Medical Plan
The Enterprise plan provides access to quality health care at reasonable costs through UnitedHealthcare and offers the choice
of PPO or EPO coverage. (An Out-of-Area medical plan (OOA300 or OOA600) is available in those areas not covered by the
UnitedHealthcare PPO network and offers benefits at the same level as the corresponding in-network PPO300 or PPO600 plan.)
When comparing plans, keep in mind that you must select the same type of coverage - either a PPO300, PPO600, or EPO - for yourself and your eligible dependents. The medical plans available to you and
your eligible dependents are based on your home zip code and will be printed on your Benefits Enrollment Form. (All plans may not be available in all areas.)
PPO300 Plan
(Preferred Provider Organization)
Participants in the PPO300 may select any physician at any time from UnitedHealthcare's nationwide network of physicians,
or they can see physicians out-of-network at a higher cost. (UnitedHealthcare may also refer to this product as Options PPO
on some communication materials.)
Here are plan highlights for in-network services and associated biweekly employee premiums:
PPO300 Plan Highlights
| • Deductible: |
$300 individual/$600 family |
| • Out-of-Pocket Maximum: |
$1,200 individual/$2,400 family |
| • Coinsurance: |
90%¹ |
| • Office Visit Copays: |
$20 primary care physician; |
|
$35 specialty care physician |
| • Urgent Care: |
90%¹ after $40 copay |
| • Emergency Room: |
90%¹ after $100 copay |
| • Ambulance: |
90%¹ |
| • Outpatient Surgery Facility: |
90%¹ after $50 copay |
| • Inpatient Hospital: |
90%¹ |
| • $350 per person per year wellness benefit |
| ¹ Subject to deductible and copay as listed above. |
Employee Premium Rates (biweekly)
| Coverage Level |
PPO300 |
| Employee only |
$ 23.50 |
| Employee + 1 |
$ 81.00 |
| Employee + 2 or more |
$148.50 |
Back to Top
PPO600 Plan
(Preferred Provider Organization)
Participants in the PPO600 may select any physician at any time from UnitedHealthcare's nationwide
network of physicians, or they can see physicians out-of-network at a higher cost. (UnitedHealthcare
may also refer to this product as Options PPO on some communication materials.)
Here are plan highlights for in-network services and associated biweekly employee premiums:
PPO600 Plan Highlights
| • Deductible: |
$600 individual/$1,200 family |
| • Out-of-Pocket Maximum: |
$1,800 individual/$3,600 family |
| • Coinsurance: |
80%² |
| • Office Visit Copays: |
$20 primary care physician; |
|
$40 specialty care physician |
| • Urgent Care: |
90%² after $50 copay |
| • Emergency Room: |
90%² after $100 copay |
| • Ambulance: |
90%² |
| • Outpatient Surgery Facility: |
80%² after $75 copay |
| • Inpatient Hospital: |
80%² after $250 per admission |
| • $350 per person per year wellness benefit |
| ² Subject to deductible and copay/admission fee as listed above. |
Employee Premium Rates (biweekly)
| Coverage Level |
PPO600 |
| Employee only |
$ 19.50 |
| Employee + 1 |
$ 67.50 |
| Employee + 2 or more |
$124.00 |
Office Visit Copays – PPO300 and PPO600
The PPO plan includes a copay for office visits to doctors participating in the PPO network.
Your copay amount depends on the type of doctor you are seeing. When visiting a primary care
physician you will pay the first $20; for visits to a specialty care physician, PPO300 participants
pay the first $35; PPO600 participants pay the first $40. After the copay, the plan then pays 100%
of the remaining charge for the office visit. Remember, the office visit copay does not apply when
visiting an out-of-network doctor.
Physician Services
Primary Care Physicians (PCP)
PPO network providers who are considered primary care physicians include Internists/Internal Medicine,
Pediatricians and General Practitioners/Family Practitioners. You will pay a $20 office visit copay
when visiting a primary care physician.
Specialty Care Physician
PPO network providers who are considered specialists include: Allergist, Chiropractor, Ear/Nose/Throat,
Neurologist, OB/GYN, Orthopedic, Urologist. You will pay a $35/PPO300; $40/PPO600 office visit copay
when visiting a specialty care physician.
Finding A PPO Provider
To locate participating PPO primary and specialty care providers, visit www.myuhc.com,
enter username and password and conduct a provider search or call UnitedHealthcare at 800-520-0746, 8am–8pm
(caller's local time). When calling to schedule your appointment, always double check with the provider to
make sure they are part of the UnitedHealthcare PPO network.
Importance Of Selecting An In-Network PPO Provider
WWhen choosing a primary care or specialty care physician it is important to remember ... the office visit copay applies only when seeing an in-network PPO physician, and after satisfying your annual deductible the plan pays 90%/PPO300; 80%/PPO600 of other covered services and supplies provided during the office visit. However, if you select an out-of-network provider, the office visit copay will not apply and the plan pays only 60% for both PPO300 and PPO600 of the office visit and other covered services and supplies provided during the office visit after satisfying your annual deductible. If you live in an area where a PPO network is not available, you will be eligible to participate in the Out-Of-Area medical plan (OOA300 or OOA600) and benefits will be provided at the same level as the corresponding in-network PPO300 or PPO600 plan. (Subject to charges considered reasonable and customary by the plan.)
Back to Top
EPO Plan
(Exclusive Provider Organization)
EPO participants are not required to get a referral from a PCP in order to see a specialist in the EPO
network, however you must use EPO network providers for services to be covered. This should reduce the
amount of time and cost incurred when employees require specialist care. (UnitedHealthcare may also refer
to this product as Select or Select EPO on some communication materials.)
Here are plan highlights for EPO network services and associated biweekly employee premiums:
EPO Plan Highlights
| • No Deductible |
| • Out-of-Pocket Maximum: |
$1,000 individual/$2,000 family |
| • Coinsurance: |
90%³ |
| • Office Visit Copays: |
$25 primary care physician; |
|
$50 specialty care physician |
| • Urgent Care: |
90%³ after $50 copay |
| • Emergency Room: |
90%³ after $100 copay |
| • Ambulance: |
90% |
| • Outpatient Surgery: |
90%³ after $150 copay |
| • Inpatient Hospital: |
90%³ after $250 per admission |
| • Unlimited wellness benefit ³ |
| ³Subject to copay/admission fee as listed above. |
Employee Premium Rates (biweekly)
| Coverage Level |
EPO |
| Employee only |
$ 22.00 |
| Employee + 1 |
$ 76.50 |
| Employee + 2 or more |
$141.00 |
Office Visit Copays - EPO
When you join the EPO plan, you choose a Primary Care Physician (PCP) for yourself and each member of your
family covered under the plan. Your PCP provides basic and routine care and keeps track of all the care you
receive, however you are not required to get a referral from a PCP in order to see a specialist in the EPO
network. When visiting a primary care physician you will pay the first $25; for visits to a specialty care
physician, EPO participants pay the first $50. After the copay, the plan then pays 100% of the remaining
charge for the office visit.
Physician Services
Primary Care Physician (PCP)
You and each dependent enrolled in the EPO must select a Primary Care
Physician (PCP) from one of the following areas of care: Internists/Internal Medicine, Pediatricians and
General Practitioners/Family Practitioners.
Specialty Care Physician
EPO network providers who are considered specialists include: Allergist,
Chiropractor, Ear/Nose/Throat, Neurologist, OB/GYN, Orthopedic, Urologist. EPO participants pay a $50 office
visit copay when visiting a specialty care physician.
Finding An EPO Provider
To locate participating EPO primary and specialty care providers, visit www.myuhc.com, enter username and password and conduct a provider search or call UnitedHealthcare at 800-520-0746, 8am–8pm (caller's local time). When calling to schedule your appointment, always double check with the provider to make sure they are part of the UnitedHealthcare Select EPO network.
Back to Top
Emergency Room Visits
Emergencies are sudden and unexpected illnesses or injuries in which loss of life, limb, or severe and
permanent medical complications could result if care is not received immediately. Here are some examples:
• Seizures
• Chest pain
• Severe burns
• Loss of consciousness
• Uncontrolled bleeding
• Inability to breath/severe shortness of breath
If you see any of these symptoms,
GET MEDICAL ATTENTION IMMEDIATELY.
• Go to the nearest emergency room; or
• Call your area's emergency services number or 911.
You're covered 24 hours a day, wherever you go.
If you are vacationing, traveling on business or can't reach your PCP:
Get the care you need. You may have to pay at the time of treatment but you can submit receipts of payments
for reimbursement minus any applicable copays. Notify UnitedHealthcare Care Management within 48 hours. Call UnitedHealthcare at 800-520-0746 (the toll free number on your UnitedHealthcare ID card) and follow the prompts to reach Care Management.
If you're admitted to the hospital:
Call UnitedHealthcare Care Management within 48 hours. Call UnitedHealthcare at 800-520-0746 (the toll free number on your UnitedHealthcare ID card) and follow the prompts to reach Care Management.
PPO300 and PPO600 Benefits:
In-network: $100/PPO300; $100/PPO600 copay per Emergency Room visit (copay waived if admitted), then plan pays 90% after calendar year deductible.
Out-of-network: $100/PPO300; $100/PPO600 copay per Emergency Room visit (copay waived if admitted), then plan pays 90% after calendar year deductible.
Except if not a true emergency, then the plan pays 60% for both PPO300 and PPO600, after copay and calendar year deductible
EPO Benefits:
$100 copay per Emergency Room visit (copay waived if admitted), then plan pays 90%.
Except if not a true emergency, then the plan pays 70% after copay.
Back to Top
Urgent Care Center Services
Urgent care situations are defined as injuries or illnesses that require prompt medical attention,
but are not life-threatening emergencies. Here are some examples:
• Minor burns
• High fevers
• Excessive vomiting
• Sprains
• Ear infections
• Urinary tract infections
First, try to contact your regular physician. If it's after hours or you're out of town, seek care
at the closest urgent care facility. To locate an urgent care center call United Healthcare at
(800) 520-0746 or visit www.myuhc.com, enter username and password and
conduct a provider search.
PPO300 and PPO600 Benefits:
In-network: $40/PPO300; $50/PPO600 copay per Urgent Care Center visit (copay waived if admitted),
then plan pays 90% after calendar year deductible.
Out-of-network: $40/PPO300; $50/PPO600 copay per Urgent Care Center visit, (copay waived if
admitted), then plan pays 90% after calendar year deductible.
Except if not a true urgent care situation, then plan pays 60% for both PPO300 and PPO600, after copay and calendar year deductible.
EPO Benefits:
$50 copay per Urgent Care Center visit (copay waived if admitted), then plan pays 90%. Except if not
a true urgent care situation, then plan pays 70% after copay.
Back to Top
UnitedHealth Allies – Call 800-860-8773
UnitedHealth Allies is a discount program that can help you save 10-50 percent on health care services that are not covered by your health, dental or vision plans. With UnitedHealth Allies, you can receive discounts on hundreds of health care products and services from participating health care professionals, facilities, retail chains, and online providers. There are no forms to fill out, no receipts to mail in, and no annual maximums. And, because this is not a health insurance plan, you are not required to receive a referral or submit any claim forms. Discounts through UnitedHealth Allies are available to you and your eligible dependents.
UnitedHealth Allies is not insurance. You are responsible for the full cost of any purchases, minus the applicable discount. Always use your health, dental or vision plans for covered services. Use UnitedHealth Allies to save on health care products and services that you must pay for yourself.
A list of available discounted products or services can be viewed online at www.healthallies.com or by calling 800-860-8773.
Back to Top
Healthy Pregnancy Program — Call 800-411-7984
The UnitedHealthcare Healthy Pregnancy Program offers personal support through all stages of
pregnancy and delivery for PPO300, PPO600 and EPO participants. Whether this is your first
pregnancy or you have other children, this program provides the information you need to make
healthy choices during your pregnancy, birth, delivery and afterward.
The Healthy Pregnancy Program features:
• The Healthy Pregnancy Web site
• Pregnancy assessment to identify your special needs
• 24-hour, toll-free access to experienced nurses for help with your questions or concerns
• Education and support for prenatal and postpartum care, including information on nutrition
and exercise, prenatal testing, fetal development, discomforts of pregnancy, childbirth, infant
feeding options, family planning options and newborn care
• Identification of pregnancy risk factors and enhanced health care needs
• Health education materials concerning your pregnancy
• Information about your baby's and your own health care needs after delivery
• Referrals to UnitedHealthcare's Care Management to help coordinate any additional services
• No charge to enroll in this program
To get the best possible benefit from this program, you should enroll in the first 12 weeks of pregnancy. But you can enroll anytime it is convenient, up to your 34th week of pregnancy. To enroll, simply call the Healthy Pregnancy Program at 800-411-7984. Registered nurses are available 24 hours a day to answer your pregnancy and new baby questions. Call 800-411-7984 and press or say 4 to reach a Healthy Pregnancy Nurse.
Back to Top
NurseLine Services — 24 Hour Health Information Line
Speak With A Registered Nurse
Call NurseLine Services any time at 866-549-8604, 24 hours every day for information and support on
many health situations and concerns, including:
• Minor injuries
• Common illnesses
• Recent diagnoses and chronic conditions
• Choosing appropriate medical care
• Self-care tips and treatment options
• How to take medication safely
• Men's, women's and children's health
• Questions to ask your doctor
• Illness prevention
• Nutrition and fitness
Health Information Library
Visit www.myuhc.com for a copy of the NurseLine Services brochure that
lists the Health Information Library topics and the corresponding 4-digit category numbers.
Simply call 866-549-8604 (toll-free), press 2 to reach the library, enter PIN 641, and key in
the topic's 4-digit category number. (TTY/TDD callers, please call the National Relay Center at
1-800-855-2880 and ask for 1-866-549-8604.)
How To Report Health Care Fraud
If you suspect medical fraud with your claims contact:
Ingenix Anti-Fraud and Abuse Hotline 866-242-7727.
Be prepared to provide the following information:
• Physician/provider's name, phone number and office location
• Item or service you are questioning
• Date on which the service is shown to have been furnished
• Reason you believe the claim should not have been paid
Back to Top
|
|
