Welcome toEssentiaCare!

YOUR GUIDE TO GOOD HEALTH

A MEDICARE PLAN YOU CAN TRUST

H0735_093015_9 CMS Approved (10142015)

EssentiaCareTABLE OF CONTENTS

1. Welcome to EssentiaCare member letter 2. Getting Started

3. Member Discounts on Items and Services

4. Prescription Drug Coverage

5. Health and Wellness

6. Fitness Program Options

7. Go Green, Go Paperless, Go Online

8. Contact Information

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Dear EssentiaCare Member,

Welcome to EssentiaCare – where you matter most. Thank you for choosing us as your health plan. Know that you are at the heart of all we do. We’re glad to have you as a member and help you get the care and coverage you need, when you need it.

This book is designed to help you explore and navigate the many benefits and features of your plan. Read it carefully, keep it handy, and refer to it for help making healthy choices in your life. Consider this your guide to good health as you choose well and live well every day.

With EssentiaCare, we think you’ll find that no other health plan offers you opportunities to improve your health the way we do. As a member, you can take advantage of great wellness benefits to keep you healthy now and in the future.

Welcome to the EssentiaCare family, and thank you for trusting us with your care.

Yours in good health,

Jim Eppel David C. Herman, MDUCare President and Chief Executive Officer Essentia Health Chief Executive Officer

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Welcome to EssentiaCare – health care with you in mind

At EssentiaCare, you are at the center of all that we do. Your health and well-being are our priority. We’re focused on providing you opportunities to improve your health. Picture it… you, making healthy choices and living well.

Take time to preview your new benefits and features – all captured in this guide.

Now that you’re an EssentiaCare member, let’s get started.

1. Keep it simple. Whether you’re calling us to discuss your benefits, pay your bill, speak to a nurse, or schedule an appointment, EssentiaCare Customer Services handles it all. We’re here to take your call 24/7 at 218-722-4915 and 1-855-432-7025 toll free. TTY machine users call 1-800-688-2534 toll free.

Anytime, anywhere – online access, too! Go to EssentiaCare.org/member for convenience and ease whenever and wherever you are, 24/7.

2. Helping you stay healthy. When you join EssentiaCare, you will receive personalized and coordinated care focused on helping you get healthy and stay healthy. Whether it’s time to set up preventive care screenings and exams or you need help to better manage a chronic condition, it’s important to know that your doctor, pharmacist, and clinic staff all work together to get you the best care you need, when you need it.

3. It’s online, it’s easy, it’s confidential. Expect a call from us soon to get started, explain your plan benefits, and set up a connection to Essentia MyHealth – your online health records. With Essentia MyHealth online health records, your notes, test results, appointment scheduling, prescription refills, and secure email access to your doctor are all available for you at essentiamyhealth.org.

In addition to Essentia MyHealth, you also have convenient access to a 24/7 nurse line (same phone number as Customer Services) and virtuwell® for virtual visits round-the-clock.

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2. Getting started

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Your EssentiaCare Member ID Card

Your member ID card is the key to helping you access the care you need. It’s also an important tool that helps providers better understand your health care coverage. Keep in mind these important tips. • Review your ID card carefully and make sure the information is correct. • Carry your ID card with you at all times. • Present your current ID card when you seek care. • Keep your ID card handy when you call Customer Services. • If you lose or misplace your ID card, order a new card through the secure member site or by calling Customer Services.

The following is a sample of an EssentiaCare member ID card.

1. EssentiaCare.org website Access the member site and helpful information by visiting EssentiaCare.org.

2. Member ID number Secure member ID

number unique to you.

3. Plan name The name of the

specific plan you have.

4. Contact information Important information,

including Customer Services and 24/7 nurse line phone numbers.

6. SilverSneakers® Fitness program

This SilverSneakers Fitness icon shows your program eligibility.

5. Health Club Savings This Health Club Savings

icon shows your program eligibility.

Issuer: 80840ID: 12345678900Name: JOHN Q DOERxBIN: 003858 RxPCN: MD RxGrp: MNUARxID: 12345678900SVC Type: Medical/DentalGroup Number: xxxxxxCare Type: EssentiaCare SecureH0735 001Medicare Limiting Charges Apply Coverage Year 2016 Issued: 11/15/2015

essentiacare.org

FOR MEMBER USE – Emergency Care: For emergency situations, go to the nearest hospital or call 911.Customer Services, including 24/7 nurse line: 218-722-4915 or 1-855-432-7025, TTY 1-800-688-2534Complaints, Appeals and Grievances: 218-722-4316 or 1-855-432-7026, TTY 1-800-688-2534FOR PROVIDER USE – Notify UCare within 24 hours of admission: 1-612-676-6705 or 1-877-447-4384, Fax 1-612-884-2499 or 1-866-610-7215Provider submit claims to:All Medical: UCare, P.O. Box 70, Minneapolis, MN 55440-0070Pharmacy: Express Scripts, Inc., Attn: Med D Accts. P.O. Box 2858, Clinton, IA 52733-2858Chiropractic: Chiropractic Care of Minnesota, Inc., c/o Landmark Healthcare, Inc., P.O. Box 13977, Sacramento, CA 95853-3977Dental: Delta Dental of Minnesota, P.O. Box 330, Minneapolis, MN 55440-0330Provider Assistance Center: 612-676-3300 or 1-888-531-1493 Pharmacy Help Desk: 1-800-824-0898

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Request the EssentiaCare member discount

VISION

When ordering eyeglasses, you will receive a 20% discount on the retail price including frames and lenses at Essentia Health Optical Shops.

Locations: Essentia Health – Duluth Clinic 2nd Street Building, Essentia Health – Virginia Clinic, Essentia Health St. Mary’s – Detroit Lakes Clinic, Essentia Health – Wahpeton Clinic, Essentia Health – South University Clinic (Fargo)

SKIN PRODUCTS and SERVICES

You will receive a 20% discount at Essentia Health Skin Renewal Services on skin products and services offered at the Essentia Health – Duluth Clinic 3rd Street Building. From treatment for blemishes to concerns about signs of aging skin, experienced skin renewal specialists offer a full selection of treatment options.

HEARING AIDS

When ordering a new hearing aid, you’ll receive a 20% discount at these locations: Essentia Health – Duluth Clinic 2nd Street Building, Essentia Health – Superior Clinic, Essentia Health – Virginia Clinic, Essentia Health – South University Clinic (Fargo), Essentia Health St. Joseph’s – Brainerd Clinic

EPIC HEARING

Take advantage of the EPIC Hearing Healthcare Network that provides you access to credentialed ENT (Ear, Nose, and Throat) physicians and licensed audiologists as well as savings on name brand hearing aids. A complimentary one-year supply of batteries is included all Standard, Advanced, and Premium level hearing aid purchases. EPIC’s prices may be as much as 60% below manufacturer’s suggested retail price, and up to 35% lower than most discount offers. Contact EPIC for more information on products and services at 1-866-956-5400 toll free (TTY 711).

WEIGHT WATCHERS®

You can receive a three-month discounted subscription for $55 and future months for $16.95. Call 218-722-4915 or 1-855-432-7025 toll free, 24/7 to obtain the discount code. Then visit www.weightwatchers.com.onlinesignup, and enter the code. This discount applies to the online program only.

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Understanding your EssentiaCare prescription drug benefits

As an EssentiaCare member, we know that your prescription drug benefits are an important part of your health care coverage. See your EssentiaCare Provider Directory for a list of plan pharmacies. Be sure to read through the prescription drug coverage pages in your EssentiaCare Evidence of Coverage book, containing all the details. Your Evidence of Coverage document is available online at EssentiaCare.org/member as well as in your new member packet.

FILLING PRESCRIPTIONS

You have options. When your doctor prescribes a medication, you have three ways to route those orders and have your prescription filled.

1. Your doctor sends your prescription to the EssentiaCare pharmacy you select 2. You take the prescription orders in person to your EssentiaCare pharmacy of choice 3. You enroll in the convenient and cost-saving mail-order program through Express Scripts

MAIL-ORDER PHARMACY

The Express Scripts mail-order program allows you to receive a 90-day supply of many medications for two copays. Interested in signing up? Here’s how:

1. Call Express Scripts at 1-877-567-6320 from 7:45 a.m. to 5 p.m. Monday through Friday. 2. Log in anytime 24/7 to Express-Scripts.com and follow the prompts to enroll.

Remember to call EssentiaCare Customer Services with any questions at 218-722-4915 or 1-855-432-7025 toll free. TTY machine users call 1-800-688-2534 toll free.

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Make the most of your membership with these servicesPreventive care is key to healthy living

Your coverage includes an annual wellness visit. Many important preventive screenings and vaccines are also available at no cost to you. You may be eligible to earn a reward for completing a mammogram or colon cancer screening, and if you’re living with diabetes, a dilated eye exam. Check it out at EssentiaCare.org/member to see if you’re eligible. Here is a checklist to review with your doctor.

SCREENINGS

Bone density Cholesterol Colon cancer

VACCINES

Annual flu vaccine. Ask your doctor for a flu shot or nasal spray. Choose any location that’s convenient for you. It’s covered! Pneumonia. Recommended at age 65. Ask about other vaccines, such as shingles.

OTHER TOPICS

If you have noticed changes to your health or have concerns, be sure to discuss with your doctor.Common concerns include:

Blood pressure Medication review Mood changes Physical activity

TAKE A CLASS GET A DISCOUNT

Sign up for a community education class and receive up to a $15 discount (limits apply). Choose from cooking, fitness, social activities, painting or another class that interests you. To find out what’s available in your community, check with your school district. GET HELP QUITTING TOBACCO

The tobacco quit line is available Monday through Friday, 7 a.m. to 10 p.m., and 10 a.m. to 4 p.m. on Saturdays at 1-888-642-5566 toll free and TTY 1-866-228-2809 toll free. Call to: • Speak to counselor about habit-changing strategies from the comforts of home. • Request nicotine patches, gum, or lozenges, which are available at no charge.

Diabetes exams (if needed)MammogramsVision

Problems with balance or fallingSleep problemsUrine leakageWeight gain/loss

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Have fun and stay active

Watch your dollars and your waistline with EssentiaCare fitness benefits. Choose between SilverSneakers® Fitness or Health Club Savings – it just depends on which program is available at your preferred club.

SILVERSNEAKERS® FITNESS PROGRAM

• Free basic fitness membership at more than 13,000 locations nationwide with 500 clubs in Minnesota, like the YMCA and most community centers, including locations close to you. • SilverSneakers FlexTM offers classes at convenient locations like parks and recreation centers. • Online tools to help you reach your fitness goals. • Fitness kit to use at home or when traveling.

Present your SilverSneakers card when you visit a participating location. For more information, visit silversneakers.com or call SilverSneakers at 1-888-423-4632 toll free (TTY: 711), Monday through Friday, 7 a.m. to 7 p.m.

HEALTH CLUB SAVINGS

• Receive up to a $20 monthly reimbursement for a participating club outside of the SilverSneakers network. Visit EssentiaCare.org/member for a club list. • Enrollment is easy. Simply show your EssentiaCare member ID card at a participating location. Typically you will begin receiving your credit two months after you sign up.

If you have questions about what’s included in your coverage, call EssentiaCare Customer Services at 218-722-4915 or 1-855-432-7025 toll free. TTY machine users call 1-800-688-2534 toll free.

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Simplify your life – register to go paperless

Clear the clutter. Sign up to receive electronic versions of your member materials. It’s good for you and good for the planet, too. For every 10 EssentiaCare members who sign up, you save a tree every year.

The EssentiaCare.org member site is your secure, online health resource. The member site gives you the tools you need to stay organized and to manage your health care – online, anytime! Register for an account and click “Go Paperless.” Simply select the paperless option.

Use the member site to: • Send questions securely to Customer Services • Print and reorder your member ID card • Look up claims, track your health care spending, and access billing information • Download a copy of your Evidence of Coverage and Summary of Benefits • Review your formulary (list of covered drugs/medications) • Receive coverage updates and important health and wellness information • Keep your contact information up-to-date

Visit EssentiaCare.org to register today.

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If you have any questions, please be sure to give us a call at the numbers below or visit our website at EssentiaCare.org.

EssentiaCare’s Customer Services Team is available 24/7 at 218-722-4915 or 1-855-432-7025 toll free

If you use a TTY machine, call 24/7 at 612-676-6810 or 1-800-688-2534 toll free

Medicare is available 24/7 at 1-800-MEDICARE (1-800-633-4227) (TTY 1-877-486-2048)

Online anytime at EssentiaCare.org

EssentiaCare is a PPO plan with a Medicare contract. Enrollment in EssentiaCare depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. You must continue to pay your Medicare Part B premium.

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