Get to know your bene ts. - mybenefits.myflorida.com · • Pregnancy care services. • Outpatient care services. • Wellness services. Deductible The amount you’ll need to pay

State of Florida 2018 Benefits Guidewelcometouhc.com/florida

Get to know your benefits.

By understanding your benefits, you can select the coverage that best fits your needs. In this guide, you'll find information about your options and benefit extras to help make your choices easier.

UnitedHealthcare is committed to providing you a smooth and simple enrollment experience with all the support you need.

Knowing your benefits helps you make more informed choices.

Table of ContentsBENEFITS PAGE NUMBER

Health Plan Details 4

HMP Plan 5

HIHP Plan With HSA 6

HEALTH & WELLNESS RESOURCES

Go Digital 7

Access to Support 8

ENROLLMENT

What's Next 12 Want more information?

Toll-free 1-877-614-0581, TTY 711Habla Español? Podemos ayudar.

welcometouhc.com/florida

• Search for network providers.

• Learn about your benefits and more.

Benefits Health & Wellness Resources Enrollment

Helpful highlights.Member Resources Make using your plan easier.• Visit Member Resources for tips and tools to help you choose a doctor, manage your costs,

know your care options and more. Get started at uhc.com/MemberResources.

UnitedHealthcare Health4Me® Mobile AppDownload Health4Me to your smartphone and you’ll get quicker access to your health plan details. It also lets you: • Search for a network doctor, clinic or hospital.

• Find options for quick care such as a nearby clinic, urgent care or ER.

• Locate and share digital health plan ID cards.

• Compare costs and see provider reviews.

• View claims and account balances.

• Find pharmacies and fill prescriptions.

Manage your plan online and on the go.Your member website: myuhc.com®.

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Helpful terms to know when choosing a plan. CoinsuranceYour share of the costs of a covered health care service, calculated as a percentage.

Copayment or CopayA fixed amount of money you’ll pay for a covered doctor visit.

Covered ServicesThe portion of a medical expense that the plan has agreed to pay for or reimburse. They include:• Doctors office visits.• Emergency services.• Hospital care. • Lab services.• Pregnancy care services.• Outpatient care services. • Wellness services.

DeductibleThe amount you’ll need to pay before your plan will start to pay for covered services.

Health Savings Account (HSA)An HSA is a personal savings account to help you save and pay for your health care. There’s no "use-it-or-lose-it" rule. You get to keep it even if you change plans, change employers or retire. The HSA option is only available for employees that elect the HIHP plan.

NetworkA network is a group of health care providers and facilities that have a contract with UnitedHealthcare. Using the network may help lower your costs because these providers and facilities have agreed to provide services at a discount.

Out-of-Pocket LimitThe most you could pay during a coverage period (usually one year) for your share of the costs of covered services. After you meet this limit, the plan will usually pay 100 percent of the allowed amount. The out-of-pocket limit includes all of your network payments.

Preventive CareRoutine health care, including screenings, checkups and patient counseling to prevent or discover illness, disease or other health problems.

FIND INSURANCE TERMS CONFUSING? Visit justplainclear.com.

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HMO Plan HIHP Plan With HSA Plan

DEDUCTIBLEWHAT YOU PAY IN THE NETWORK

OUT OF THE NETWORK

WHAT YOU PAY IN THE NETWORK

OUT OF THE NETWORK

EE None Not covered $1,350 Not coveredFamily None Not covered $2,700 Not covered

COVERED SERVICES

Doctors and Specialists Primary Care $20 copay Not covered 20%*** Not coveredSpecialist $40 copay Not covered 20%*** Not coveredPreventive Care

Screenings and Counseling $0 copay* Not covered 100% covered Not coveredEmergency CareUrgent Care Visit $25 copay Not covered 20%*** Not coveredEmergency Room $100 copay/100% $100 copay/100% 20%*** 20%***HospitalizationIn-patient $250 copay Not covered 20%*** Not coveredOutpatient $0 copay Not covered 20%*** Not coveredVisionOptometrist $40 copay Not covered 20%*** Not coveredOphthalmologist $40 copay Not covered 20%*** Not covered

OUT-OF-POCKET LIMITEE $1,500 Not covered $3,000 Not coveredFamily $3,000 Not covered $6,000 Not covered

GLOBAL OUT-OF-POCKET LIMITEE $7,350 Not covered $3,000 Not coveredFamily $14,700 Not covered $6,000 Not covered

*100% covered.**Met by medical copays.***Of eligible expenses.****Global network, out-of-pocket max met by Rx only or medical and Rx copays.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. See back page for all legal statements.

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1Age-appropriate preventive care services are covered 100 percent when received in the plan network.You may be required to receive approval for some services before they can be covered.

HMO Plan.Use our national network to help save money.

Preventive care is covered 100 percent in our network.1

Save money by staying in our network.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 our network. If you don’t use the network, you’ll have to pay for all of the costs.

There’s no need to select a primary care physician (PCP) or get referrals to see a specialist. Consider choosing a PCP. Your PCP can be your partner in managing your care. They can help you avoid duplicating tests and services and connect you to a specialist.

DETAILED BENEFITS on Page 4.

For all of the COVERAGE DETAILS, see your official health plan documents.

The network can help lower your costs.The doctors and facilities in our network have agreed to provide you services at a discount. We have:

• 884,689 physicians and health care professionals.*

• 5,634 hospitals.*

• 67,000+ pharmacies.*

Search the network at welcometouhc.com/florida.

*As of 3/31/17.

How paying for network care works.

+ +After reaching theout-of-pocket limit

Plan pays 100% of covered expenses

Copayment1

You pay

Out-of-pocket limitThe most you pay for health care in one plan year (includes all of your network payments).

Coinsurance1

You pay a percentage of the cost

The percentage you pay after you reach your deductible.

Deductible1

You pay 100%

The amount you pay before your insurance plan pays a portion.

The fixed amount you pay for each covered doctor visit or prescription.

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You can open an HSA.An HSA is a personal savings account to help you save and pay for your health care.

It’s your money.There’s no “use-it-or-lose-it” rule. You get to keep it even if you change plans, change employers or retire.

Set a goal, even a small one. Check with your employer to see if you can set up regular, pretax deposits through payroll deduction.

HIHP Plan With HSA with a Health Savings Account (HSA).

Get a plan with network freedom and an HSA.

Save money by staying in our network.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 our network.

There’s no need to select a primary care physician (PCP) or get referrals to see a specialist.Consider choosing a PCP. Your PCP can be your partner in managing your care. They can help you avoid duplicating tests and services and connect you to a specialist.

Preventive care is covered 100 percent in our network.1

1Age-appropriate preventive care services are covered 100 percent when received in the plan network.You may be required to receive approval for some services before they can be covered.


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.

Look for care in our network first.The doctors and facilities in our network have agreed to provide you services at a discount. We have:

• 884,689 physicians andhealth care professionals.*

• 5,634 hospitals.*

• 67,000+ pharmacies.*

Search the network at welcometouhc.com/florida.

*As of 3/31/17.

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Individual $3,4503

Family $6,9003

Your deductibleYou pay for all services, including prescriptions, until you meet your deductible. You can use an HSA to help pay it.

Your coinsuranceAfter you reach the deductible, you share the costs with the plan. You can use an HSA to help pay your share.

Your out-of-pocket limit When you reach the limit, you are done paying. The plan will pay 100 percent of covered services for the rest of the plan year.

+

STEP1

STEP2

STEP3

You are done paying

Preventive care is covered 100 percent when you use a network doctor.4

Your plan pays 80%

Pay with your HSA or pay another way

You pay 20%


How paying for network care works with an HSA.

Save on taxes.2

You don’t have to pay federal taxes or, in most cases, state income taxes when you deposit money into your HSA, let it collect interest or use it for qualified expenses. The 2018 IRS HSA deposit limits are:

Paying for prescriptions.You will have to pay the full cost of your covered prescriptions until you’ve paid the deductible. You can use your HSA to help pay. After the deductible, you will pay coinsurance. For more details, see your official health plan documents.

You own the HSA. Use it to help save and pay.

Qualified expenses:

• Doctor office visits.

• Prescriptions.

• Eyeglasses and contacts.

• Dental care and braces.

• Chiropractic services and more.

2 Precise HSA tax effects depend on federal law. We recommend that you see your tax advisor for specific tax advice.3 This includes all deposits, including any contributions your employer makes.4 Age-appropriate preventive care services are covered 100 percent when received in the plan network.You may be required to receive approval for some services before they can be covered.

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Get access to support and care at any time.Need help? We’re on it.We know that managing your health plan benefits and your health isn’t always easy. That’s why we have a team of people dedicated to helping you. From understanding your claims to estimating costs ahead of time, we’re here to help.

You may want to know:• Is this treatment covered?

• How much will I have to pay for a test my doctor wantsme to get?

• What does this charge mean on my bill? And why isit this amount?

• Can you help explain my benefits and what I need to do?

• If I need to find a new doctor, can you help me?

1 Prescription services may not be available in all states.

Contact us for help with a personal touch.Call the number listed on your health plan ID card.

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Have a health plan question? Just ask.We are here to help you find information and resources — plain and simple.

• Have questions about your health care benefits?

• Need help resolving a claim?

• Not sure where to go for care?

• Have questions about a recent screening or test?

• Can’t find a doctor?

As a member, you can call 1-877-614-0581, TTY 711.

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.

We’re here to help.

Talk to a registered nurse 24/7.When a health question comes up, you can talk with a registered nurse any time, day or night. He or she can help:

• Choose appropriatemedical care.

• Understand a wide rangeof symptoms.

• Determine if the emergency room,a doctor visit or self-care is right foryour needs.

• Find doctors or hospitals that meetyour needs and preferences.

• Locate an urgent care centerand other health resources inyour area.

As a member, you can connect with a nurse by calling the number on your health plan ID card or logging in to myuhc.com.

Talk to a registered nurse 24/7.When a health question comes up, you can talk with a registered nurse any time, day or night. He or she can help:

• Choose appropriate medical care.

• Understand a wide range of symptoms.

• Determine if the emergency room, a doctorvisit or self-care is right for your needs.

• Find doctors or hospitals that meet yourneeds and preferences.

• Locate an urgent care center and otherhealth resources in your area.

As a member, you can connect with a nurse by calling the number on your health plan ID card or logging in to myuhc.com.

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Get support throughout your pregnancy.The Healthy Pregnancy Program is a personalized maternity wellness program. Throughout your pregnancy, you can receive additional support, education and answers to questions about pregnancy. You can enroll by calling the number on your health plan ID card.

Call to talk to a maternity nurse.Get support during and after pregnancy from an experienced maternity nurse who provides assistance, guidance, answers and education.

Get help if you have work-related or personal issues.Behavioral Health Solutions gives you confidential help with:

• Depression, stress and anxiety.

• Relationship difficulties.

• Child and elder care support.

• Substance use, recovery and more.

Visit liveandworkwell.com to learn more.

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What comes next?Choose a plan.As you consider your benefits, think about how often you go to the doctor and the total cost of your benefits, including how much you pay in monthly premiums.

Once coverage begins.WATCH THE MAIL for your welcome kit and ID card.

START USING YOUR PLAN once your coverage starts.

GET STARTED ONLINE at myuhc.com and download the Health4Me app to help manage your health and benefits.

1. Go to myuhc.com.

2. Click on Register Now.

uhc.com welcometouhc.com/florida

Toll-free 1-877-614-0581, TTY 711 Habla Español? Podemos ayudar.

Before coverage starts.

SEARCH OUR NETWORK for providers near you at welcometouhc.com/florida.

While we’re setting up your insurance:

Use your plan.Here are some great ways to use your plan throughout the year:

SCHEDULE A PREVENTIVE EXAM, flu shot or other preventive screening service.

USE OUR RESOURCES to help stay healthier and save money.

ESTIMATE YOUR COSTS before you get care with myuhc.com or the Health4Me app.

MANAGE YOUR PLAN AND HEALTH ONLINE at myuhc.com.

GET ON-THE-GO ACCESS to health and account info, tools and resources with the Health4Me app.

CALL US FOR HELP when you need us.

Do you need more help?

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This information is not intended as legal or tax advice. Please contact a competent legal or tax professional for personal advice on eligibility, tax treatment and restrictions. Federal and state laws and regulations are subject to change.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 copay, coinsurance or deductible.The UnitedHealthcare plan with Health Savings Account (HSA) is a high deductible health plan (HDHP) that is designed to comply with IRS requirements so eligible enrollees may open a Health Savings Account (HSA) with a bank of their choice or through Optum Bank, Member of FDIC. The HSA refers only and specifically to the Health Savings Account that is provided in conjunction with a particular bank, such as Optum Bank, and not to the associated HDHP.For a complete description of the UnitedHealth Premium® program, including details on the methodology used, geographic availability, program limitations and medical specialties participating, please see myuhc.com.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. Please discuss with your doctor how the program information provided is right for you.The NurseLine 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 coverage 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.Mastercard® is a registered trademark of MasterCard Worldwide.App Store is a registered trademark of Apple, Inc. Android and Google Play are trademarks of Google, Inc.This communication is not intended as legal or tax advice. Please contact a competent legal or tax professional for personal advice on eligibility, tax treatment and restrictions. Federal and state laws and regulations are subject to change.The information in this guide is a general description of your coverage. It is not a contract and does not replace the official benefit coverage documents which may include a Summary of Benefits and Coverage and Certificate of Coverage/Summary Plan Description. If descriptions, percentages, and dollar amounts in this guide differ from what is in the official benefit coverage documents, the official benefits coverage documents prevail.

Administrative services provided by United HealthCare Services, Inc. or their affiliates.10/17 ©2017 United HealthCare Services, Inc. (ES 17-0875)

Documents

Get to know your bene ts. - mybenefits.myflorida.com · • Pregnancy care services. • Outpatient care services. • Wellness services. Deductible The amount you’ll need to pay