1. Partnership Plan 2.0 UnitedHealthcare/Oxford welcomes You to the
State of Connecticut Partnership Plan 2.0
Benefits:
The Partnership Plan 2.0 offers a rich plan design, featuring the same no-referral Point-of-Service (POS) plan design offered to state employees, providing:
In- and Out-of-Network coverage
100% coverage for In-Network preventive care
Coverage for naturopaths, chiropractic care and acupuncture
An extensive local and national network through UnitedHealthcare/Oxford
Health Enhancement Program (HEP)
Dedicated Service Team
The Health Enhancement Program (HEP) is a program designed to promote preventive screenings, wellness visits and chronic disease education and counseling for employees and, as a result, saves money on health care in the long term by focusing health care dollars on prevention
The Partnership Plan 2.0 has a dedicated team of individuals who are your point of contact throughout the process. You will not be lost in the shuffle with questions or concerns about enrollment, billing, or claims
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2. Most Questioned Benefits
In-Network Coverage
Out-of-Network Coverage
Preventive Care:
Adult and Pediatric
No Copay
Deductible Plus Coinsurance
Immunizations/Vaccines
Primary Care and Specialist Sick Visits
$15 Copay
Naturopathic Physician Visits
Emergency Room
$35 Copay
*Waived if Admitted
Urgent Care Center
Routine Vision Exam & Refraction
- 1 Exam Per Calendar Year
Deductible Plus 50% Coinsurance
Infertility Services
$15 Copay Office
No Copay Inpatient and Outpatient Hospital
Outpatient PT/OT
- Unlimited Visits
- 30 Visits Per Calendar Year
Speech Therapy
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3. Most Questioned Benefits – Continued
In-Network Coverage
Out-of-Network Coverage
Chiropractic
No Copay
- Unlimited Visits
Deductible Plus Coinsurance
- 30 Visits Per Calendar Year; *Medical necessity required
Acupuncture
- 20 Visits Per Calendar Year
Combined In- and Out-of-Network
$15 Copay
Durable Medical Equipment
Foot Orthotics
Nutritional Counseling
- 3 Visits per person per calendar year
Out-of-Network Deductible: $300 (individual) / $900 (family)
Out-of-Network Coinsurance: 80/20
Out-of-Network Out-of-Pocket Maximum: $2,300 / $4,900 (includes deductible)
In-Network Out-of-Pocket Maximum: $2,000 / $4,000
*For a complete listing of covered services, please review the Summary Plan Description (SPD), available on the State Comptroller’s website for the Partnership Plan. See page 10 for website information.
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

4. Provider Network Information – Local
Local Network: “Oxford Freedom”
As a UnitedHealthcare/Oxford member, you will have access to one of the largest networks in the Connecticut, New York* and New Jersey tri-state area. In the tri-state, you will utilize the Oxford Freedom network. Oxford members can seek services from any participating Oxford Freedom provider in Connecticut, New York * and New Jersey without a referral.
Note: When speaking to your physician about their participation status, please use “Oxford Freedom,”, not “the State Plan”
*The following counties in New York are considered within the Oxford Freedom network area: New York, Bronx, Dutchess, Kings, Nassau, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Sullivan, Ulster and Westchester. All other counties in New York would be considered out of the Oxford Freedom area, so members would utilize the UnitedHealthcare Choice Plus national network.
Searching for Local Providers
To search for your physician, or any participating physician, online:
Visit
In the upper right-hand corner, click on “Find a Physician or Facility”
Select “Freedom” from the list of Oxford Networks
You can search for Physicians or Facilities, and search for both by Location, Name or Oxford Provider ID by clicking on the appropriate radio button
Complete the required fields marked with an asterisk - at minimum - and click “Search”
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5. Provider Network Information – National
National Network: “UnitedHealthcare Choice Plus”
When traveling outside of the tri-state area, if you live out of the area, or if you have a child attending school out of the area, you also have seamless access to the UnitedHealthcare Choice Plus national network. By finding one of our UnitedHealthcare Choice Plus physicians, your services will be treated just as if you were still at home.
Please note only those providers located outside the tri-state service area are considered participating Choice Plus providers for Oxford members
*The following counties in New York are considered within the Oxford Freedom network area: New York, Bronx, Dutchess, Kings, Nassau, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Sullivan, Ulster and Westchester. All other counties in New York would be considered out of the Oxford Freedom area, so members would utilize the UnitedHealthcare Choice Plus national network.
Searching for Providers Out of the Area
To search for a Choice Plus physician online:
Visit
You can search by provider name or provider specialty by entering your search criteria in the rectangular box and hitting “Search”
*You can narrow your search by changing the zip code
You can also search a list of providers by specialty, service type, condition, etc. by selecting one of the blue boxes
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

6. UnitedHealthcare/Oxford Clinical Programs
All Partnership Plan 2.0 members have access to the following programs:
*For more in-depth information on any of these programs, please see the enclosed “State of Connecticut Partnership Plan Health, Wellness and Clinical Management Programs” handout
All Partnership Plan 2.0 members also have access to the Rally Web Portal on oxfordhealth.com
For additional information on Rally please visit and put your cursor over “Online Tools & Resources”, then click on “Your Member Website”
Additionally, after your effective date, you may log into your account, then click on the “Health and Wellness” tab
UnitedHealthcare/Oxford Clinical Programs
PHS 2.0: Personal Health Support Nurse Team
CKS: Comprehensive Kidney Solutions
NL: Oxford On-Call Nurse Line
TRS: Transplant Resource Services
WC:  Telephonic Wellness Coaching
UBH: Full Care Management
TDS: Treatment Decision Support
HPP: Healthy Pregnancy Program
CHD: Congenital Heart Disease
MIP: Managed Infertility Program
CSP: Cancer Support Program
NRS: Neonatal Resource Services
CRS: Cancer Resource Services
HeN: HealtheNotes
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

7. The following services require prior authorization*:
Air Ambulance
Oral Surgery
Chemotherapy
Organ Transplant
Colonoscopy
Orthoptic Exercises
Dialysis
Outpatient Physical and Occupational Therapy
Durable Medical Equipment Over $500
Outpatient Surgery
High Cost Diagnostic Imaging (MRI, CT Scan, etc.)
Private Duty Nursing
Infertility Treatments
Skilled Nursing Facility Admission
Inpatient Admissions
Specialized Formula
Inpatient Hospice
Specialized Infant Formula
Inpatient Mental Health / Substance Abuse
Specialty Hospital Admission
Inpatient / Outpatient Sleep Study
Substance Abuse Residential Treatment
*Please note, this list is not complete and is subject to change. It is best to have your physician call UnitedHealthcare/Oxford for confirmation prior to services being rendered
Members who obtain non-emergency services from a Non-Network Provider without obtaining the required Prior Authorization may be subject to a penalty equal to $500 or 20% of the cost of such services, whichever is less. To inquire if a specific procedure that you are interested in is covered and/or requires prior authorization, please obtain the procedure code from your physician and call Customer Service at the numbers on slide 9
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

8. Subject to Med. Criteria? Oxford will approve Transitional Care if
Transition of Care
Transitional care is a process in which a member may be allowed to access non-network providers on an In-Network basis to continue a course of treatment during a transitional period. Transitional Care is sometimes referred to as “Continuity of Care”
If a member is currently undergoing treatment for a life threatening or disabling disease or condition, or is in their second or third trimester of pregnancy, and their physician is not participating with UnitedHealthcare/Oxford (Oxford Freedom Network) as of the effective date of the plan, members can qualify to continue using their physician for 60 days after transition at the In-Network level of care
Type
Form Used
Subject to Med. Criteria?
Oxford will approve Transitional Care if
New member enrollment  
Transitional Care Agreement Form for New Member
*Form can be provided upon request No
The member meets criteria relating to:
Life threatening disease/condition
Disabling disease/condition
Second or third trimester of pregnancy
Provider signs the Transitional Care Agreement Form for New Member and agrees to Oxford's policies and procedures
MD review is not required to certify
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

9. Contact Information
UnitedHealthcare/Oxford Contact Information
UnitedHealthcare/Oxford has proudly served the State of Connecticut since 2005 with a designated service team. The following numbers are staffed by individuals who understand the State’s benefits, and are there to help you through this process.
Customer Service Access: 8:00am – 6:00pm EST
Prior to Effective Date:
When prompted, state “Become a Member”
Hold the line and the next available representative will answer your call
After Effective Date:
Member Websites:
Partnership Plan Dedicated Site:
Contains information regarding the Partnership Plan, HEP information, how to search for a provider, links to other vendors in Partnership and more
Oxford Secure Member Portal:
Secure site for members to look up claims information, wellness information, order ID cards and more after the effective date of the plan
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

10. Additional Contact Information
Oxford’s Mental Health Site -
Secure site for members to search for a mental health provider near them and find reference information on mental health assistance
To Perform a mental health provider search on LiveandWorkWell.com:
Click on “Find a Provider” in the upper right box
On the next page, click on “Search for Mental Health Clinicians Near You”
The following page will allow you to search for a Provider or a Facility by geographic location, or by Name
The results page will let you further narrow down your search by level of the clinician (definitions provided online), by treatment options, by availability and much more
For information pertaining to Oxford’s medical and administrative policies, please visit:
To review in-depth coverage information, please visit the Comptroller’s website:
Scroll to the bottom of the page and click on “Medical Documents”
This will bring up the Summary Plan Description (SPD)
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.