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 (tiered benefits do not apply)
Coverage for naturopathic care, 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. Care Management Solutions, Inc. (CMSI) will provide additional information on the HEP program
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
$0 (Preferred)/$15 Copay
Naturopathic Physician Visits
$15 Copay
Emergency Room
$250 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
*Medical necessity required
30 Visits Per Calendar Year
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3. Most Questioned Benefits – Continued
In-Network Coverage
Out-of-Network Coverage
Speech Therapy
No Copay
- Unlimited Visits if the treatment is related to one of the specific diagnoses outlined in the SPD. All other physician-prescribed speech therapy has a 30 visit per calendar year limit and requires Prior Authorization
Deductible Plus Coinsurance
- 30 Visits Per Calendar Year if the treatment is related to one of the specific diagnoses outlined in the SPD. All other physician prescribed speech therapy has a 30 visit per year combined In-and-Out-of-Network limit and requires Prior Authorization
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.
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4. Tiered PCP and Specialist Copay
If a member utilizes a “Preferred” Primary Care Physician (PCP) or a specialist in one of the 10* specialties below in Connecticut ONLY the copay will be as follows:
Allergy & Immunology -- Ophthalmology*
Cardiology Orthopedic Surgery
Endocrinology -- Rheumatology
ENT Urology
Gastroenterology -- OB/GYN
“Preferred” (two solid blue hearts ) - $0 Copay
“Non-Preferred” (less than two solid blue hearts) - $15 Copay
Deductible and Coinsurance for Out-of-Network providers
Any specialist type not listed above that is In-Network will be a $15 copay
*Ophthalmology providers do not follow the blue heart designation. You can find a list of “Preferred” Ophthalmology providers on the dedicated website for Partnership Plan members (see page 11 for website information)
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5. Provider Network Information – Local
Local Network: “Oxford Freedom”
As a UnitedHealthcare/Oxford member, you will have access to a large network of providers 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. When seeking services from a Primary Care Physician (PCP), or a specialist in one of the 10 specialties on page 4, please remember to pay attention to the physician’s heart status for your cost-share.
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 (see next page for information on Choice Plus)
Search for local Oxford Freedom providers online:
Visit
Select “Freedom” from the list of Oxford Networks
Click on “Change Location” to search by an address or zip code – then click “Update Location”
You can then search by specialty, provider name or practice name – then click “Search”
On the results page, you will have filter options on the left-hand side to narrow your search even further
Look for the two solid blue hearts for Connecticut PCP and specialists in the 10 specialties for a $0 copay
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

6. 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 that office visits for providers outside of Connecticut are not subject to the tiered benefit level, and visits for non-routine services will apply a member cost-share.
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.
Search for ChoicePlus providers online:
Visit:
Click on “Shopping Around”
Choose “Choice Plus” from the list of available plans
Click on “Change Location” to search by an address or zip code near you – then click “Update Location”
You can search by provider name or provider specialty by entering your search criteria in the rectangular box and hitting “Search”. You can also search a list of providers by specialty, service type, condition, etc. by selecting one of the blue boxes below
On the results page, you will have filter options on the left-hand side to narrow your search even further
Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

7. UnitedHealthcare/Oxford Clinical Programs
All Partnership Plan 2.0 members have access to the following clinical 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.

8. Site of Service Program for Lab and Diagnostic Radiology
This program is for lab and diagnostic radiology services, and ONLY applies to services rendered in the state of Connecticut or Westchester county in New York; it does not apply to services rendered in any other NY county, NJ or any other state
You pay the standard copay for these services when they are performed during the course of an office visit at a physician or specialist’s office (for a Preferred Provider office visit the standard copay is $0; $15 for all others). Imaging and lab work performed at your physician’s office is covered under Site of Service at no cost to you.
A list of “Preferred” lab and radiology providers is posted on the State of CT Partnership dedicated Member website:
Members will be responsible for the following cost-shares:
$0 copay for “Preferred” lab and diagnostic radiology providers
20% In-Network Coinsurance for “Non-Preferred” In-Network providers
Deductible and 40% Out-of-Network Coinsurance for Out-of-Network providers
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9. 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. Also, any authorizations obtained with your previous carrier will not carry over to UnitedHealthcare/Oxford. A new authorization will need to be obtained.
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. If you are utilizing a participating provider, it is that provider’s responsibility to obtain the authorization for you.
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10. Transition of Care and Scheduled Procedures
Transition of 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 disabling or life threatening disease or condition, or is in their second or third trimester of pregnancy, and their physician will not be 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
To qualify for Transition of Care, a member’s physician must complete a Transitional Care Agreement form, accepting Oxford’s clinical guidelines and fees as payment in full
Currently Scheduled Procedures
If you or a dependent in your family, do not fall within the criteria above, but are currently scheduled for a procedure that requires Prior Authorization after the effective date of the policy, the Prior Authorization under your current carrier will not transfer to UnitedHealthcare/Oxford. Your physician will be required to obtain the necessary approvals before the procedure will be covered by UnitedHealthcare/Oxford
If you or a dependent in your family falls into this category, please notify you HR team. UnitedHealthcare/Oxford will work with your HR team during the transition, and once the group has been loaded into the system and an ID number generated, we can begin working with your physician to begin the clinical review process. Please note that this is not a guarantee of coverage, but we will work with your physician to identify the steps necessary to obtain any necessary approvals
Many of UnitedHealthcare/Oxford’s medical policies can be found online at the link on page 12
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11. 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.

12. Additional Contact Information
Oxford’s Behavioral Health Site -
Secure site for members to search for a behavioral health provider near them and find reference information on Behavioral health assistance
To Perform a behavioral health provider search on LiveandWorkWell.com:
Click on “I don’t know my access code”
Select Oxford Health Plan in the drop down menu and click “enter”
Click the “Find a provider” quick link in the “How can we help you” drop down menu
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.