Welcome to Chapter 3 – Medical Plan Options Please remember: All Chapters provided in the 2016 Employee Presentation are intended to be part of a module

•Welcome to Chapter 3 – Medical Plan Options•Please remember:

• All Chapters provided in the 2016 Employee Presentation are intended to be part of a module series

• There are 6 chapters• Follow along with and compile these into your own

presentation (see below) in the order they are presented

• Text items in red are variable. Please modify them as necessary in order to fit your customers’ needs

• Please pick and choose from the slides provided to create a custom presentation that is right for you and your customers. Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.1

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Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

UnitedHealthcare Preventive

With the UnitedHealthcare Preventive plan, you can use any doctor, clinic, hospital or health care facility in our national network.

Save money by staying in our network. If you use a doctor who is not in the Options PPO network, the cost of your office visit and any screenings will not be paid by the plan.

There’s no need to choose a primary care provider (PCP).

Preventive care is covered 100% in our Options PPO network.Preventive care is covered 100% so you won’t need to worry about these costs and payments

UnitedHealthcare Preventive plan is not designed for non-routine care.

BENEFITS

What you need to know about UnitedHealthcare PreventiveThis plan does not coverhospital care or non-preventivephysician services. In addition,costs for other services,such as x-rays, blood tests,emergency department visitsor any other services to treatmedical conditions are notcovered. If you currently have,or expect to incur, significanthealth care expenses, youshould enroll in a morecomprehensive health care plan.

If you sign up for UnitedHealthcare Preventive, you will NOT be eligible for a subsidy – financial assistance from the government to help pay for health coverage.

For COVERAGE DETAILS, see your official health plan documents.

UnitedHealthcare Preventive


Network preventive care is covered 100%

One physical checkup every year

One OB/GYN checkup every year (Pap Smear)

One screening for breast cancer every year (mammogram)

Birth control pills or other forms of birth control

Shots for measles and other childhood diseases (Immunizations)

One colonoscopy every five years (colorectal cancer screening test)

Other preventive tests required by the Affordable Care Act

Network Search

NETWORK-UnitedHealthcare Preventive

Select the Options PPO network at myuhc.com®

You can search by name, location and specialty.


1

2

Searching our network before you enroll.

Find a doctor

Prescription Savings Program

Save on your prescription medications•Use your discount card at more than 62,000 pharmacies nationwide•Savings average over 36%, with potential savings up to 75%* •Find estimated pricing information and location of participating pharmacies at www.myprescriptiondrugsavings.com •Unlimited use at participating pharmacies•Use for everyone in the household, every medication is eligible for savings


The Best Price Advantage…The Best Price Advantage means if a drug is ever “on sale,” or if the pharmacy price is less than the discounted price, you will pay the lower of the two prices on retail prescription purchases.

Go online to print off a discount

card

Present your card

at participati

ng pharmacy

Discount is applied

You pay discounted

price

*Based on 2013 ScriptSave data

http://www.myprescriptionsavings.com/


Choice Plan

With the Choice plan, you can use any doctor, clinic, hospital or health care facility in our national network.

Save money by staying in our network. If you go out-of-network, you’ll have to pay for all of the costs.

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.Preventive care is covered 100% so you won’t need to worry about these costs and payments


BENEFITS

CO-PAYMENT*

PCP <$XX>

Specialist <$XX>

DEDUCTIBLE*

[Self<$XXXX

>

[Family<$XXXX

>

CO-INSURANCE* <XX%>

OUT-OF-POCKET LIMIT

[Self<$XXXX

>

[Family<$XXXX

>

Paying for network care


Core Essential Plan

With the Core Essential plan, you can use any doctor, clinic, hospital or health care facility in the Core Essential network.

Save money by staying in our network. If you go out-of-network, you’ll have to pay for all of the costs.




BENEFITS

CO-PAYMENT*

PCP <$XX>

Specialist <$XX>

DEDUCTIBLE*

[Self<$XXX

X>

[Family<$XXX

X>

CO-INSURANCE* <XX%>

OUT-OF-POCKET LIMIT

[Self<$XXX

X>

[Family<$XXX

X>



SignatureValue® Plan

The SignatureValue® plan gives you a PCP so you can get the quality of care you deserve and the protection you need from major health care costs.

•Select your personal PCP from the plan network. Each enrolled person must select a PCP.

•You need to get referrals to see a specialist.

•There’s no coverage if you go out-of-network.You will be responsible for the entire cost of the service.

•Preventive care is covered 100% in our network.Preventive care is covered 100% so you won’t need to worry about these costs and payments


BENEFITS

CO-PAYMENT*

PCP <$XX>

Specialist <$XX>

DEDUCTIBLE*

[Self<$XXX

X>

[Family<$XXX

X>

CO-INSURANCE* <XX%>

OUT-OF-POCKET LIMIT

[Self<$XXX

X>

[Family<$XXX

X>



Navigate® Plan

This is plan that requires you to select a PCP who can help guide you through the health care system so you can get the right care at the right time.

•You need to select your personal PCP from the plan network.

•Referrals are not required to see a specialist.But you will get the highest level of coverage if you get one.



For COVERAGE DETAILS, see your official health plan

documents.

BENEFITS

CO-PAYMENT*

PCP <$XX>

Specialist <$XX>

DEDUCTIBLE*

[Self<$XXX

X>

[Family<$XXX

X>

CO-INSURANCE* <XX%>

OUT-OF-POCKET LIMIT

[Self<$XXX

X>

[Family<$XXX

X>



Navigate® Balanced Plan

This is plan that requires you to select a PCP who can help guide you through the health care system so you can get the right care at the right time.






documents.

BENEFITS

CO-PAYMENT*

PCP <$XX>

Specialist <$XX>

DEDUCTIBLE*

[Self<$XXX

X>

[Family<$XXX

X>

CO-INSURANCE* <XX%>

OUT-OF-POCKET LIMIT

[Self<$XXX

X>

[Family<$XXX

X>



With this health plan, you can get higher quality care and pay less by using Tier 1 network providers. This plan requires you to select a primary care provider (PCP) from the network who will help guide you through the health care system.

•You need to select your personal PCP [from <ACO provider group>’s network] [from the plan network].

•Online referrals are needed from your PCP to see network specialists.

•Save money by staying in our network. If you go out-of-network, you’ll have to pay for all of the costs.

•Preventive care is covered 100% in our network.


documents.

BENEFITS

*Preventive care is covered 100% so you won’t need to worry about these costs and payments.

<Navigate Plan [in partnership with <ACO

Provider Group>]>

UnitedHealthcare has partnered with <ACO provider group> who is a Tier 1 Provider Group. <ACO provider group> is one of the most trusted names in health care and consistently earns high marks for patient satisfaction.]

<ACO Provider

Group Logo>

[


CO-PAYMENT* TIER 1 PROVIDER IN THE NETWORK OUT OF NETWORK

PCP <$XX> <$XX> <$XX>

Specialist <$XX> <$XX> <$XX>

DEDUCTIBLE*

[Self <$XXXX> <$XXXX> <$XXXX>

[Family <$XXXX> <$XXXX> <$XXXX>

CO-INSURANCE* <XX%> <XX%> <XX%>

OUT-OF-POCKET LIMIT

[Self <$XXXX> <$XXXX> <$XXXX>

[Family <$XXXX> <$XXXX> <$XXXX>

Paying for care

BENEFITS

<Navigate Plan [in partnership with <ACO

Provider Group>]>

BENEFITS


Your PCP:

Must be a general practice, family practice, pediatrician or internal medicine physician

Can be selected for the entire family or each covered dependent can select their own

Must submit all referrals online

When you sign up, have this information ready.

First name, last name and address

Physician ID number (you will find this number when you do a PCP search online)

Here’s how to choose your PCP.

BENEFITS


Advantages of using <ACO provider group>:

•Online test results and scheduling

•Registered nurse phone line

•One-stop multi-specialty care

•More predictable costs

•Fewer out-of-pocket expenses

•Out-of-area emergency coverage

•Extra Urgent Care access

•Higher quality care

•Better health care experience

Pay less using <ACO Provider Group>.

[Find Premium® Tier 1 physicians.These are doctors in 27 different medical specialties who are recognized for meeting national standards for quality and local market benchmarks for cost efficiency.

Look for the Tier 1 symbol when doing a NETWORK search.


Choice Plus Plan

With the Choice Plus plan, you can use any doctor, clinic, hospital or health care facility, but you save money when you use the national network.

There’s coverage if you need to go out-of-network.Choose what’s best for you. Just remember out-of-network providers will likely charge you more.



BENEFITS


If you go out-of-network, your costs may be higher. Out-of-network providers can even bill you for amounts higher than what your plan will cover. For COVERAGE DETAILS, see your official health plan documents.

CO-PAYMENT*

PCP <$XX>

Specialist <$XX>

DEDUCTIBLE*

[Self<$XXX

X>

[Family<$XXX

X>

CO-INSURANCE* <XX%>

OUT-OF-POCKET LIMIT

[Self<$XXX

X>

[Family<$XXX

X>


UnitedHealthcare Tiered Benefits PlanWith the UnitedHealthcare Tiered Benefits plan, you can use any doctor, clinic, hospital or health care facility, but you save money when you use the Choice Plus national network.

Reduced out-of-pocket costs when using UnitedHealth Premium® Tier 1 physicians



BENEFITS



CO-INSURANCE*

Tier 1 <$XX>

PCP <$XX>

Specialist <$XX>

DEDUCTIBLE*

[Self<$XXXX

>

[Family<$XXXX

>

OUT-OF-POCKET LIMIT

[Self<$XXXX

>

[Family<$XXXX

>


Options PPO Plan

With the Options PPO plan, you can receive care and services from anyone in or out of our network, but you save money when you use the national network.




BENEFITS



CO-PAYMENT*

PCP <$XX>

Specialist <$XX>

DEDUCTIBLE*

[Self<$XXX

X>

[Family<$XXX

X>

CO-INSURANCE* <XX%>

OUT-OF-POCKET LIMIT

[Self<$XXX

X>

[Family<$XXX

X>


Non-Differential Options PPO PlanWith the Non-Differential Options PPO plan, you can use any doctor, clinic, hospital or health care facility in the country.

You’ll have the same level of coverage for any health care provider or facility you use.If you can, use doctors and hospitals in the network. They can help keep your costs low.



BENEFITS



CO-PAYMENT*

PCP <$XX>

Specialist <$XX>

DEDUCTIBLE*

[Self<$XXX

X>

[Family<$XXX

X>

CO-INSURANCE* <XX%>

OUT-OF-POCKET LIMIT

[Self<$XXX

X>

[Family<$XXX

X>


Core Plan

With the Core plan, you have quality network care nearby. If you travel, you’ll get access to a national network to help lower your costs.



Preventive care is covered 100% in our network.

BENEFITS



CO-PAYMENT*

PCP <$XX>

Specialist <$XX>

DEDUCTIBLE*

[Self<$XXX

X>

[Family<$XXX

X>

CO-INSURANCE* <XX%>

OUT-OF-POCKET LIMIT

[Self<$XXX

X>

[Family<$XXX

X>

*Preventive care is covered 100% so you won’t need to worry about these costs and payments.


This health plan requires you to select a PCP who can help guide you through the health care system so you can get the right care at the right time.


•There’s coverage if you need to go out-of-network.Choose what’s best for you. Just remember out-of-network providers will likely charge you more.



BENEFITS



CO-PAYMENT*

PCP <$XX>

Specialist <$XX>

DEDUCTIBLE*

[Self<$XXX

X>

[Family<$XXX

X>

CO-INSURANCE* <XX%>

OUT-OF-POCKET LIMIT

[Self<$XXX

X>

[Family<$XXX

X>

Navigate Plus Plan


With the Catalyst plan, you can save money when you use the national network and take advantage of your pre-deductible allowance.

You get a pre-deductible allowance.It will help you pay for certain services before your deductible.

[There’s coverage if you need to go out-of-network.Choose what’s best for you. Just remember out-of-network providers will likely charge you more.]



BENEFITS



CO-PAYMENT*

PCP <$XX>

Specialist <$XX>

DEDUCTIBLE*

[Self<$XXX

X>

[Family<$XXX

X>

CO-INSURANCE* <XX%>

OUT-OF-POCKET LIMIT

[Self<$XXX

X>

[Family<$XXX

X>

Catalyst® Plan


Catalyst® Plan: Pre-deductible Allowance – two payments

Your employer gives you a pre-deductible allowance. This allowance is money that your employer sets aside for you to help pay for covered services.

•You can save money.The allowance can pay for certain covered services before you have to pay a deductible.

•You’ll receive two separate allowances for the year. One allowance can be used for doctor visits and the other can be used for emergency care.

BENEFITS

Qualified expenses:Qualified expenses:

Doctor office visits

Emergency care

Note: Cannot be used for pharmacy expenses, such as prescriptions

Catalyst® Plan



•You can save money.The allowance can pay for certain covered services before you have to pay a deductible.

•You’ll receive one allowance for the year.You can use this money for doctor visits and emergency care.

BENEFITS



Emergency care


Catalyst® Plan



You can save money.The allowance can pay for certain covered services before you have to pay a deductible.

You’ll receive one allowance for the year.You can use this money for all types of care.

BENEFITS



Emergency care

Surgery

Lab and X-ray services


Catalyst® Plan


Paying for network care with a pre-deductible allowanceYour deductible: You will pay a co-payment for covered services and then your pre-deductible allowance pays until it’s gone. Then, you’ll have to pay until you reach your deductible.

BENEFITS

STEP

1

Your deductible

STEP

1

Your allowance pays first

You pay+

Catalyst® Plan


Paying for network care with a pre-deductible allowanceYour co-insurance: After you reach the deductible, you share the costs with the plan.

BENEFITS

STEP

2

Your co-insurance

STEP

2

Your plan

pays %

You pay %

+

Your deductible

STEP

1


You pay+

Catalyst® Plan


STEP

3

Paying for network care with a pre-deductible allowanceYour out-of-pocket limit: When you reach the limit, you are done paying. The plan pays 100% of covered services for the rest of the plan year.

BENEFITS

Your out-of-pocket limit

STEP

3

You are done paying

Your co-insurance

STEP

2

Your plan

pays %

You pay %

+

Your deductible

STEP

1


You pay+

Catalyst® Plan


Select Plan

The Select Plan requires you to choose a primary care provider (PCP) who can help manage your care.

You need to select your personal PCP from the plan network.

There’s no need get referrals to see a specialist.

There’s no coverage if you go out-of-network.You will be responsible for the entire cost of the service.



BENEFITS

Paying for network careCO-PAYMENT*

PCP <$XX>

Specialist <$XX>

DEDUCTIBLE*

[Self<$XXX

X>

[Family<$XXX

X>

CO-INSURANCE* <XX%>

OUT-OF-POCKET LIMIT

[Self<$XXX

X>

[Family<$XXX

X>

BENEFITS


CO-PAYMENT DEDUCTIBLE CO-INSURANCEOUT-OF-POCKET LIMIT

Plan PCP <$XX>SPECIALIST <$XX>

SELF <$XX>FAMILY <$XX>

<$XX>SELF <$XX>FAMILY <$XX>

Your costs

BENEFITS



Plan 1PCP <$XX>SPECIALIST <$XX>






Your costs by plan

BENEFITS












Your costs by plan

BENEFITS















Your costs by plan

BENEFITS


















Your costs by plan

• This ends Chapter 3- Medical Plans• Please open Chapter 4- CDH Plans• Copy and paste slides from Chapter 4 to

your Master1. Click on the first slide and then press shift

while you click on the last slide2. Right click on the first slide and select copy3. Go to your Master (Chapter 1)4. Click below the thumbnail of the last slide in

that section5. Right click there and select Copy—Use

Source Formatting

• Delete any slides from Chapter 4 that do not apply to your customer’s needs

Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.34



Documents

Welcome to Chapter 3 – Medical Plan Options Please remember: All Chapters provided in the 2016 Employee Presentation are intended to be part of a module