2Today’s Agenda Medical Plan Review Being a Good Consumer Using the UHC BenefitsReminder: Health AdvocateEnrollment Procedures/ID Cards
3Health Plan Review Effective January 1, 2013 There will be no change in carriers.The current plan designs will remain in place but there will be a slight increase in the employee contribution.
4Health Plan Review Health care costs continue to rise New technology, drug developmentPoor lifestyle habits and behaviorsInability for consumers to recognize the difference in quality & costChoice of options allow you to decide where to spend your money – paycheck or doctor’s officePlans both encourage employees/dependents to continue to utilize preventative services and fill prescriptions
5Insurance Terminology Annual DeductibleThe amount you must pay for certain covered health services in a calendar year before the plan will begin paying for major medical benefits in that calendar year.CoinsuranceThe amount or percentage the plan (UHC) pays and you pay after the deductible is met.Maximum Out-of-PocketThe maximum amount of Annual Deductible and Coinsurance you pay every calendar year. Once you reach the Out-of-Pocket maximum, benefits are payable at 100% of Eligible Expenses during the rest of that calendar year.NOTE: These do not include benefits that are subject to copays.
6Plan Options Plan Designs Certificate of Coverage through UHC The plan designs – deductible, coinsurance, out of pocket expenses – remains the same.Certificate of Coverage through UHCWhile the essential benefits of the plan stay the same, there are a few enhancements with the Womens’ Wellness coverage.Employee ContributionThere will be slight increases to both plan options this year.
7NOTE: The Out-of-Pocket Maximum INCLUDES the Annual Deductible. Choice PlusIn NetworkOut of NetworkAnnual DeductibleIndividual$1,500$5,000Family$3,000$10,000CoInsurance80%60%Maximum Out-of-Pocket$4,000$8,000$20,000Preventive CareCovered at 100%60% after DeductibleDependent CoverageUp to age 26.NOTE: The Out-of-Pocket Maximum INCLUDES the Annual Deductible.Copayments do not accumulate to the Deductible or Maximum Out-of Pocket.
8NOTE: The Out-of-Pocket Maximum INCLUDES the Annual Deductible. Navigate – WI HMOIn NetworkOut of NetworkAnnual DeductibleIndividual$2,000N/AFamily$4,000CoInsurance80%Maximum Out-of-Pocket$8,000Preventive CareCovered at 100%Emergency CoverageIn-Network Deductible / CoinsuranceDependent CoverageUp to age 26.NOTE: The Out-of-Pocket Maximum INCLUDES the Annual Deductible.Copayments do not accumulate to the Deductible or Maximum Out-of Pocket.
9Both Plans – Employee Cost Single per monthFamily per monthChoice Plus$117.38$305.20Navigate (WI HMO)Choice (IL HMO)$108.56$282.17
10Introducing the UnitedHealthcare NavigateSM Plan Cover area with cropped image.Do not overlap blue bar.Completely cover gray area.Introducing the UnitedHealthcare NavigateSM Plan
11UnitedHealthcare NavigateSM Plan Connects you to a primary care physician (PCP) that you can trust who will provide and manage most of your careThe Navigate PlanStresses delivery of quality careCoordinates care across specialists, hospitals and other health care providersHelps to improve the overall health care experienceHelps set a path to better health outcomesThat’s why we are happy to introduce to you the UnitedHealthcare Navigate Plan. It’s a health plan that requires a primary care physician to be your firstcontact but also your guide to the right treatment, or the right specialist, at the right time. The Navigate Plan:Connects you to a trusted primary care physician (PCP) who provides and manages most of your careStresses delivery of quality careCoordinates care across specialists, hospitals and other health care providersImproves the overall health care experienceSets a path to better health outcomes
12UnitedHealthcare NavigateSM Plan You must select a primary care physician (PCP) near where you live.Network coverage only (unless emergency)Referrals are required to see network specialistsNot receiving the right care can result in:Unnecessary proceduresDuplication of servicesNeeded care not being recognizedPoor quality and outcomesPatient confusion and frustrationPRESENTER NOTE: Delete if not offeredThat is why you have the opportunity to enroll in a UnitedHealthcare Navigate Plan. It’s a health plan that can help put you on the path to the quality of care you deserve. And you get the protection you need from catastrophic health care costs. The plan comes with predictable office visit copayments and other costs when you see your primary care physician or need a prescription, so that there are no surprises. Here are the Navigate Plan highlights:You must select a primary care physician (PCP) near where you live.Network coverage only (unless emergency)Referrals are required to see network specialistsYou will have predictable office visit copayments or coinsuranceYou will have 100 percent preventive care coverage in our networkYou will have care management help if you require hospital stayWe will discuss more about this plan in a few minutes.12
13Selecting a Primary Care Physician Once you are there, just click on the plan or plans that apply to you to do a search.Search by clicking on the plan link.
14The Primary Care Physician Once you select a PCP, he or she will:Provide your preventive care and routine care for most illnesses & injuriesCoordinate all of your care, from staying healthy to managing serious and chronic conditions Refer you to other network physicians and specialists as neededThe following physicians can be selected as a PCP: General Practitioners Family Practitioners Internists PediatriciansOnce you select a PCP, he or she will:Provide your preventive care and routine care for most illnesses & injuriesCoordinate all of your care, from staying healthy to managing serious and chronic conditions Refer you to other network physicians and specialists as neededYour PCP will be your guide to the right treatment, the right specialist, at the right time.14
15Selecting a Primary Care Physician You must select a PCPEach family member may select a different PCP in your areaIf you do not select a PCP, UnitedHealthcare will assign oneNavigate health plan ID cards will include the name of your PCPYou can request to change your PCP after you enroll. This process could take up to 6 weeks.Health plan ID cards will include name of your PCPIn summary:You must select a primary care physicianEach family member may select a different primary care physicianIf you do not select a primary care physician , UnitedHealthcare will assign one. You will have the option to change your PCP after you enrollNavigate health plan ID cards will include the name of your primary care physician15
16Selecting a Primary Care Physician If you want to change your PCPCall Customer Care or log in to myuhc.com®Must submit change request by the 15th of the month to have new PCP by the 1st of the next month (e.g., submitted June 15th, effective July 1st)If submitted on the 16th (or after), change won’t occur until the following month (e.g., submitted June 16th, effective August 1st)New health plan ID cards will be issued whenever there is a PCP changeRetroactive changes will not be permittedJune 2011July 2011August 2011You may change your PCP by using our online services or calling Customer Care. If your new PCP selection is made on or before the 20th of the month, you can start using your new PCP at the beginning of the next month. A new health plan ID card will be issued to you with the name of your new PCP. Be sure to check your new health plan ID card to confirm your selected PCP. To change your PCP, call Customer Care or log in to myuhc.com.Here’s an example of how it works.You must submit a change request by the 15th of the month to have new PCP by the 1st of the next month (e.g., submitted June 15th, effective July 1st)If the request is submitted on the 16th (or after), the change won’t occur until the following month (e.g., submitted June 16th, effective August 1st)New health plan ID cards will be issued whenever there is a PCP changeRetroactive changes will not be permittedIf you change your PCP and have a referral to a specialist, you may need to get a new referral from your new PCP.1616
17Obtaining Referrals OR 1. 2. 3. You make an appointment with your PCP You’re not feeling well. You make an appointment with your PCPYour PCP evaluates you.2.Your PCP asks questions to try to understand what may becausing the illness. If necessary, your physician will order some tests.Once you select your primary care physician, he or she will be your first point of contact when you need care. So let’s assume you are not feeling well and you make an appointment with your primary care physician.Your primary care physician will provide most of your regular and routine care. This will include annual well visits and preventive care, as well as care for sickness or injury. Your primary care physician will see that you receive the highest quality of care at the right time.If your primary care physician feels that you need special care beyond what they can provide, they will help arrange it for you and will provide a referral to see a network physician or specialist.When you think about it, the referral process is a good thing – it’s not a barrier to care. You won’t have to worry about delays in care waiting for a specialist because your PCP can take care of most of your needs. If you do need a specialist, your PCP is there for you to make sure you see the right type of specialist and can help facilitate faster appointments or more immediate care, if needed.Based on the evaluation, your PCP may:3.Provide a treatment plan and/orprescribe medicationsRefer you to a network specialistOR17
18Obtaining ReferralsNavigate members must receive referrals before seeing another network primary care physician or specialistReferrals are not needed for emergency care even if received at a non-network hospitalReferrals are NOT REQUIRED for services from network:OB/GYNs and ChiropractorsBehavioral health and substance abuse disorder cliniciansOptometrist/ophthalmologist for refractive examsUrgent and convenience care centersIn summary:Navigate members must receive referrals before seeing another network primary care physician or specialistNavigate Balanced & Navigate Plus members must receive referrals before seeing another network primary care physician or specialist to receive highest level of benefitsReferrals are not needed for emergency care even if received at a non-network hospitalNOTE: Referrals are NOT REQUIRED for services from network:OB/GYNsBehavioral health and substance abuse disorder cliniciansProviders who provide routine refractive examsUrgent and convenience care centers18
19Good Consumers of Health Care Dollars Saving money starts with communication…..Make sure you at least have a Primary Care Physician.Ask questions and be in control of your care.Create a healthcare journal – track your own condition as well as your treatments and concerns.
20Good Consumers of Health Care Dollars Use your insurance plan’s resources.Register onKnow how to read your Explanation of Benefits.Use the Treatment Cost Estimator to determine and plan for the costs of your treatment.Remember, your health care involves both your coverage as well as your treatment.
21Good Consumers of Health Care Dollars Take charge! It’s your health and money!Use the Care24 services to help deciding on place of service (ER vs Urgent Care).Find out if generics are available and if they qualify for the pill-splitting program.Do your homework – find the Premium Designated physicians and facilities for your diagnosis.
22Using the UHC Benefits Register for MyUHC website Once you receive your UHC ID CardVisitSelect REGISTER NOWType in the requested informationGet started!
23Using the UHC Benefits - MyUHC.com Find a Doctor – send to cell phoneFind a HospitalLook up ClaimsImprove HealthOrder Prescriptions onlineReplace ID cardEnhanced Personal Health RecordEmbrace WellnessCheck BenefitsTreatment Cost EstimatorAnd Much More!71 percent of all eligible users access myuhc.com for claim/benefit information
24Using the UHC Benefits - Care24 Services Seven days a week – 24 hours a dayToll-free number ( )Access to registered nurses – assistance with place of service decisions
26Health Advocate Offers a Personalized and Comprehensive Service Find qualified doctors, dentist, hospitals, other healthcare providers anywhere in the countryExpedite appointments including hard-to-reach specialists; arranges for specialized treatments and testsHelp resolve insurance claims; negotiates billing/payment arrangementsAssist with eldercare such as finding adult daycare, assisted living and other related issues facing parents, parents-in-lawObtain unbiased health information about complex medical conditions to help make informed decisionsWork with insurance companies to obtain appropriate approvals for needed servicesAnswer general questions about test results, treatments and medication prescribed by the physicianAssist in the transfer of medical records, x-rays and lab resultsLocate and research the newest treatments for a medical conditionAssist with finding qualified wellness programs, providers and services
27Health Advocate Connects Member Consumer /MemberHealth PlanMD’s/HospitalsHealth AdvocateWellness ProgramsCommunity &Government ProgramsPBM or EAPCommunicationResolution= happy memberClaim AppealsDisease Management
28Healthcare Cost Estimator Pre-service pricing toolIntegrated into Health Advocate’s work-flowLargest source of private sector claims data – MedStatDatabase of over 69 million member records
29Privacy and Confidentiality Protection We protect your privacyYour healthcare information is kept strictly confidentialWe fully comply with the federal HIPAA lawMedical Authorization Form
30Employee Testimonials “I used it and it was great! My daughter seen an out-of network provider and I called Health Advocate to assist with the billing. The clinic worked with them and ended up writing off half of the bill. ”“I’ve used Health Advocate 2 or 3 times already. I’ve used them to help interpret why a service either isn’t covered or isn’t covered fully and to help decipher the multiple bills that are sent sometimes when you have hospital services (i.e. hospital, doctor, anesthesiologist…they all get their own bill!)”““I had a question about coverage for my son’s allergy shots. I contacted Health Advocate & the question was answered right away from the source itself (United Health Care). No long waits and I dealt only with customer service representatives (not automated computer-generated messages). I will definitely contact them again.”
31How to Reach Health Advocate Telephone: (toll-free)Website:Open: Monday – Friday 8am and 9pm Eastern TimeAfter hours: Health Advocate can be accessed 24/7. After hours and during weekends, on-call staff is always available for assistance with issues that need to be addressed during non business work hours.
32Enrollment Reminders Open Enrollment: Nov 15th -Nov 30th PLEASE NOTE: This election will be from 1/1/13 – 12/31/13.For January 1st, 2013 the medical, dental, and Flexible Spending enrollments are all aligned. The next opportunity for changes will be in November of 2013 for January 1, 2014 outside of a Qualifying Event.If you are not making any changes to your current plans, the only form to complete is the FSA Enrollment form if you are making an election for This must be done annually.
33Enrollment Forms Due: Nov 30th Enrollment RemindersIf you need to make any changes (new enrollment/add/move to HMO/cancel coverage) or enrolling in the FSA plan for 2013, you will need to complete an enrollment form.You can send forms in by:Mailing forms to the Benefits Dept at MSCScan and forms toFax forms toEnrollment Forms Due: Nov 30th
34For any Benefits-related questions, call Goodwill atTHANK YOU!