDL) is the list of prescriptions that are covered by the plan and organized by cost tiers. Choosing medications in the lower tiers may save you money. Get more at myuhc.com. Refill prescriptions. Tier 1 Lower-cost Medications Tier 2 [+ 3] Midrange-cost Medications Tier 4 Higher-cost Medications Search the NETWORK and the PDL at welcometouhc.com. Find network pharmacies. Estimate and compare costs. 7

8 Benefits worthy MYUHC.COM of your favorites bar Manage your benefits and health care at mymedica.com. Track claims and expenses. Pay health care bills. Find network providers, care centers and pharmacies. Find and compare medications. Refill prescriptions. Access your benefits and get help any time, anywhere. It s myuhc.com in your pocket. With the UnitedHealthcare Health4Me app, you can access your virtual health plan ID card, check claim updates, find physicians and facilities, estimate costs and get answers to questions. Starting healthier habits just got fun. Rally SM is an experience on myuhc.com that may help you eat better, be more active and complete activities to improve your health. Estimate health care costs. You have easy-to-use tools so you can see what a treatment or procedure typically costs, estimate costs of prescriptions, and see what your share of expenses may be. Get help finding quality care. To help you make more informed choices about health care, the UnitedHealth Premium Designation Program includes doctors who meet quality and costeffeciency guidelines. You can find a doctor s designation on myuhc.com. 8

9 Get your RallySM Age. Take the Health Survey and instantly get your Rally Age a number that gives you a measure of your health age. Then pick missions to help you get your health on track. You can also store your health history and connect with online communities by joining fun challenges. Earn coins as you track and accomplish each mission, then use them to enter sweepstakes for chances to win great prizes! Stay on top of your preventive care. Preventive care focuses on your current health, when you are symptom-free, and helps you and your doctor find health issues at an early stage to help prevent more serious health problems. Remember, preventive care received by a network doctor is covered 100%. Please see your official health plan documents for more details about preventive care coverage. WELLNESS Support to reach your wellness goals Find support at myuhc.com. anage your Personal M Health Record. Chat with a nurse. et the latest health G news and more. Save up to 50% with our Health Discount Program: Teeth whitening Laser eye surgery Massages Infertility treatments Check out Source4Women.com When it comes to your family s health, you need a resource you can turn to for information and support. Source4Women gives you answers to your health and wellness questions, in plain language. And more Powered by: For upcoming seminars and more, Source4Women Source4WomenUHC Source4Women 9

10 SUPPORT We re here to help. Whether it s finding care or managing a complex health condition, you ll get help whenever you need it. Here are some of the programs and services that are available as part of your health plan with no additional cost to you. Talk to a registered nurse 24/7. When a health question comes up, you can talk with a registered nurse to help you find answers. They can: Answer questions about an illness or injury. Provide support on managing a chronic condition. Find support for dealing with cancer. Help you find doctors and schedule appointments. As a member, you can connect with a nurse through the Health4Me app or you can call Get help through pregnancy and delivery. Enroll in the Healthy Pregnancy Program by calling the number on your health plan ID card to access nurses, get information to help you identify health risks and more. You ll even get a gift for mom and baby. Many questions come up when you or a loved one has cancer. With the Cancer Support Program, dedicated cancer nurses will help you find the information and the emotional support for you and your family. Get access to the nation s leading health care facilities. Our Centers of Excellence network provides access to leading health care facilities, physicians and services to support safe, specialized and cost-effective care for complex conditions. 10

11 Why is preventive care so important? Regular preventive care visits and health screenings help you learn your current health status and may help identify potential health issues before they become more serious. Working with your doctor can help you determine what preventive care services may be right for you. PREVENTIVE CARE Common preventive care office services* Annual wellness exam Measurements of your weight, blood pressure, glucose (blood sugar) and cholesterol Will my health plan consider medications a preventive service? Immunization vaccines, such as flu shots Well-baby and well-child visits Common preventive care screening services* Cancer screenings, such as mammography, colorectal and cervical Osteoporosis screening Tobacco use and sexually transmitted diseases screening Healthy diet, physical activity and depression screening How is preventive care covered? Certain preventive health services will be covered based on age, gender and other factors without cost sharing (100% without charging a co-payment, deductible or co-insurance), as long you receive these services from a network provider. How do I know if a service is preventive care or not? Plans that include a pharmacy benefit may cover some prescriptions as preventive care. These may include: Certain FDA-approved women s contraceptives Folic acid supplements for women who may become pregnant Iron supplements for children at risk for anemia Certain over-the-counter preventive medications may also be covered under your plan. Please see your official health plan documents for specific COVERAGE GUIDELINES. Preventive care focuses on your current health when you are symptom-free. If you are receiving treatment due to a symptom or an existing illness, the services provided usually won t be considered or covered as preventive care. * This content is provided for informational purposes only, and does not constitute medical advice. Always consult your doctor about any decisions about medical care. The services outlined here do not necessarily reflect the services, vaccines, screenings, or tests that will be covered under your benefit plan. Always refer to your plan documents for specific benefit coverage and limitations or call the toll-free member number on your health plan ID card. Certain procedures may not be fully covered under some benefit plans. 11

12 welcometouhc.com 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. Source4Women content and materials are for information purposes only, are not intended to be used for diagnosing problems and/or recommending treatment options, and are not a substitute for your doctor s care. Lists of potential treatment options and/or symptoms may not be all inclusive. Certain preventive care services are provided as specified by the Patient Protection and Affordable Care Act (ACA), with no cost-sharing to you. These services are based on your age, gender and other health factors. UnitedHealthcare also covers other routine services that may require a co-pay, co-insurance or deductible. 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 see myuhc.com. Rally Health provides health and well-being information and support as part of your health plan. It does not provide medical advice or other health services, and is not a substitute for your doctor s care. If you have specific health care needs, consult an appropriate health care professional. Participation in the health survey is voluntary. Your responses will be kept confidential in accordance with the law and will only be used to provide health and wellness recommendations or conduct other plan activities. Disclosure: The Health Discount Program is administered by HealthAllies, Inc., a discount medical plan organization. The Health Discount Program is NOT insurance. The discount program provides discounts at certain health care providers for medical services. The discount program does not make payments directly to the providers of medical services. The discount program member is obligated to pay for all health care services but will receive a discount from those health care providers who have contracted with the discount plan organization. HealthAllies, Inc., is located at P.O. Box 10340, Glendale, CA, 91209, , [email protected]. 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. M / United HealthCare Services, Inc.