1. Open Enrollment Meetings January 1, 2013
Goodwill Industries
Open Enrollment Meetings
January 1, 2013

2. Today’s Agenda Medical Plan Review Being a Good Consumer
Using the UHC Benefits
Reminder: Health Advocate
Enrollment Procedures/ID Cards

3. Health 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.

4. Health Plan Review Health care costs continue to rise
New technology, drug development
Poor lifestyle habits and behaviors
Inability for consumers to recognize the difference in quality & cost
Choice of options allow you to decide where to spend your money – paycheck or doctor’s office
Plans both encourage employees/dependents to continue to utilize preventative services and fill prescriptions

5. Insurance Terminology
Annual Deductible
The 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.
Coinsurance
The amount or percentage the plan (UHC) pays and you pay after the deductible is met.
Maximum Out-of-Pocket
The 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.

6. Plan Options Plan Designs Certificate of Coverage through UHC
The plan designs – deductible, coinsurance, out of pocket expenses – remains the same.
Certificate of Coverage through UHC
While the essential benefits of the plan stay the same, there are a few enhancements with the Womens’ Wellness coverage.
Employee Contribution
There will be slight increases to both plan options this year.

7. NOTE: The Out-of-Pocket Maximum INCLUDES the Annual Deductible.
Choice Plus
In Network
Out of Network
Annual Deductible
Individual
$1,500
$5,000
Family
$3,000
$10,000
CoInsurance
80%
60%
Maximum Out-of-Pocket
$4,000
$8,000
$20,000
Preventive Care
Covered at 100%
60% after Deductible
Dependent Coverage
Up 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.

8. NOTE: The Out-of-Pocket Maximum INCLUDES the Annual Deductible.
Navigate – WI HMO
In Network
Out of Network
Annual Deductible
Individual
$2,000
N/A
Family
$4,000
CoInsurance
80%
Maximum Out-of-Pocket
$8,000
Preventive Care
Covered at 100%
Emergency Coverage
In-Network Deductible / Coinsurance
Dependent Coverage
Up 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.

9. Both Plans – Employee Cost
Single per month
Family per month
Choice Plus
$117.38
$305.20
Navigate (WI HMO)
Choice (IL HMO)
$108.56
$282.17

10. Introducing the UnitedHealthcare NavigateSM Plan
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Introducing the UnitedHealthcare NavigateSM Plan

11. UnitedHealthcare NavigateSM Plan
Connects you to a primary care physician (PCP) that you can trust who will provide and manage most of your care
The Navigate Plan
Stresses delivery of quality care
Coordinates care across specialists, hospitals and other health care providers
Helps to improve the overall health care experience
Helps set a path to better health outcomes
That’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 first
contact 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 care
Stresses delivery of quality care
Coordinates care across specialists, hospitals and other health care providers
Improves the overall health care experience
Sets a path to better health outcomes

12. UnitedHealthcare 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 specialists
Not receiving the right care can result in:
Unnecessary procedures
Duplication of services
Needed care not being recognized
Poor quality and outcomes
Patient confusion and frustration
PRESENTER NOTE: Delete if not offered
That 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 specialists
You will have predictable office visit copayments or coinsurance
You will have 100 percent preventive care coverage in our network
You will have care management help if you require hospital stay
We will discuss more about this plan in a few minutes. 12

13. Selecting 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.

14. The Primary Care Physician
Once you select a PCP, he or she will:
Provide your preventive care and routine care for most illnesses & injuries
Coordinate all of your care, from staying healthy to managing serious and chronic conditions 
Refer you to other network physicians and specialists as needed
The following physicians can be selected as a PCP:  
General Practitioners 
Family Practitioners 
Internists 
Pediatricians
Once you select a PCP, he or she will:
Provide your preventive care and routine care for most illnesses & injuries
Coordinate all of your care, from staying healthy to managing serious and chronic conditions 
Refer you to other network physicians and specialists as needed
Your PCP will be your guide to the right treatment, the right specialist, at the right time. 14

15. Selecting a Primary Care Physician
You must select a PCP
Each family member may select a different PCP in your area
If you do not select a PCP, UnitedHealthcare will assign one
Navigate health plan ID cards will include the name of your PCP
You 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 PCP
In summary:
You must select a primary care physician
Each family member may select a different primary care physician
If 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 physician 15

16. Selecting a Primary Care Physician
If you want to change your PCP
Call 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 change
Retroactive changes will not be permitted
June 2011
July 2011
August 2011
You 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 change
Retroactive changes will not be permitted
If you change your PCP and have a referral to a specialist, you may need to get a new referral from your new PCP. 16 16

17. Obtaining Referrals OR 1. 2. 3. You make an appointment with your PCP
You’re not feeling well. You make an appointment with your PCP
Your PCP evaluates you. 2.
Your PCP asks questions to try to understand what may be
causing 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/or
prescribe medications
Refer you to a network specialist OR 17

18. Obtaining Referrals
Navigate members must receive referrals before seeing another network primary care physician or specialist
Referrals are not needed for emergency care even if received at a non-network hospital
Referrals are NOT REQUIRED for services from network:
OB/GYNs and Chiropractors
Behavioral health and substance abuse disorder clinicians
Optometrist/ophthalmologist for refractive exams
Urgent and convenience care centers
In summary:
Navigate members must receive referrals before seeing another network primary care physician or specialist
Navigate Balanced & Navigate Plus members must receive referrals before seeing another network primary care physician or specialist to receive highest level of benefits
Referrals are not needed for emergency care even if received at a non-network hospital
NOTE: Referrals are NOT REQUIRED for services from network:
OB/GYNs
Behavioral health and substance abuse disorder clinicians
Providers who provide routine refractive exams
Urgent and convenience care centers 18

19. Good 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.

20. Good Consumers of Health Care Dollars
Use your insurance plan’s resources.
Register on
Know 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.

21. Good 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.

22. Using the UHC Benefits Register for MyUHC website
Once you receive your UHC ID Card
Visit
Select REGISTER NOW
Type in the requested information
Get started!

23. Using the UHC Benefits - MyUHC.com
Find a Doctor – send to cell phone
Find a Hospital
Look up Claims
Improve Health
Order Prescriptions online
Replace ID card
Enhanced Personal Health Record
Embrace Wellness
Check Benefits
Treatment Cost Estimator
And Much More!
71 percent of all eligible users access myuhc.com for claim/benefit information

24. Using the UHC Benefits - Care24 Services
Seven days a week – 24 hours a day
Toll-free number ( )
Access to registered nurses – assistance with place of service decisions

26. Health Advocate Offers a Personalized and Comprehensive Service
Find qualified doctors, dentist, hospitals, other healthcare providers anywhere in the country
Expedite appointments including hard-to-reach specialists; arranges for specialized treatments and tests
Help resolve insurance claims; negotiates billing/payment arrangements
Assist with eldercare such as finding adult daycare, assisted living and other related issues facing parents, parents-in-law
Obtain unbiased health information about complex medical conditions to help make informed decisions
Work with insurance companies to obtain appropriate approvals for needed services
Answer general questions about test results, treatments and medication prescribed by the physician
Assist in the transfer of medical records, x-rays and lab results
Locate and research the newest treatments for a medical condition
Assist with finding qualified wellness programs, providers and services

27. Health Advocate Connects Member
Consumer /
Member
Health Plan
MD’s/Hospitals
Health Advocate
Wellness Programs
Community &
Government Programs
PBM or EAP
CommunicationResolution
= happy member
Claim Appeals
Disease Management

28. Healthcare Cost Estimator
Pre-service pricing tool
Integrated into Health Advocate’s work-flow
Largest source of private sector claims data – MedStat
Database of over 69 million member records

29. Privacy and Confidentiality Protection
We protect your privacy
Your healthcare information is kept strictly confidential
We fully comply with the federal HIPAA law
Medical Authorization Form

30. Employee 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.”

31. How to Reach Health Advocate
Telephone: (toll-free)
Website:
Open: Monday – Friday 8am and 9pm Eastern Time
After 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.

32. Enrollment 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.

33. Enrollment Forms Due: Nov 30th
Enrollment Reminders
If 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 MSC
Scan and forms to
Fax forms to
Enrollment Forms Due: Nov 30th

34. For any Benefits-related questions,
call Goodwill at
THANK YOU!