terre hill 2021 oe uhc slideshow [read-only] · 2020. 12. 1. · microsoft powerpoint - terre hill...

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Get to knowyour benefits.

Terre Hill Concrete

Open Enrollment

January 1, 2021

Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. 9126775.1 7/20 19-13383

UnitedHealthcare®

app

Rally®

myuhc.com®

Manage your plan and health online (and on the go).

Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

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Navigate HMO with HSA

Choice HSA

Choice HRA

Your plan choices.

Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. 9126827 7/20 19-12448

Please read your plan documents. Additional information such as benefit details, plan limitations and exclusions, and the costs of coverage can be found in the Summary of Benefits.

No referralsrequired

Out-of-network coverage

Nationwide network

No PCP required

Pharmacybenefits

Navigate HMO Choice HSA Choice HRA

Comparing plans.


Benefits at a Glance - In Network

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Navigate HMO w HSA Choice HSA

Deductible (Single/Family) $5,000/$10,000 $5,000/$10,000

Member Co-Insurance 80% 80%

Out-of-Pocket Limit $6,750/$13,500 $6,750/$13,500

Preventive Care 100% 100%

PCP 80% after deductible 80% after deductible

Specialist Visit 80% after deductible 80% after deductible

Lab X-Rays / Outpatient Surgery FreestandingOutpatient Surgery Hospital

80% after deductible60% after deductible


In-Patient Hospital Stay 80% after deductible 80% after deductible

Major Diagnostics FreestandingMajor Diagnostics Hospital



Emergency Room 80% after deductible 80% after deductible

Urgent Care 80% after deductible 80% after deductible

Virtual Visit 100% after deductible 100% after deductible

Prescription Drugs4 Tier Essential PDL

Value Network (Excl CVS/Target)3 Tier Advantage PDL

Retail (31-day supply)Tier 1 / Tier 2 / Tier 3 / Tier 4

$10/$35/$70/$200 after deductible $10/$30/$50 after deductible

Mail Order (90-day supply) 2.5x retail 2.5x retail


Benefits at a Glance - In Network

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Choice HRA

Deductible (Single/Family) $5,000/$10,000

Member Co-Insurance 80%

Out-of-Pocket Limit $7,900/$15,800

Preventive Care 100%

PCP $20

Specialist Visit $35

Lab X-Rays / Outpatient Surgery FreestandingOutpatient Surgery Hospital


In-Patient Hospital Stay 80% after deductible

Major Diagnostics FreestandingMajor Diagnostics Hospital


Emergency Room $150

Urgent Care $60

Virtual Visit 100% after deductible

Prescription Drugs 3 Tier Advantage PDL

Retail (31-day supply)Tier 1 / Tier 2 / Tier 3 / Tier 4

$10/$35/$70

Mail Order (90-day supply) 2.5x retail


You


Find your PCP at welcometouhc.com/navigate

Your primarydoctor will needto refer you to a

specialist

You will need to choose a

primary doctor

Get care and save money with a PCP.

Select a primary care provider (PCP) from the plan network.

Network coverage only.

No coverage out of network.

Referrals are required from your PCP for you to see a network specialist.

Preventive care is covered 100 percent in our network.

UnitedHealthcare Navigate® Plan.

Certain preventive care items and services, including immunizations, are provided as specified by applicable law, including the Patient Protection and Affordable Care Act (ACA), with no cost-sharing to you. These services may be based on your age and other health factors. UnitedHealthcare also covers other routine services, and some plans may require copayments, coinsurance or deductibles for these benefits. Always review your benefit plan documents to determine your specific coverage details.

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See providers in your network by visiting myuhc.com Please read your plan documents. Additional information such as benefit details, plan limitations and exclusions, and the costs of coverage can be found in the Summary of Benefits.

*Laws in some states allow you to choose a specialist, like an OB-GYN, as your PCP.

Find your PCP at welcometouhc.com/Navigate

They get to know your health history.

They may help prevent and catch health issues before they become serious.

They can refer you to a specialist, if needed.

How can a PCP help you?

PCP information needed when you enroll:

• First name, last name, and address.

• Provider ID number (Find this 14-digit ID number online when searching our network for a PCP.)

• A PCP will be assigned to you if you do not select a PCP at enrollment.

PCP requirements:

• One can be selected for the entire family, or each covered dependent can select their own.

• Must be located near your home.

• Must be a general practice, family practice, pediatrician or internal medicine physician*.

Choosing a Primary Care Provider (PCP).

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• Obstetricians/gynecologists (OB/GYNs).

• Behavioral health or substance use disorder clinicians.

• Convenience care clinics.

• Emergency care at an emergency room.

• Optometrists.

• Urgent care clinics.

• Virtual clinic visits.

You don’t need an online referral to see the following network providers:

Paper referrals are not valid.

Look on myuhc.com to make sure your PCP has submitted this for you before you seek care.

Your PCP needs to submit any referrals online.

Referrals.

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Health Savings Accounts

Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. 10


Please read your plan documents. Additional information such as benefit details, plan limitations and exclusions, and the costs of coverage can be found in the Summary of Benefits. The UnitedHealthcare plan with Health Savings Account (HSA) is a high deductible health plan (HDHP) that is designed to comply with IRS requirements so eligible enrollees may open a Health Savings Account (HSA) with a bank of their choice or through Optum Bank, Member of FDIC. The HSA refers only and specifically to the Health Savings Account that is provided in conjunction with a particular bank, such as Optum Bank, and not to the associated HDHP.

The money is there when you need it:

• Use your Optum Bank debit Mastercard® to pay at the pharmacy, doctor’s office or at locations that accept Mastercard®.

• Or save it. Your HSA is yours, so it stays with you if you change health plans, employers or retire.

You can build savings for retirement.

It’s a bank account with tax advantages.

Health Savings Account (HSA).

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Other restrictions apply. Please consult a tax, benefits or financial advisor.

You must be enrolled in a qualifying high-deductible health plan (HDHP).

You cannot be covered by any other health coverage.

You cannot be enrolled in Medicare, TRICARE or TRICARE for Life.

You cannot be claimed as a dependent on someone else’s tax return.

HSA eligibility.

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Please read your plan documents. Additional information such as benefit details, plan limitations and exclusions, and the costs of coverage can be found in the Summary of Benefits. The UnitedHealthcare plan with Health Savings Account (HSA) is a high deductible health plan (HDHP) that is designed to comply with IRS requirements so eligible enrollees may open a Health Savings Account (HSA) with a bank of their choice or through Optum Bank, Member of FDIC. The HSA refers only and specifically to the Health Savings Account that is provided in conjunction with a particular bank, such as Optum Bank, and not to the associated HDHP.

The IRS limits how much you can put into your HSA each year. The 2020 limits are:

$3,600 for individual coverage$7,200 for family coverage

Are you age 55 or older?You can put in an extra $1,000 this year.

Your contributions and the company contribution cannot exceed the IRS limits.

2021 Contribution Limits.

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Prescriptions

Pharmacy Benefit


OptumRx is your UnitedHealthcareplan’s pharmacy care services manager. OptumRx is committed to helping provide you with easier and lower-cost ways to get the medication you need.

Your covered medications.


Before a higher cost medication is covered

Try a lower cost medication first

You get a prescription

• Step 1 Medications: Proven to be clinically similar and effective.

• Step 2 Medications: Treats the same condition but may cost more.

Step therapy.

• The largest quantity of medication covered per copayment or in a defined time period.

• Based on FDA guidelines for medication dosage, clinical guidelines or usage patterns.

Supply limits.

• Requires your doctor to tell UnitedHealthcare why you’re taking a medication to determine if covered under your plan.

• To start the process, talk to your doctor or call the number on your ID card.

Prior authorization.

Promoting safe and appropriate prescription use.


• Higher-cost medications.

• Lowest overall value.

• Mostly brands.

TIERS

3&4

• Mid-range cost.

• Good overall value.

• Mix of brands and generics.

TIER

2• Lower-cost medications.

• Highest overall value.

• Mostly generics.

TIER

1

The UnitedHealthcare Prescription Drug List (PDL) is a list of commonly prescribed medications covered by the plan.

Medications are placed into tiers that represent the cost you pay out of pocket.

How we cover prescriptions.

TO SEARCH THE ESSENTIAL PDL:• Go to: www.WelcometoUHC.com

• Under BENEFITS, select PHARMACY Benefits, then select Search Essential PDL

• CVS and Target are not in network with the Essential PDL


Advantage of using home delivery.

Refill reminders.

Free shipping.

Get up to a 3-month supply.

May cost less than retail.

24/7 pharmacist access.

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Tools and Resources to help you stay healthy and save money.


Get help losing weight and keeping it off.

Real Appeal®

• An online coach who leads ongoing group sessions and provides guidance tailored to your unique lifestyle.

• 24/7 online support and a mobile app to help set, track progress toward and reach your goals.

• A Success Kit with scales, exercise tools, food guides and more delivered to your door.

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Quit For Life®

Quit For Life is a tobacco cessation program.

Quit For Life is a tobacco cessation program offered.

The program uses an evidence-based combination of physical, psychological and behavioral strategies designed to help employees overcome their tobacco addiction.

Access to Quit Coach®

staff

Text2Quit®

text messaging

Onlinetools

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See a doctor wherever, whenever.

Virtual Visits

• Get access to care online, at any time.

• See and talk to a doctor from your mobile device* or computer.

• Doctors can diagnose and treat a wide range of non-emergency medical conditions, including bladder infection, bronchitis, cold/flu, pink eye, and more.

• Choose from an Amwell®, Doctor On Demand® or Teladoc® network provider – all covered under your health plan benefits.

NOTE: There is a cost for this service.

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Virtual Visits phone and video chat with a doctor are not an insurance product, health care provider or a health plan. Unless otherwise required, benefits are available only when services are delivered through a Designated Virtual Network Provider. Virtual Visits are not intended to address emergency or life-threatening medical conditions and should not be used in those circumstances. Services may not be available at all times, or in all locations, or for all members. Check your benefit plan to determine if these services are available.*Data rates may apply



See a provider anywhere, anytime.

Behavioral Health Virtual Visits

• Connect with a provider from your mobile device, tablet or computer from the comfort of home.

• Use a behavioral health virtual visit for needs such as:

- Depression

- Anxiety

- ADD/ADHD

- Addiction

- Mental Health Disorders and Counseling

NOTE: There is a cost for this service.

• *Data rates may apply.

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Have work-related or personal concerns?

Behavioral Health Solutions and the Employee Assistance Program provide confidential help with:

• Depression and anxiety.

• Substance use and recovery.

• Relationship difficulties

• Inpatient behavioral care

• Outpatient behavioral care.

• And more.

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Thank you!

terre hill 2021 oe uhc slideshow [read-only] · 2020. 12. 1. · microsoft powerpoint - terre hill...

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