Your Plan Explained UnitedHealthcare Group Medicare Advantage (PPO) UHEX11MP3230855_001 Y0066_100616_09113
Your Medicare. This brochure explains your Medicare Advantage plan, a type of health plan also known as Medicare Part C. Medicare Advantage plans combine your Medicare Part A (hospital) and Medicare Part B (doctor and out-patient) coverage, then provide additional benefits that contribute to improving your health and wellness. Some Medicare Advantage plans also include prescription drug coverage. You have to be enrolled in Medicare Part A and purchase Medicare Part B to be eligible to enroll in this plan. If you re not sure you are enrolled, check with your local Social Security office. You must continue paying your Medicare Part B premium to keep your coverage under this group-sponsored plan. If you stop your payments, you will automatically be disenrolled from this plan. No physicals or health questions are required to enroll, and pre-existing conditions do not affect your eligibility. All Medicare Advantage plans are offered by private insurance companies, like UnitedHealthcare, who are required to offer coverage that is as good as Original Medicare or better. The government pays them a fixed fee for your care. UnitedHealthcare then handles the payments to doctors and hospitals. Hospital Doctors Drugs Extras Your UnitedHealthcare. Choosing the right health care plan is a big decision. It involves looking at the costs, benefits, access to doctors and other health care services and so much more. We want you to feel good about your plan choice, and to help you get the most out of your health care dollar. Five reasons to choose a UnitedHealthcare plan. 1. A company you know and trust With over 25 years of experience, UnitedHealthcare is one of the nation s largest providers of health care coverage for older adults. Nationally, we serve one in five people eligible for Medicare. 1 2. Help controlling your care costs Your plan helps limit your out-of-pocket expenses by providing an annual limit and affordable copayments (copays). 3. Flexibility We understand that your choice of doctors, hospitals and other health care providers is important. With this plan, you will have access to a national contracted network through UnitedHealthcare. Plus, you can see non-contracted providers as long as they participate in Medicare. You can also get your prescriptions filled through a national network of more than 60,000 chain pharmacies. 4. Additional health and wellness programs that make a difference This plan offers the same coverage as Medicare Parts A and B, plus extras that contribute to your health and wellness. 5. Dedicated Customer Service We have created a helpful customer service team that has been trained on your specific employer group-sponsored plan. With one simple phone call, you can get answers to all your health plan benefit questions. 2
Your Plan. Your plan is a Preferred Provider Organization (PPO) plan. This type of plan helps keep health care decisions in your hands. You can take advantage of our large group of in-network doctors. If a doctor is in-network, that means they have a contract with UnitedHealthcare for this plan. You also have the flexibility to see doctors that are out-of-network. These doctors do not have a contract with UnitedHealthcare for this plan. Unlike most PPO plans, in this plan you pay the same costs in and out-of-network. When you sign up for a UnitedHealthcare Group Medicare Advantage (PPO) plan, all of your health care coverage is combined into a single plan. You get coverage for hospital care, doctor care and prescription drugs. All from one company, with one member ID card. It s an easier way for you to manage your benefits. Plan highlights: Your benefits cover health services provided to you by any doctor or medical professional who participates in Medicare. You can enjoy predictable copayments (a flat dollar amount) or coinsurance (a percentage) that represents your share of the cost. This can help make budgeting for health care costs easier. You can take advantage of a $0 copayment for some Medicare-covered preventive services including an Annual Wellness Visit. There is a limit on your out-of-pocket spending for the year. Frequently asked questions. Will the doctor or hospital accept my plan? In-Network Yes Out-of-Network Has the choice to accept plan (except for emergencies) What is my copay or coinsurance? You pay the same copay or coinsurance whether you see a provider in or out-of-network Do I need to choose a Primary Care Physician (PCP)? Do I need a referral to see a specialist? No No No No For more information about your plan details including copays, plan benefits and prescription drug coverage refer to the Benefit Highlights booklet. 3
Your Extra Benefits. Your plan provides the same coverage as Medicare Parts A and B, plus many extra benefits that contribute to your health and wellness. See the member benefits materials to learn more about the added benefits included with your plan. They may include: Routine annual physicals Membership in a fitness program designed for seniors Health and well-being programs A Caregiver support program Your Doctor. Seeing a doctor is easy. With our large network, most likely your doctor is already part of the plan. However, even if your doctor is not part of our network, we have made it easy for your doctor to accept this plan. Different from PFFS plans, PPO plans have been around a long time. Doctors are used to working with PPOs. We pay as Medicare pays so your doctor will receive the same payment as under Medicare. If your doctor does not accept Medicare assignment, we will pay the excess charges. To find out about the doctors or hospitals in your network, see the online Provider Directory at www.uhcretiree.com. This directory is updated regularly to provide you with the current listing of network providers. If you would like help finding a network doctor or to request a written copy of the Provider Directory, please call Customer Service. 4
Your Prescription Drug Coverage. Your plan includes Medicare Part D prescription drug coverage, so there s no need to get a stand-alone Medicare Part D plan. Members can fill their prescriptions at more than 60,000 national chain pharmacies. As with stand-alone Medicare Part D plans, you pay some of the cost of your drugs (a copay or coinsurance) and the plan pays the rest. The amount you pay depends on the drugs you take. Please note if you enroll in a separate Medicare Part D plan after you enroll in this plan, you will lose your plan sponsored medical coverage. Ways to save on prescription drug costs. Your plan s formulary (drug list) includes 100 percent of the drugs covered by Medicare Part D. Please review this plan s drug list to be sure your prescription drugs are covered (not all drug lists are the same). This drug list is organized into different categories called tiers. In general, the lower the tier, the lower your cost for the drug. Many drugs on the drug list have other generic and brand-name drug choices in lower tiers that treat the same conditions, but cost less. If you re taking a Tier 2 or Tier 3 drug, you may be able to switch to a lower-tier (Tier 1 or Tier 2) drug and save money. Talk to your doctor to find out if there is an effective lower-tier drug for your current medication. Tier Your cost Description Tier 1 Tier 2 Tier 3 Tier 4 (Specialty Tier) Low Medium High High Includes most, but not all generic prescription drugs. For the lowest out-of-pocket expense, you and your doctor should decide if Tier 1 medications are right for your treatment. Includes many common brand-name drugs and some higher-cost generic prescription drugs. Includes non-preferred generic and non-preferred brand-name drugs. Tier 3 drugs usually have lower-cost choices in Tier 1 or Tier 2 that can treat the same condition. Includes unique or very high-cost drugs. You pay a high copayment or a percentage of the total cost, called coinsurance. 5
List of commonly used drugs. Shown here are some of the most commonly used drugs covered by this plan. This is not a complete drug list. To make sure your drugs are covered and to find out tier information, please call 1-877-714-0178, TTY 711, 8 a.m. 8 p.m. local time, 7 days a week. Or visit us online at www.uhcretiree.com. Drug Name Abilify Bystolic Exelon Acetaminophen/Codeine Carbidopa/Levodopa Famotidine Actonel Carisoprodol Felodipine Actos Carvedilol Fentanyl Advair Diskus Celebrex Fexofenadine Aggrenox Cephalexin Finasteride Alendronate Ciprofloxacin Flomax Allopurinol Citalopram Fluconazole Ambien CR Clindamycin Fluoxetine Amiodarone Clonidine Fluticasone Amitriptyline Clotrimazole/Betamethasone Furosemide Amlodipine Combivent Gabapentin Amlodipine/Benazepril Coumadin Gemfibrozil Amoxicillin Cozaar Glimepiride Amoxicillin/K Clav Crestor Glipizide Aricept Cyclobenzaprine Glipizide er Arimidex Cymbalta Glipizide xl Atenolol Detrol la Glyburide Avandia Diclofenac Glyburide/Metformin Avapro Digoxin Humalog Avinza Diltiazem Hydralazine Avodart Diovan Hydrochlorothiazide Azithromycin Diovan hct Hydrocodone/Acetaminophen BD Pen Needle Divalproex Hydroxychloroquine Benazepril Dorzolamide/Timolol Hydroxyzine hcl Benicar Doxazosin Hyzaar Benicar hct Doxycycline Hyclate Ibuprofen Bisoprolol/Hydrochlorothiazide Effexor xr Insulin Syringe Boniva Enablex Isosorbide Mononitrate Bupropion Enalapril Januvia Bupropion hcl Estradiol Kadian Buspirone Evista Klor-con 10 Bold = Brand-name drug 6
Drug Name continued Klor-Con M10 Nasonex Risperidone Klor-Con M20 Nexium Ropinirole Labetalol Niaspan Seroquel Lamotrigine Nifedipine Sertraline Lansoprazole Nitrofurantoin Simvastatin Lantus Nitroglycerine Singulair Levaquin Novolog Smz/Tmp Ds Levemir Omeprazole Sotalol Hcl Levetiracetam Onglyza Spiriva Levothyroxine Opana ER Spironolactone Levoxyl Oxybutynin Synthroid Lexapro Oxycodone Terazosin Lidoderm Oxycodone/Acetaminophen Timolol Maleate Lipitor Oxycontin Topiramate Lisinopril Pantoprazole Toprol XL Lisinopril/Hydrochlorothiazide Paroxetine Torsemide Lovastatin Phenytoin Ex Tramadol Hcl Lovaza Plavix Travatan Z Lumigan Polyethylene Glycol Trazodone Lunesta Potassium Chloride Triamcinolone Lyrica Potassium CL Micro Triamterene/Hydrochlorothiazide Meclizine Pravastatin Tricor Meloxicam Prednisone Trilipix Metformin Premarin Uroxatral Methotrexate Prevacid Ventolin Hfa Methylprednisolone ProAir HFA Verapamil Metoclopramide Promethazine Vytorin Metoprolol Propoxyphene-N/Acetaminophen Warfarin Metoprolol Tartrate Propranolol Xalatan Mirtazapine Protonix Zetia Morphine Sulfate Proventil HFA Zolpidem Mupirocin Quinapril Zyprexa Namenda Ramipril Naproxen Ranitidine Bold = Brand-name drug Trademarks for the drugs listed above are owned by third parties with whom this plan has no affiliation. This is not a complete drug list. Please note that the drug list is updated periodically throughout the year, and the list of covered drugs may change as drugs are added or deleted from the list. To find out if your drugs are covered, call Customer Service. 7
Important Notes and Next Steps. 1. UnitedHealthcare will make sure you are eligible for the plan. 2. In about 4-6 weeks, you will receive your new member ID card. 3. Once you are officially enrolled in the plan, you will receive a Welcome Kit with complete details about the benefits and services of your new health plan. 4. On your effective date, you can begin using your new member ID card to enjoy your benefits and services. 5. While enrolled in the plan, you may be notified by your plan sponsor about meetings concerning updates or changes to your benefits. 6. If you drop your group-sponsored retiree health coverage in the future, you may not be able to re-enroll. Limitations and restrictions vary by plan sponsor. Questions? Call Customer Service toll-free about your plan: 1-877-714-0178, TTY 711 8 a.m. 8 p.m. local time, 7 days a week When you contact customer service, have your group number available. You can find your group number on the front of the Benefit Highlights booklet. 1 2008 UnitedHealth Group Annual Report The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. Plans are insured or covered by an affiliate of UnitedHealthcare Insurance Company, a Medicare Advantage Organization with a Medicare contract and a Medicare-approved Part D sponsor.