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Open Enrollment MeetingsJanuary 1, 2013
Goodwill Industries
Today’s AgendaMedical Plan ReviewBeing a Good ConsumerUsing the UHC BenefitsReminder: Health AdvocateEnrollment Procedures/ID Cards
Effective January 1, 2013There 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.
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
Health Plan Review
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.
CoinsuranceThe amount or percentage the plan (UHC) pays and you pay after the deductible is met.
Maximum Out-of-PocketThe 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.
Plan OptionsPlan Designs
The plan designs – deductible, coinsurance, out of pocket expenses – remains the same.
Certificate of Coverage through UHCWhile 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.
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
Individual $4,000 $10,000
Family $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.
Navigate – WI HMO In Network Out of Network
Annual Deductible
Individual $2,000 N/A
Family $4,000 N/A
CoInsurance 80% N/A
Maximum Out-of-Pocket
Individual $4,000 N/A
Family $8,000 N/A
Preventive Care Covered at 100% N/A
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.
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
Introducing the UnitedHealthcare NavigateSM Plan
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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
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UnitedHealthcare NavigateSM PlanYou 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
Selecting a Primary Care Physician
Search by clicking on the plan link.
The Primary Care Physician
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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
Your PCP will be your guide to the right treatment, the right specialist, at the right
time.
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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
Selecting a Primary Care Physician
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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
Your PCP evaluates you.
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Obtaining Referrals
You’re not feeling well. You make an appointment with your PCP
You make an appointment with your PCP
1.
Your PCP asks questions to try to understand what may becausing the illness. If necessary, your physician will order some tests.
2.
Based on the evaluation, your PCP may:
Provide a treatment plan and/or prescribe medications
3. ORRefer you to a network specialist
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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
Good Consumers of Health Care DollarsSaving 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.
Good Consumers of Health Care DollarsUse your insurance plan’s resources.Register on www.myuhc.com. 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.
Good Consumers of Health Care DollarsTake 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.
Using the UHC Benefits
Register for MyUHC websiteOnce you receive your UHC ID CardVisit www.myuhc.comSelect REGISTER NOWType in the requested informationGet started!
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
Using the UHC Benefits - Care24 Services
Seven days a week – 24 hours a dayToll-free number (1-888-887-4114)Access to registered nurses –
assistance with place of service decisions
Goodwill Industries
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
Consumer /Member
Health Plan
MD’s/Hospitals
Wellness Programs
Disease Management
Claim Appeals
Health Health AdvocateAdvocate
PBM or EAPCommunicationResolution
= happy member
Health Advocate Connects Member
Community &Government Programs
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
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
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.”
How to Reach Health Advocate
Telephone: 1-866-695-8622 (toll-free)
Email: [email protected]
Website: www.HealthAdvocate.com
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.
Enrollment RemindersOpen 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 2013. This must be done annually.
Enrollment RemindersIf 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 MSCScan and email forms to [email protected] forms to 414-847-4193
Enrollment Forms Due: Nov 30th
THANK YOU!
For any Benefits-related questions,
call Goodwill at 414-847-4233.