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University of Arkansas

System UnitedHealthcare

Group Medicare Advantage

(PPO)

2014 benefit plan

Y0066_130717_100929

Welcome

Why We’re Here

Medicare Basics

Plan Benefits

Questions & Answers

How to Enroll

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Why UnitedHealthcare?

UnitedHealthcare is here for you. At UnitedHealthcare, you get help understanding how to get the most from

your plan. You get connected to the care you need, when you need it. And

you get the programs, resources and tools to help you live a healthier life.

Medicare

Basics

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The ABCs of Medicare

Medicare Parts A & B (Original Medicare)

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Medicare Part B

• Medicare Part B Premium:

• You pay a premium each month for Medicare Part B (Medical Insurance)

• Most people pay the Part B premium of $104.90 each month in 2013

• However, if your modified adjusted gross income as reported on your IRS tax

return from 2 years ago is above a certain amount, you may pay more

• Medicare Part B Late Enrollment Penalty

• If you don't sign up for Part B when you're first eligible or if you drop Part B and

then get it later, you may have to pay a late enrollment penalty for as long as you

have Medicare

• You can sign up between January 1–March 31 each year. Your coverage will

begin July 1

• Your monthly premium for Part B may go up 10% for each full 12-month period

that you could have had Part B, but didn't sign up for it

Medicare Part C (Medicare Advantage Plans)

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Medicare Part D (Prescription Drug Plans)

When are you eligible for Medicare?

You’re eligible for Original Medicare

(Parts A and B) if:

You’re 65 years old, or you’re under

65 and qualify on the basis of

disability or other special situation.

-AND-

You’re a U.S. citizen or a legal

resident who has lived in the

United States for at least five

consecutive years.

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Plan Benefits

Premiums

What you pay today New starting 1-1-2014 SAVINGS

Just you: $ 262.10 (Classic) $ 292.00 (POS)

$ 198.20

$ 63.90 or $ 93.80 per month $ 766.80 or $ 1,125.60 per year

You and spouse are both on Medicare: $ 529.23 (Classic) $ 589.70 (POS)

$ 198.20 x 2 = $ 396.40

$ 132.83 or $ 193.30 per month $ 1,593.96 or $ 2, 319.60 per year

If your spouse is < 65 and not on Medicare…

No change. They stay on the UA plan, same individual rates as current: $ 361.04 (Classic) $ 399.87 (POS)

NA

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Important Enrollment Information

Sample ID Card

Put your Medicare

card in a safe

place

Front Back

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UnitedHealthcare® Group Medicare

Advantage (PPO) plan

All the benefits of Part A (Medicare covered services)

• Hospital stays • Skilled nursing • Home health

The advantages of a single plan. Medicare Advantage (Part C) plans are provided through private insurers,

like UnitedHealthcare. They include Part A, Part B, and Part D — all in

one plan. Medicare Advantage plans also offer additional benefits beyond

doctor and hospital visits.

All the benefits of Part B (Medicare covered services)

• Doctor’s visits • Outpatient care • Screenings and shots • Lab tests

Prescription drug coverage (Medicare Part D drugs)

• Included in the Medicare Advantage plan

Additional benefits (non-Medicare covered services)

• Included in the plan is non-Medicare covered Podiatry , non-Medicare

covered eye exam, Bonus Prescription Drug List

Medicare Advantage (PPO)

We make things simple.

• Hospital costs, doctor and outpatient care in one plan. Benefits are the

same whether you are in or out of the network

• Includes prescription drug coverage

• Vision, hearing and podiatry coverage

• No referral needed to see a specialist

• See any provider anywhere in the United States who accepts Medicare

• The provider does not have to be part of the UnitedHealthcare network

• Providers who have a contract with UnitedHealthcare (in-network) must

accept this plan if you are a current patient

• Providers who do not have a contract with UnitedHealthcare (out-of-network)

have the choice to accept the plan, except in the case of a medical

emergency when they have to accept

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Member Guide to Care

UnitedHealthcare Group Medicare

Advantage (PPO) plan

You Pay

Deductible (deductible does apply to

annual out of pocket maximum) $500

Annual out-of-pocket maximum

(this does not include prescription drug

benefits)

$1,000

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UnitedHealthcare Group Medicare

Advantage (PPO) plan

Benefit Coverage Member Responsibility

Primary care physician

(PCP) office $25 copay

Specialist office visit $40 copay

Urgently needed care (waived if admitted within 24 hrs) $50 copay

Emergency room (waived if admitted within 24 hrs) $65 copay

Inpatient hospitalization / per admit $500 Deductible then $450

copay

Outpatient surgery $500 Deductible then $200

copay

UnitedHealthcare Group Medicare

Advantage (PPO) plan

Benefit Coverage Member Responsibility

Clinical Lab Services $0 copay

Outpatient X-ray Services $0 copay

Diagnostic Procedure/Tests $500 Deductible then 20%

coinsurance

Diagnostic Radiology Services $500 Deductible then 20%

coinsurance

Therapeutic Radiology Services $500 Deductible then 20%

coinsurance

Influenza (Flu), Pneumococcal Pneumonia, Hepatitis B

Vaccines $0 copay

Shingles Vaccine Subject to applicable copay ($25

PCP and/or $70 pharmacy)

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UnitedHealthcare Group Medicare

Advantage (PPO) plan

Benefit Coverage Member Responsibility

Non-Medicare routine podiatry $500 Deductible then $40 copay / 6

visits per year

Non-Medicare routine vision $40 copay

Medicare-covered chiropractor $20 copay

Medicare-covered vision services exam $40 copay

Medicare-covered hearing services $40 copay

Diabetic Supplies (blood glucose monitor,

blood glucose test strips, lancet devices and lancets,

and glucose-control solutions for checking the

accuracy of test strips and monitors)

$500 Deductible then 20% coinsurance

Medicare Covered Preventive Care

These services are Covered at 100%, no out of pocket cost to you!

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Services that apply toward

the annual deductible and out-of-pocket maximum

Member Responsibility Member Responsibility

Annual Deductible Annual Out of pocket Maximum

$500 $1,000

Deductible Yes

ALL PHYSICIAN SERVICES

Primary Care Physician (PCP)/Office Visit (includes Non-MD office visit in a PCP office) Yes

Specialist Office Visit (include Non-MD in specialist office) Yes

INPATIENT SERVICES

Inpatient Hospital Stay - Facility Cost Share for Day Range 1 or Per Admit (Includes Inpatient Substance Abuse)

Yes Yes

Skilled Nursing Facility Care Yes Yes

Inpatient Mental Health in a Psychiatric Hospital - Facility Cost Share Yes Yes

Transplants - Cost Share (For MA Plans - related to Travel and Lodging Only. For Sr. Supp. Plans - Professional services in addition to Inpatient Hospital Services)

Yes

Services that apply toward

the annual deductible and out-of-pocket maximum Member Responsibility Member Responsibility

Annual Deductible Annual Out of pocket Maximum

$500 $1,000

OUTPATIENT SERVICES

Outpatient Surgery Yes Yes

Outpatient Hospital Services Yes Yes

Outpatient Mental Health/Substance Abuse (Individual Visit)

Yes

Outpatient Mental Health/Substance Abuse (Group Visit)

Yes

Partial Hospitalization Yes

Comprehensive Outpatient Rehabilitation Faciity (CORF)

Yes Yes

Occupational Therapy Yes Yes

Physical Therapy and Speech/Language Therapy Yes Yes

Cardiac/Pulmonary Rehabilitiation Services Yes Yes

Kidney Dialysis Yes Yes

MEDICARE-COVERED SERVICES

Chiropractic Visit (Medicare-covered) Yes

Podiatry Visit (Medicare-covered) Yes

Eye Exam, (Medicare-covered)

Yes

Hearing Exam (Medicare-covered) Yes

Dental Services (Medicare-covered Yes

Smoking Cessation Visit (Medicare-covered) Yes

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Services that apply toward

the annual deductible and out-of-pocket maximum Member Responsibility Member Responsibility

Annual Deductible Annual Out of pocket Maximum

$500 $1,000 AMBULANCE/EMERGENCY ROOM/URGENT CARE

Ambulance Services Yes Emergency Room (includes Worlwide Coverage) Yes

Urgently Needed Care (Contracted Providers) Yes PART B DRUGS Yes Yes Blood Yes DURABLE MEDICAL EQUIPMENT (DME) AND SUPPLIES

Durable Medical Equipment Yes Yes Durable Medical Equipment purchased in a pharmacy

Yes Yes

Orthotics and Prosthetics Yes Yes Medical Supplies Yes Yes Diabetes Monitoring Supplies Yes Yes HOME HEALTHCARE AGENCY Home Health Services Yes Yes Hospice (Medicare-covered) Yes PROCEDURES Diagnostic Procedure/Test Yes Yes Clinical Laboratory Services Yes Outpatient X-ray Services Yes Diagnostic Radiology Services Yes Yes

Therapeutic Radiology Service Yes Yes

Services that apply toward

the annual deductible and out-of-pocket maximum

Member Responsibility Member Responsibility

Annual Deductible Annual Out of pocket

Maximum

$500 $1,000 PREVENTIVE SERVICES Cardiovascular Screenings (Medicare-covered)

Yes

Immunizations Yes Cervical and Vaginal Cancer Screening Yes Prostate Cancer Screening Yes Colorectal Cancer Screenings Yes Bone Mass Measurements (Bone Density) Yes Mammography Yes Diabetes - Self Management Training Yes Medical Nutrition Therapy Yes Annual Wellness Visit (Physical Exam) and One-time Welcome-to-Medicare Exam. (Medicare-covered)

Yes

Annual Routine Physical Exam (Non Medicare-covered)

Yes

ADDITIONAL BENEFITS/PROGRAMS - (Non Medicare-covered)

Routine Podiatry (Non Medicare-covered) Yes

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Your New Prescription Drug Plan (PDP) • More than 65,000 network pharmacies nationwide — most national drugstore chains and

independent pharmacies are included.

• Thousands of covered brand name and generic drugs.

• Generic drugs as low as $2 through our Pharmacy Saver program2. (Wal-Mart and Sam’s Club

joining the network 1/1/2014)

• www.UnitedPharmacySaver.com

• Bonus drug coverage in addition to Medicare Part D drug coverage.

• Your plan provides full coverage in the Coverage Gap (donut hole).

• Check your plan's drug list or call Customer Service to see if your prescription drugs are

covered.

Your New Prescription Drug Plan

Bonus Drug List (BDL)

• This Bonus Drug List gives you additional coverage on some

prescription drugs that are normally excluded from the Part D formulary

• The list is included in the Pre-Enrollment materials

• Additional covered drugs are not part of the Part D plan and do not

count toward Medicare Part D out-of-pockets costs

• Included in the Bonus Drug List but not limited to: Analgesics,

Antimigraine Agents, Dermatological Agents, Gastrointestinal Agents,

Erectile Dysfunction drugs, Hormone Replacement Drugs, Nutritional

Supplements, Otic Agents, Respiratory Tract Agents

• Drug cost is determined by cost-sharing tier

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Your New Part D benefit highlights

Tier Prescription

Drug Type Your Costs

Retail (30 day supply) Preferred Mail Order (90 day

supply)

Tier 1 Generic and some

brands $10 copay $20 copay

Tier 2 Preferred Brand and

some generics $35 copay $70 copay

Tier 3 Non-Preferred Brand and

some generics $70 copay $140 copay

Tier 4 Specialty Drugs and

some generics $70 copay $140 copay

Prescription Examples Prescription

What I pay now in the UA plan NEW cost (mail order for 3 months)

Crestor $70 for 1 month $210 for 3 months

$35 for 1 month $70 for 3 months

Nexium $189 for 1 month $ 567 for 3 months (reference based pricing)

$35 for 1 month $70 for 3 months

Diovan HCT $35 for 1 month $105 for 3 months

$35 for 1 month $70 for 3 months

Synthroid $27 for 1 month $81 for 3 months

$35 for 1 month $70 for 3 months

Vesicare $160 for 1 month $480 for 3 months (reference based pricing)

$35 for 1 month $70 for 3 months

Janumet Full cost ~ $77 for 1 month (not

covered in our formulary)

$35 for 1 month $70 for 3 months

Both plans apply the lesser of logic. If a prescription drug is lesser than

the copay amount, you will always pay the lesser amount.

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More Prescription Examples

Prescription

What I pay now in the UA plan NEW cost (mail order for 3 months)

Lexapro $70 for 1 month $210 for 3 months

$70 for 1 month $140 for 3 months

Premarin $35 for 1 month $105 for 3 months

$35 for 1 month $70 for 3 months

Lisinopril $4 for 1 month $12 for 3 months

$4 for 1 month $8 for 3 months

Zetia $70 for 1 month $210 for 3 months

$35 for 1 month $70 for 3 months

Cymbalta $35 for 1 month $105 for 3 months

$35 for 1 month $70 for 3 months

Both plans apply the lesser of logic. If a prescription drug is lesser than the

copay amount, you will always pay the lesser amount

Mail Service Pharmacy

A pharmacist

reviews your

information for

drug

interactions,

allergies and

dosage.

For your

security,

another

pharmacist

reviews your

medication for

accuracy after

it is dispensed.

OptumRx

seals your

medication in

a tamper-

evident

package.

They mail

your

medication to

you and

notify you

when it has

been

shipped.

Your order

enters

OptumRx

fulfillment

system.

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More ways you can save

Review your medications. • Review your prescription drugs with your doctor at least once a year.

Ask, “Do I still need them all? Can I stop taking the ones I don’t need?”

Use your member ID card. • Show your member ID card at the pharmacy to get the plan’s

discounted rates.

Use participating network pharmacies. • You’ll get the greatest benefit, if you use in-network pharmacies.

Take advantage of our Pharmacy Saver Program • Prescriptions as low as $22.

• www.UnitedPharmacySaver.com

Use mail service pharmacy.

• You’ll save time and trips to the pharmacy. 2Drugs and prices may vary between pharmacies and are subject to change during the plan year. Prices are based on quantity fil led

at the pharmacy. Quantities may be limited by pharmacy based on their dispensing policy or by the plan based on Quantity Limit

requirements; if prescription is in excess of a limit, copay amounts may be higher.

Income Related Monthly Adjustment Amount

(IRMAA)

• In January of 2011, the Affordable Care Act established an income related

monthly adjustment amount under the Part D program which is known as

the Part D-IRMAA

• The Part D-IRMAA must be withheld from Social Security, RR Board or

Office of Personnel Management benefit checks unless the monthly

payment isn’t enough to cover the entire amount owed. Otherwise member

will receive a bill from Medicare

• Members will have to pay this extra amount each month, in addition to their

monthly Part D plan premium, to keep Medicare prescription drug coverage

• Social Security will send affected members a letter if they have to pay an

extra amount for their prescription drug coverage. The letter will explain

how they determined the amount the member must pay

• UnitedHealthcare does not determine who will be subject to the Part D-

IRMAA. If a member disagrees with the amount they are required to pay,

they must contact Social Security

• If members do not pay the Part D-IRMAA, they will be disenrolled from the

plan

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Income Related Monthly Adjustment Amount

(IRMAA)

Fitness program

Stay physically fit and active at no additional cost.

Join SilverSneakers and enjoy:

• Stay active with SilverSneakers® Fitness Program. Choose a fitness

center from more than 11,000 participating locations. Find the nearest

location at www.silversneakers.com).

• Classes, cardio equipment, resistance machines, free weights and

heated pools (at certain locations). Amenities may vary at

each location.

• Many women-only locations, including Curves®, nationwide.

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Fitness program

Don’t live near a fitness center?

If the nearest fitness center is 15 miles or more away from your

home, you can request the SilverSneakers steps program. Once

you enroll in Steps, you may select one of the four kits that best

fits your lifestyle and fitness level – general fitness, strength,

walking or yoga. The Steps wellness tools can help you get fit at

home or on the go.

NurseLineSM

You’re never alone. Whether you have questions about a medication or have a health

concern in the middle of the night, with NurseLine a nurse is only a

phone call away.

Services include:

Nurses answer your health questions 24 hours a day. They

can:

• Help you choose a new doctor

• Provide tips on how to help control diabetes, blood pressure or

high cholesterol

• Review your medication and look for generic options

• Connect you with community resources for exercise

• Provide easy ways you can add fruits and vegetable to your diet

• Provide tips to help stop smoking

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Solutions for Caregivers

Helping you care for a loved one.

Solutions for Caregivers supports you, your family and

those you care for.

Services include:

• On-site assessment by a registered nurse

• A personalized care plan

• Connections to local resources

The products and services described above are neither offered nor guaranteed under our contract with the Medicare program.

In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be

subject to the UnitedHealthcare grievance process.

Hearing program

• In addition to your $500 hearing aid benefit you have access to deeply

discounted hearing aids

• Hearing loss is the third most common chronic health condition among older

Americans, and 40% of people age 65 or older are hearing impaired3

• Custom programmed hearing aids can address your personal hearing needs

• Batteries and ear tubes/wax guards, provided at no additional cost, that last most

users six months

• 70-day no-risk trial period

• One-year manufacturer’s warranty

• The convenience of delivery right to your home

• 1-855-523-9355, or www.hiHealthInnovations.com/united

Hearing aids starting at $599 - $799 each,

depending on the model you choose.

3 “Epidemiology of Hearing Loss Study” by the University of Wisconsin School of Medicine and Public Health

The products and services described above are neither offered nor guaranteed under our contract with the Medicare program. In

addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject

to the UnitedHealthcare grievance process.

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• Welcome Kits are sent to each

of the Retirees Households.

• These Welcome kits contain

the following materials.

• Welcome to Your Plan

Getting Started

• Evidence of Coverage

• Formulary

• Mail Order Rx Form

• Provider Directory

• Pharmacy Directory

• Missing Enrollment Information

Letter

• Confirmation of Enrollment

Confirmation that

UnitedHealthcare has sent the

Retirees enrollment to CMS, and

the enrollment has been accepted

(or) confirmed with CMS. This

letter includes the Retirees ID

card. Required by CMS.

• The Pre-Enrollment booklets

are sent out by

UnitedHealthcare to each of the

Retirees Households.

• These Pre-Enrollment booklets

contain the following materials.

• Pre-booklet Cover Letter

including opt out

information

• Your Plan Explained

• Benefit Highlights

• Summary of Benefits

• Member Rights &

Responsibilities

• The Announcement Letter

is sent out by UAS to

announce the 2013 plan

year benefit changes with

UnitedHealthcare,

Announcement

Letter Sent to

Retirees

Pre-Enrollment Kits

Sent to Retirees

Letters Sent to

Retirees Welcome Kits

September 3, 2013 September 2013 November/December 2013 December 2013

41

Member Mailings and what to expect

General Member Billing Information

•

•

•

•

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Understand Medicare’s Rules

• You must keep Medicare Parts A and B and continue to pay your

Medicare Part B premium.

• You can only be in one Medicare Advantage plan at a time. Enrolling

will automatically disenroll you from any other Medicare Advantage or

prescription drug plan.

• Please read your Evidence of Coverage (EOC), including appeals and

grievance rights.

– The EOC also covers specific plan benefits, copays, exclusions, limitations and other terms.

Please review the full text of the Statement of Understanding in your

2014 enrollment kit.

Questions &

Answers