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Thisway tohealthier.
Plan Year 2019 Choice Open Access (LR) | Choice Plus Advanced (L9) MD-IPA (JP) | HDHP with HSA (V4)
Federal Employees Health Benefits Overview1-877-835-9861 uhcfeds.comChoice Plus Advanced (L9) and MD-IPA (JP): Washington, DC | Maryland | Northern Virginia Choice Open Access (LR) and HDHP with HSA (V4): Washington, DC | Maryland | Virginia
UnitedHealthcare Insurance Company MD-Individual Practice Association, Inc.
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Your path to a better health care experience.
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At UnitedHealthcare, we’ve been working together to help people live healthier for more than 40 years. Our Choice Open Access, Choice Plus Advanced and High Deductible Health Plans offer a nationwide network of providers that bring you more simplicity, choice and savings.
In the following pages, you’ll also see how we can help make health care easier for you, with tools, information and support to help you and your family get access to the care you need. We hope you find it useful as you choose the plan that works for you.
Table of contents.Cost information 4
Health plan details: 5–10
Choice Open Access Plan (LR) 5
Choice Plus Advanced Plan (L9) 6
MD-IPA Plan (JP) 7
High Deductible Health Plan with Health Savings Account (V4) 8–9
Dental and vision 10
Health and wellness resources 11
Helpful tools 12
Enrollment information 13
Have a question or want more information?
Visit uhcfeds.com or give us a call at 1-877-835-9861.
Habla Español? Podemos ayudar.
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Benefits Health & Wellness Resources Enrollment
Know your premiums.Cost is an important part of your decision. To find out what you can expect to pay, see the chart below. Plan details are included on the next few pages.
Enrollment Type
Enrollment Code
Non-postal Premium (Biweekly)
Non-postal Premium (Monthly)
Postal Premium (Biweekly)
Postal Premium (Biweekly)
Your Share Your Share Category 1 Your Share Category 2 Your Share
CHOICE OPEN ACCESS (LR) DC, MD, VA — SEE BENEFIT DETAILS ON P. 5
Self Only LR1 $78.10 $169.22 $74.90 $65.31
Self Plus One LR3 $170.52 $369.46 $163.68 $143.17
Self and Family LR2 $205.29 $444.80 $197.99 $176.11
CHOICE PLUS ADVANCED (L9) DC, MD, NORTHERN VA — SEE BENEFIT DETAILS ON P. 6
Self Only L91 $50.43 $109.26 $48.41 $41.86
Self Plus One L93 $98.49 $213.39 $94.55 $81.74
Self and Family L92 $141.40 $306.37 $135.75 $117.36
MD-IPA (JP) DC, MD, NORTHERN VA — SEE BENEFIT DETAILS ON P. 7
Self Only JP1 $134.83 $292.14 $131.63 $122.04
Self Plus One JP3 $220.59 $477.94 $213.75 $193.24
Self and Family JP2 $498.16 $1,079.35 $490.86 $468.98
HDHP WITH HSA (V4) DC, MD, VA — SEE BENEFIT DETAILS ON P. 8
Self Only V41 $57.19 $123.92 $54.91 $47.47
Self Plus One V43 $122.97 $266.43 $118.05 $102.06
Self and Family V42 $131.54 $285.01 $126.28 $109.18
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Choice Open Access Plan (LR). This plan is an open access HMO. See any network doctor or hospital nationwide without the need for referrals to see a specialist, all with no deductible. This plan does not include out-of-network coverage, except for emergencies. Find a network provider at uhcfeds.com. The outline below is intended as a summary only. For a detailed description of your benefits, exclusions and limitations, please refer to Federal Employee Health Benefits (FEHB) brochure #73-890 at uhcfeds.com.
NetworkDeductible $0
Out-of-Pocket Limit
Self Only $5,000
Self Plus One $10,000
Self and Family $10,000
Preventive Care1 $0
Medical
Primary care physician (PCP) $25 copayment/$0 copayment for children under 18
Virtual Visit $5 copayment
Specialist • Non-Tier 1 designated physician $50 copayment• Tier 1 designated physician $35 copayment
Hospitalization2
Inpatient $150 per day (up to $750 per admission)
Outpatient care $150 freestanding facility/$300 hospital-based facility
Urgent care $35 copayment per visit
Emergency room services $150 copayment per visit (waived if admitted)
Lab and X-Ray3
Lab, minor X-ray and other diagnostic testing $50 copayment
Major diagnostic testing (MRI, CT scan, PET scan)2 $150 copayment
Mental Health and Substance Use Disorder2
Office $25 copayment
Inpatient $150 copayment per day (up to $750 per admission)
Outpatient $50 copayment
Prescription Drugs 30-Day Retail 90-Day Mail Order
Tier 1 $10 $25
Tier 2 $40 $100
Tier 3 $85 $212.50
Tier 4 $175 $437.50
1Excludes immunizations for travel. 2Prior authorization and/or notification required for some services. 3Quest Diagnostics is now a national provider as well as LabCorp.
Benefits Health & Wellness Resources Enrollment
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Choice Plus Advanced Plan (L9). Visit any doctor or hospital nationwide without the need for referrals to see a specialist. You could pay less when you stay in the network and when you use Tier 1 physicians and freestanding health care facilities instead of hospitals. Find a network provider at uhcfeds.com. The outline below is intended as a summary only. For a detailed description of your benefits, exclusions and limitations, please refer to FEHB brochure #73-887 at uhcfeds.com.
Network Out of NetworkDeductible1
Self Only $500 $1,000
Self Plus One $1,000 $2,000
Self and Family $1,000 $2,000
Out-of-Pocket Limit
Self Only $3,000 $6,000
Self Plus One $6,000 $12,000
Self and Family $6,000 $12,000
Preventive Care2 $0 You pay 100%
Medical
Primary care physician (PCP) $25 copayment 50% after deductible
Virtual Visit $5 copayment No coverage
Specialist • Non-Tier 1 physicians $75 copayment 50% after deductible• Tier 1 physicians $50 copayment 50% after deductible
Hospitalization3
Inpatient 20% after deductible 50% after deductible
Outpatient surgical center• Freestanding facility 20% after deductible 50% after deductible• Hospital-based facility 20% after per occurrence deductible
of $250 and annual deductible50% after per occurrence deductible of $250 and annual deductible
Urgent care $100 copayment 50% after deductible
Emergency room services $250 copayment per visit $250 copayment per visit
Lab and X-Ray4
Lab, minor X-ray and other diagnostic testing 20% after deductible 50% after deductible
Major diagnostic testing (MRI, MRA, CT scan)1,3
• Freestanding facility or physician’s office 20% after deductible 50% after deductible• Hospital-based facility1 20% after per occurrence deductible
of $250 and annual deductible50% after per occurrence deductible of $250 and annual deductible
Mental Health and Substance Use Disorder3
Mental health/substance use Physician services: $25Facility services: 20% after deductible 50% after deductible
Prescription Drugs 30-Day Retail 90-Day Mail Order Out of Network
Tier 1 $10 $25 You pay 100%
Tier 2 $35 $87.50 You pay 100%
Tier 3 $60 $150 You pay 100%
Tier 4 $100 $250 You pay 100%
1Some copayments do not apply toward the annual deductible. All individual deductible amounts will count toward the family deductible, but an individual will not have to pay more than the individual deductible amount. This plan contains a per occurrence deductible that applies to certain covered health services. This per occurrence deductible must be met prior to and in addition to the annual deductible. 2Excludes immunizations for travel. 3Prior authorization and/or notification required for some services. 4Quest Diagnostics is now a national provider as well as LabCorp.
Benefits Health & Wellness Resources Enrollment
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MD-IPA Plan (JP). You’ll choose a primary care physician (PCP) from our regional network to help you manage your health and refer you to specialists, if needed. This plan has no deductible and does not include out-of-network coverage, except for emergencies. Find a network provider at uhcfeds.com. The outline below is intended as a summary only. For a detailed description of your benefits, exclusions and limitations, please refer to FEHB brochure #73-100 uhcfeds.com.
NetworkDeductible $0
Out-of-Pocket Limit
Self Only $5,000
Self Plus One $10,000
Self and Family $10,000
Preventive Care1 $0
Medical
Primary care physician (PCP) $25 copayment/$0 copayment for children under 18
Specialist $40 copayment
Virtual Visit $5 copayment
Hospitalization2
Inpatient $150 per day, up to $450 per admission
Outpatient care•Non-surgical $50 copayment•Surgical $100 copayment (freestanding facility)/$200 copayment (hospital)
Urgent care $75 copayment
Emergency room services $125 copayment (waived if admitted)
Lab and X-Ray
Most services in physician’s office at time of visit or at a designated lab $0
Services in outpatient facilities•Non-surgical $50 copayment•Diagnostic (MRI, CT scan, PET scan)2 $100 copayment
Mental Health and Substance Use Disorder2
Office $25 copayment
Inpatient $150 copayment per day (up to $450 per admission)
Outpatient $50 copayment
Prescription Drugs 30-Day Retail 90-Day Mail Order
Tier 1 $7 $21
Tier 2 $35 $105
Tier 3 $65 $195
Tier 4 $100 $300
1Excludes immunizations for travel. 2Prior authorization and/or notification required for some services.
New MD-IPA members — please select your PCP at myuhc.com or call 1-877-835-9861 for help.
Benefits Health & Wellness Resources Enrollment
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High Deductible Health Plan (HDHP) with Health Savings Account (HSA) (V4).Visit any doctor or hospital nationwide without the need for referrals to see a specialist. Save money when you use an HSA to help cover qualified health care expenses and see network providers. Find a network provider at uhcfeds.com. The outline below is intended as a summary only. For a detailed description of your benefits, exclusions and limitations, please refer to FEHB brochure #73-891 at uhcfeds.com.
A way to help lower costs: UnitedHealthcare contributes $750 for Self Only enrollment and $1,500 for Self Plus One or Self and Family enrollment into your HSA. This is half of your network deductible!
Network Out of NetworkDeductible1
Self Only $1,500 $2,500
Self Plus One $3,000 $5,000
Self and Family $3,000 $5,000
Out-of-Pocket Limit
Self Only $4,000 $6,850
Self Plus One $6,850 $10,000
Self and Family $6,850 $10,000
Preventive Care2 $0 You pay 100%
Medical
Primary care physician (PCP) $15 copayment after deductible 30% after deductible
Specialist $30 copayment after deductible 30% after deductible
Virtual Visit $5 copayment after deductible No coverage
Hospitalization3
Inpatient $500 copayment per admissionafter deductible 30% after deductible
Outpatient surgery $250 copayment after deductible 30% after deductible
Urgent care $35 copayment after deductible 30% after deductible
Emergency room services $150 copayment after deductible 30% after deductible
Lab and X-Ray4
Lab, X-ray and other diagnostic testing2,3 $50 copayment after deductible 30% after deductible
Mental Health and Substance Use Disorder3
Office $15 copayment after deductible 30% after deductible
Inpatient $500 per admission after deductible 30% after deductible
Outpatient $50 copayment after deductible 30% after deductible
Prescription Drugs (subject to the deductible) 30-Day Retail 90-Day Mail Order Out of Network
Tier 1 $10 $25 You pay 100%
Tier 2 $40 $100 You pay 100%
Tier 3 $85 $212.50 You pay 100%
Tier 4 $175 $437.50 You pay 100%
1Some copayments do not apply toward the annual deductible. All individual deductible amounts will count toward the family deductible, but an individual will not have to pay more than the individual deductible amount. 2Excludes immunizations for travel. 3Prior authorization and/or notification required for some services. 4Quest Diagnostics is now a national provider as well as LabCorp.
Benefits Health & Wellness Resources Enrollment
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Experience the advantages of an HDHP with HSA.An HDHP with HSA allows you to set up a personal savings account that you can use, tax-free, to pay for current and future qualified medical expenses. Your HSA is funded in part by the health plan, and you can also make contributions.
Benefits Health & Wellness Resources Enrollment
Use your HSA to pay for: ✓ Doctor office visits
✓ Prescriptions
✓ Eye glasses and contacts
✓ Dental care and braces
✓ Chiropractic services
Key features:• Your own HSA contributions are either tax deductible* or pre-tax (if made by
payroll deduction) up to the IRS limit.
• Interest earned on your account is tax-free.
• Withdrawals for qualified medical expenses are tax-free.
• Unused funds and interest are carried over, without limit, from year to year.
• You own the HSA and it is yours to keep, even when you change plans or retire.
*Consult with a tax professional for specific details.
How the plan works:Step 1: Deductible.Use your HSA to help pay for health care services and prescriptions until you meet your deductible.
Step 2: Coinsurance.Use your HSA to help pay your share of coinsurance once you meet your deductible.
Step 3: Out-of-pocket limit.Once you reach your limit, you’re done paying for the rest of the year. Save money in your HSA to help cover future health care expenses.
For more information:Visit uhcfeds.com or give us a call at 1-877-835-9861.
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Dental Preferred Provider Organization (PPO) for Choice Open Access (LR), Choice Plus Advanced (L9) and HDHP with HSA (V4) Plans.
Dental — PPO Plan (non-FEHB benefit).See any licensed dentist; present your PPO Dental ID Card to access benefits
Network services $0 (100% for covered services)
Deductible $0
Annual maximum $500 per person per year
Oral exam,1 prophylaxis (cleaning),1 X-rays and sealants2 $0 network/40% out of network3
1 Limited to 2 times per consecutive 12 months. 2 Sealants available to children under the age of 16. 3 You pay 40 percent of the negotiated rate and any difference between our allowance and the billed amount.
Visit uhcfeds.com to download dental plan documents and find participating dentists near you.
Dental and vision plans for the MD-IPA (JP) Plan.Dental — PPO Plan (non-FEHB benefit).See any licensed dentist; present your PPO Dental ID Card to access benefits
Network services $0 (100% for covered services)
Deductible $0
Annual maximum $500 per person per year
Oral exam,1 prophylaxis (cleaning),1 X-rays and sealants2 $0 network/40% out of network3
Amalgam and composite restorations (fillings) $0 network/40% out of network3
1 Limited to 2 times per consecutive 12 months. 2 Sealants available to children under the age of 16. 3 You pay 40 percent of the negotiated rate and any difference between our allowance and the billed amount.
Dental — Discount Plan. Applicable Discount
See a participating dentist | No claim forms, no waiting periods, no deductiblePresent your health plan ID card to access benefits
Non-cosmetic dental procedures 25%–30%
Cosmetic dental procedures 10%–15%
Vision.Preferred Provider(Walmart, Sam’s Club, MyEyeDr)
Participating Provider
Out of Network
Eyeglasses (every 24 months) $25 copayment $40 copayment See allowances below
Frames $130 frame allowance $130 frame allowance $45 allowance
Lenses (every 24 months)Single vision, lined bifocal or trifocal, and lenticular covered in full
Single vision, lined bifocal or trifocal, and lenticular covered in full
Single vision: $40Bifocal: $60Trifocal: $80Lenticular: $80
Contact lenses (in lieu of eyeglasses) $125 allowance $125 allowance $125 allowance
Benefits Health & Wellness Resources Enrollment
Visit uhcfeds.com for a list of vision providers.
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Benefits Health & Wellness Resources Enrollment
Working together to help reach your goals.
Getting healthier just got fun.Rally® is an interactive, personalized health and wellness experience on myuhc.com that gives you support and tools to help you achieve your personal health goals. Based on your responses to a Health Survey, you’ll get your Rally AgeSM, a measure of your overall health.
Call to talk to a maternity nurse.The Maternity Support Program offers comprehensive maternity services before, during and after pregnancy. Get support through 1-on-1 access to an experienced maternity nurse, medical director and social worker throughout your pregnancy, regardless of risk level, to provide assistance, guidance, answers and education. The Maternity Support Program includes a pregnancy app that delivers personalized content.
Lose weight. Feel great.Whether you want to lose a lot of weight or just a few extra pounds, Real Appeal® is designed to help with steps and support along the way for lasting weight loss. Members receive a success kit featuring a personal blender, digital food scale and more. All at no additional cost to Real Appeal participants.
Save money on wellness purchases.Save 10 percent to 50 percent with our UnitedHealth Allies® health discount program on:
✓ Fitness memberships
✓ Weight management programs
✓ Fitness gear
✓ Nutrition and natural products
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Manage your plan online and on the go.Get information and support when (and where) you need it.
Use myuhc.com to help manage your health and benefits. Access your benefits, find a network doctor, track claims, get health tips and more on our private member website.
Enjoy the convenience of our Health4Me smartphone app. Download our free app and see how easy it is to find network doctors, manage claims, view your health plan ID card and more.
Help is a call or web chat away. Talk on the phone or chat online with a registered nurse, 24 hours a day.
Virtual Visits: Access to care online, anytime.No driving. No waiting rooms. No appointment necessary. A Virtual Visit lets you see a doctor from anywhere using your smartphone, tablet or computer.* Get help with non-emergency conditions such as a cough or cold, pink eye, bronchitis, allergies and more.
*Data rates may apply.
Learn more at uhcfeds.com.
Benefits Health & Wellness Resources Enrollment
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Benefits Health & Wellness Resources Enrollment
What comes next?You’ve considered what’s covered. You’ve explored resources to help you stay healthier. Now you’re ready for the next step: enrolling in the plan that works best for you and your family.
Choose your plan. Jot down the enrollment code for the plan that works best for you — you will need it when you sign up for coverage.
Two ways to enroll:Online:• Visit employeeexpress.gov.
• Postal employees: Visit https://ewss.usps.gov.
Paper:• Go to your benefits office and ask for
Standard Form (SF) 2809.
• Postal employees: Call PostalEASE at 1-877-477-3273.
Before coverage starts.While we’re setting up your insurance:
Search our extensive network for providers near you at uhcfeds.com/find-a-doctor.
Once coverage begins. Watch the mail for your welcome kit and ID card.
Start using your plan once your coverage begins.
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.”
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.
Call us for help when you need us.
Estimate your costs before you get care with myuhc.com or the Health4Me app.
Get on-the-go access to health and account info, tools and resources with the Health4Me app.
Manage your plan and health online at myuhc.com.
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The fine print.We do not treat members differently because of sex, age, race, color, disability or national origin. If you think you were treated unfairly because of your sex, age, race, color, disability or national origin, you can send a complaint to the Civil Rights Coordinator.
Online: [email protected]
Mail: Civil Rights Coordinator, UnitedHealthcare Civil Rights Grievance, P.O. Box 30608, Salt Lake City, UT 84130
You must send the complaint within 60 days of when you found out about it. A decision will be sent to you within 30 days. If you disagree with the decision, you have 15 days to ask us to look at it again.
If you need help with your complaint, please call the toll-free phone number listed on your ID card, TTY 711, Monday through Friday, 8 a.m. to 8 p.m.
You can also file a complaint with the U.S. Dept. of Health and Human Services.
Online: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
Phone: Toll-free 1-800-368-1019, 1-800-537-7697 (TDD)
Mail: U.S. Dept. of Health and Human Services, 200 Independence Avenue, SW Room 509F, HHH Building, Washington, D.C. 20201
We provide free services to help you communicate with us, such as letters in other languages or large print. Or, you can ask for an interpreter. To ask for help, please call the toll-free phone number listed on your ID card, TTY 711, Monday through Friday, 8 a.m. to 8 p.m.
ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Please call the toll-free phone number listed on your identification card.
ATENCIÓN: Si habla español (Spanish), hay servicios de asistencia de idiomas, sin cargo, a su disposición. Llame al número de teléfono gratuito que aparece en su tarjeta de identificación.
請注意：如果您說中文 (Chinese)，我們免費為您提供語言協助服務。請撥打會員卡所列的免付費會員電話號碼。
XIN LƯU Ý: Nếu quý vị nói tiếng Việt (Vietnamese), quý vị sẽ được cung cấp dịch vụ trợ giúp về ngôn ngữ miễn phí. Vui lòng gọi số điện thoại miễn phí ở mặt sau thẻ hội viên của quý vị.
알림: 한국어(Korean)를 사용하시는 경우 언어 지원 서비스를
무료로 이용하실 수 있습니다. 귀하의 신분증 카드에 기재된
무료 회원 전화번호로 문의하십시오.
PAALALA: Kung nagsasalita ka ng Tagalog (Tagalog), may makukuha kang mga libreng serbisyo ng tulong sa wika. Pakitawagan ang toll-free na numero ng telepono na nasa iyong identification card.
ВНИМАНИЕ: бесплатные услуги перевода доступны для людей, чей родной язык является русском (Russian). Позвоните по бесплатному номеру телефона, указанному на вашей идентификационной карте.
تنبيه: إذا كنت تتحدث العربية (Arabic)، فإن خدمات المساعدة اللغوية المجانية متاحة لك. يرجى االتصال برقم الهاتف المجاني المدرج على بطاقة التعريف الخاصة بك.
ATANSYON: Si w pale Kreyòl ayisyen (Haitian Creole), ou kapab benefisye sèvis ki gratis pou ede w nan lang pa w. Tanpri rele nimewo gratis ki sou kat idantifikasyon w.
ATTENTION : Si vous parlez français (French), des services d’aide linguistique vous sont proposés gratuitement. Veuillez appeler le numéro de téléphone gratuit figurant sur votre carte d’identification.
UWAGA: Jeżeli mówisz po polsku (Polish), udostępniliśmy darmowe usługi tłumacza. Prosimy zadzwonić pod bezpłatny numer telefonu podany na karcie identyfikacyjnej.
ATENÇÃO: Se você fala português (Portuguese), contate o serviço de assistência de idiomas gratuito. Ligue gratuitamente para o número encontrado no seu cartão de identificação.
ATTENZIONE: in caso la lingua parlata sia l’italiano (Italian), sono disponibili servizi di assistenza linguistica gratuiti. Per favore chiamate il numero di telefono verde indicato sulla vostra tessera identificativa.
ACHTUNG: Falls Sie Deutsch (German) sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Bitte rufen Sie die gebührenfreie Rufnummer auf der Rückseite Ihres Mitgliedsausweises an.
注意事項：日本語 (Japanese) を話される場合、無料の言語支援
サービスをご利用いただけます。健康保険証に記載されている
フリーダイヤルにお電話ください。
توجه: اگر زبان شما فارسی (Farsi) است، خدمات امداد زبانی به طور رايگان در اختيار شما می باشد. لطفا با شماره تلفن رايگانی که روی کارت شناسايی شما قيد شده تماس
بگيريد.
धयान द: यदि आप हिदी (Hindi) बोलत ह, आपको भाषा सहायता सबाए, नि:शलक उपलबध ह। कपया अपन पहचान पतर पर सचीबदध टोल-फरी फोन नबर पर कॉल कर।CEEB TOOM: Yog koj hais Lus Hmoob (Hmong), muaj kev pab txhais lus pub dawb rau koj. Thov hu rau tus xov tooj hu deb dawb uas teev muaj nyob rau ntawm koj daim yuaj cim qhia tus kheej.
ចណាបអារមមណៈ បបើសនអនកនយាយភាសាខ មរ (Khmer) បសវាជនយ ភាសាបោយឥតគតថលៃ គមានសរាបអនក។ សមទរសពទបៅបេឥតគតថលៃ ខែេមានបៅបេើអតដសញញា ណបណណ របសអនក។PAKDAAR: Nu saritaem ti Ilocano (Ilocano), ti serbisyo para ti baddang ti lengguahe nga awanan bayadna, ket sidadaan para kenyam. Maidawat nga awagan iti toll-free a numero ti telepono nga nakalista ayan iti identification card mo.
DÍÍ BAA’ÁKONÍNÍZIN: Diné (Navajo) bizaad bee yániłti’go, saad bee áka’anída’awo’ígíí, t’áá jíík’eh, bee ná’ahóót’i’. T’áá shǫǫdí ninaaltsoos nitł’izí bee nééhozinígíí bine’dęę’ t’áá jíík’ehgo béésh bee hane’í biká’ígíí bee hodíilnih.
OGOW: Haddii aad ku hadasho Soomaali (Somali), adeegyada taageerada luqadda, oo bilaash ah, ayaad heli kartaa. Fadlan wac lambarka telefonka khadka bilaashka ee ku yaalla kaarkaaga aqoonsiga.
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Notes.
Contact us anytime: 1-877-835-9861
uhcfeds.com | myuhc.com
Habla Español? Podemos ayudar.
UnitedHealthcare Insurance Company MD-Individual Practice Association, Inc.
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.UnitedHealthcare dental coverage underwritten by UnitedHealthcare Insurance Company, located in Hartford, Connecticut, UnitedHealthcare Insurance Company of New York, located in Islandia, New York, or their affiliates. Administrative services provided by Dental Benefit Providers, Inc., Dental Benefit Administrative Services (CA only), DBP Services (NY only), United HealthCare Services, Inc. or their affiliates. Plans sold in Texas use policy form number DPOL.06.TX, DPOL.12.TX and DPOL.12.TX (Rev. 9/16) and associated COC form numbers DCOC.CER.06, DCOC.CER.IND.12.TX and DCERT.IND.12.TX. Plans sold in Virginia use policy form number DPOL.06.VA with associated COC form number DCOC.CER.06.VA and policy form number DPOL.12.VA with associated COC form number DCOC.CER.12.VA.Member phone number services should not be used for emergency or urgent care needs. In an emergency, call 911 or go to the nearest emergency room. The information provided through the member phone number service is for informational purposes only and provided as part of your health plan. Wellness nurses, coaches and other representatives cannot diagnose problems or recommend treatment and are not a substitute for your doctor’s care. Your health information is kept confidential in accordance with the law. Member phone number services are not an insurance program and may be discontinued at any time.The health care reform law requires the coverage of certain preventive services, based on your age, gender and other health factors, with no cost-sharing. The preventive care services covered are those preventive services specified in the health care reform law. UnitedHealthcare also covers other routine services, which may require a copayment, coinsurance or deductible. Always refer to your plan documents for your specific coverage.Access to Virtual Visits and prescription services may not be available in all states or for all groups. Go to myuhc.com for more information about availability of Virtual Visits and prescription services. Always refer to your plan documents for your specific coverage. Virtual Visits are not an insurance product, health care provider or a health plan. Virtual Visits are an internet-based service provided by contracted UnitedHealthcare providers that allow members to select and interact with independent physicians and other health care providers. It is the member’s responsibility to select health care professionals. Care decisions are between the consumer and physician. Virtual Visits are not intended to address emergency or life-threatening medical conditions and should not be used in those circumstances. Services may not be available at all times or in all locations. Members have cost-share responsibility and all claims are adjudicated according to the terms of the member’s benefit plan. Payment for Virtual Visit services does not cover pharmacy charges; members must pay for prescriptions (if any) separately.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, 1-800-860-8773, www.unitedhealthallies.com, [email protected] information provided under the Maternity Support Program is for general informational purposes only and is not intended to be nor should be construed as medical and/or nutritional advice. Participants should consult an appropriate health care professional to determine what may be right for them.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.Real Appeal is a voluntary weight loss program that is offered to eligible participants as part of their benefit plan. The information provided under this program is for general informational purposes only and is not intended to be nor should be construed as medical and/or nutritional advice. Participants should consult an appropriate health care professional to determine what may be right for them. Any items/tools that are provided may be taxable and participants should consult an appropriate tax professional to determine any tax obligations they may have from receiving items/tools under the program.Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Health Plan coverage provided by or through MD-Individual Practice Association, Inc. (MD-IPA).
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MT-1037879.2 (Mid-Atlantic) 10/18 ©2018 United HealthCare Services, Inc. 18-8690
