Your Health Plan Coverage and freedom of choice similar to a PPO You can see any doctor you want. You save money when you choose doctors (including specialists), hospitals and pharmacies in our network. They’ve agreed to charge lower rates. If you receive care outside of our network, you’ll be covered, but it might cost more money. Plus, emergencies are covered anywhere in the world. You do not need referrals. You are not required to choose a primary care physician, but it helps to have one. And if you want to see a specialist, you can do so without a referral. Your preventive care is covered. The health care reform law requires the coverage of certain preventive services, based on your age, gender and other health factors, with no cost-sharing. As required by the law, UnitedHealthcare covers preventive services at 100 percent without charging a copayment, coinsurance or deductible, as long as they are received in the health plan’s network. UnitedHealthcare also covers other routine services, which may require a copayment, coinsurance or deductible. You have coverage for a wide range of prescriptions. You can fill your prescriptions through one of our 60,000+ retail network pharmacies across the U.S. If you have our mail-order service, you may save money with a three-month medication supply, which is mailed to you with standard shipping at no additional cost to you. You have coverage for a routine vision exam. You and your covered dependents are eligible for one routine vision exam. The exam must be done at a network eye clinic. Discounts may apply to frames, contacts, lenses and lens options. See your benefit plan documents for all of the coverage details. Your Health Reimbursement Account An account to help pay your health care bills Your employer is funding a health reimbursement account (HRA) for you. An HRA is an account that helps pay for eligible health care expenses, including those that may apply to your annual deductible. Think of the HRA as your money. Even though your employer owns and funds the HRA, think of it as your money. By doing so, you’ll realize that spending your HRA wisely can help save you money. As long as you have money in your HRA, that’s less money you have to pay out of your pocket for health care expenses. See how the HRA helps you save. The money in the HRA may be enough to cover all of your health care costs for the year. In addition: • What you don’t spend might roll over so you can use the money next year. • You will likely pay less in monthly premiums compared to traditional copayment plans. • You will usually not have to pay a copayment for doctor visits. Your employer owns and funds the HRA . In the future, if you decide to change your plan or leave your employer, you cannot keep the money or take it with you. How the plan works Your plan has an annual deductible. The deductible must be paid before your plan will help pay for eligible health care expenses. You do not need to pay anything out of your pocket for eligible preventive care as those will be covered 100 percent when received in the network. Read on to learn about how the plan works before and after you meet your deductible. 1. Your deductible – Your HRA pays first. When you have an eligible expense, like a doctor visit, the entire cost of the visit will apply to your deductible. The HRA will pay for all your eligible expenses first, as long as there is money in the account. This means you won’t have to pay anything until the HRA is spent. If you spend all of the HRA , you will need to pay out of pocket. You will need to pay the full cost of your health care expenses until the remaining deductible is paid. 2. Your coverage – Your plan pays a percentage of your expenses. Once the deductible is paid, your health plan has coinsurance. With coinsurance, the plan shares the cost of expenses with you. The plan will pay a percentage of each eligible expense and you will pay the rest. For example, if your plan pays 80% of the cost, you will pay 20%. After the deductible, your plan may have a copayment for certain services, such as prescriptions. 3. Your out-of-pocket maximum – You are protected from major expenses. An out-of-pocket maximum protects you from major expenses. The out-of-pocket maximum amount is the most you have to pay each year for covered services. The plan will then pay 100 percent of all remaining covered expenses for the rest of the plan year. Your deductible and coinsurance payments will apply to your out-of-pocket maximum. Copayments (if they apply) do not go toward meeting the out-of-pocket maximum. Personal Services at No Extra Cost Your plan helps you get the care you need when you need it. Here are just a few examples. 24-hour registered nurses You have access to registered nurses 24 hours a day, seven days a week. They can help answer important questions, direct you to network doctors and even schedule appointments. A nurse can help you with a variety of situations, such as: • Better managing an illness or injury • Recognizing urgent and emergency symptoms • Locating doctors and hospitals in your area • Understanding medication interactions and how you may be able to reduce your prescription costs Healthy Pregnancy Program We can help soon-to-be-mothers through every stage of their pregnancy and delivery. We will check for risks, share healthy-baby tips, and keep you informed by phone and newsletter. Employee Assistance Program Life can bring challenges and serious problems. Our counselors are here to help with depression, stress, relationship problems, alcohol or drug abuse, money problems, and coping with grief or loss. And they keep it completely private. Care management We’ll work with you and your physician to help you understand your options if you need care. We’ll also let you know about special programs to help you make informed health care decisions. Personal health coaches If you have health risks, our health coaches may contact you to offer their support. They can set up a personal plan to help you and coach you along the way. You can call them any time if you want help improving your health. myuhc.com — Tools to Help You Make BETTER Decisions The more you know about cost and the options you have, the easier it is for you to make better decisions. Once you enroll in the plan, you’ll be able to use these helpful tools and services on myuhc.com. myHealthcare Cost Estimator* is your personalized online tool to help you make smart health care decisions. You can access important information that will enable you to better understand your choices in procedures, providers, even estimated prices. It’s available 24/7, at no additional cost, to help you find meaningful ways to increase your savings and improve your health. Health Savings Checkup gives you an estimate of your retirement health care costs and information on how to stay healthy, spend less and save more. It even offers you an action plan and help from a Health Wealth Coach. Our medication pricing tools let you search and compare prescription medication costs and see costs based on your specific plan. It’s an easy way to find lower cost options, like generic medications. Filling prescriptions through mail-order gives you a three-month supply of your maintenance medications. You save because the cost is usually lower than what you’d pay if you were refilling each month. There is no charge for shipping the medication to your home. And it eliminates frequent trips to the pharmacy for refills. Personalized messages will be available to you on health statements and in your myuhc.com message center. We will remind you about money-saving tips, scheduling wellness exams and more. *All UnitedHealthcare members can access a cost estimator online tool. Depending on your specific benefit plan and the ZIP code that is entered, either the new myHealthcare Cost Estimator or the current Treatment Cost Estimator will be available. A mobile version of myHealthcare Cost Estimator will be launched soon, and additional ZIP codes and procedures will be added soon. Discounts that can add up to big savings Enjoy a healthy lifestyle for less, with typical discounts of 10 to 25 percent on fitness club memberships, weight loss programs, teeth whitening and more through our Health Discount Program. I feel healthy Lower monthly premiums Lower premiums may add up to big savings for you at the end of the year. How will this plan help me ? • Lower monthly premiums Save money with lower premiums compared to other health plans you may have had in the past. • An HRA to help you pay for eligible medical expenses, including your deductible You pay less out of your pocket because you can use the money in the HRA to help pay for medical bills. • The choice to use any doctor If you have a doctor you prefer, you can continue to use that doctor. You’ll likely save more if the doctor is in our network. • Coverage at 100% for preventive care services received in our network You won’t have to pay a copayment, coinsurance or deductible, as long as they are received in our network. I need affordable care for my family Save money on quality care You save money when you use a doctor in our network. The network is large, so you can rest easy knowing a doctor is nearby when you’re on vacation or if you’re covering a child going to school in another state. I have health issues Choice to use any doctor Wondering who is the right doctor to treat your health condition? With the UnitedHealth Premium program, you can choose a doctor based on quality and cost-efficiency guidelines. Just look for the stars to find them. • Convenient prescription services With more than 60,000 retail pharmacies, it’s easy to locate a pharmacy to fill your prescriptions. If you have mail-order services, you can have your prescriptions mailed to your home at no additional cost. • Discounts on healthy lifestyle products Take advantage of discounts on fitness club memberships, weight loss programs, teeth whitening and more. • Coverage for routine vision exams Each year you can have a routine vision exam and you may even receive discounts on frames, contacts and lenses. • Personal support The plan offers counselors who can help with depression, stress, and coping with grief and loss. You also get a care management program to help you get the most from all your options. I’m planning for retirement More potential retirement savings With the money in your HRA, you may pay less out of your pocket for medical bills. That leaves more money to help fund your retirement. A Plan Designed for Your Needs Learn how this plan can help you: • Be as healthy as you can • Get the care you need when you need it • Save more than you might think possible Before you enroll, visit welcometouhc.com • Find out if your doctor is in the network or learn which doctors are near you. Choose with confidence. Our UnitedHealth Premium® designation program takes the guesswork out of your doctor search because it recognizes physicians and hospitals for meeting quality and cost-efficiency guidelines. Just look for the to find them. • Estimate the cost of the plan. • Find a network pharmacy. • See recommended preventive care services based on your age and gender. Your HRA may roll over. If you have dollars remaining in your HRA at the end of the year, they may roll over so you can use them next year. Please check your benefit plan documents to see if roll over is available under your plan. Paying for Prescriptions Your prescription payments and coverage may work differently depending on the type of plan you have. If your plan has a combined medical and pharmacy deductible: Eligible prescription expenses will apply to the deductible. The HRA can be used to help pay for those prescriptions. If all of the HRA is spent, you will need to pay the entire cost of your prescriptions out of your pocket until you meet your deductible. If your plan does not have a combined deductible: Prescription costs will not be paid from the HRA and will not apply to your deductible. You will likely pay copayments or coinsurance for your prescriptions. See your benefit plan documents for the details about your prescription coverage. Eligible Medical Expenses The IRS defines a list of expenses that can be paid for and reimbursed by an HRA. Employers can choose which expenses from the list will be covered under your plan. Visit welcomtouhc.com to see a list of common eligible expenses. We’ll reach out to you. Or, you make the call. If you have certain risk factors or chronic conditions, you may receive a phone call from a nurse. Our nurses can help you improve your health, control costs and put you on a path to quality care. StoryTellers Watch personal success stories from real members about their UnitedHealthcare experience. Visit welcometouhc.com. UnitedHealthcare Health4MeSM Mobile App Download our Health4Me mobile app to your smartphone or tablet and see how easy it is to find nearby physicians, check the status of a claim, see your account balance or speak directly with a nurse. What are your points of view? Everyone has different health care needs depending on where they are in life and their priorities. What counts most to you? Explore Health Care Lane® (healthcarelane.com) Main Street Visit different businesses with friendly employees who are excited to talk to you about all sorts of health care topics, including the HRA. Community Center Watch U. Horace Cartright deliver simple facts and straight answers about the health reform law. Wellness Days Join the Wellness Days festival to learn about tools, services and programs available to UnitedHealthcare members.
Published by United Healthcare / Open Enrollment . View All Articles.