Par Partnership ip Plan Plan 2.0 UnitedHealthcare re/Ox Oxfo - PowerPoint PPT Presentation

Par Partnership ip Plan Plan 2.0 UnitedHealthcare re/Ox Oxfo ford rd w welcomes You t to the State o of Co Conne nnecticut Partnership Plan n 2.0 Benefits: The Partnership Plan 2.0 offers a rich plan design, featuring the same no no-referral al Point-of-Service (POS) plan design offered to State employees, providing: o In- and Out-of-Network coverage o 100% coverage for In-Network preventive care (tiered benefits do not apply) o Coverage for naturopathic care, chiropractic care and acupuncture o An extensive local and national network through UnitedHealthcare/Oxford o Health Enhancement Program (HEP) o Dedicated Service Team • The Healt alth E Enhancement P Program am (HEP) is a program designed to promote preventive screenings, wellness visits and chronic disease education and counseling for employees and, as a result, saves money on health care in the long term by focusing health care dollars on prevention. Care Management Solutions, Inc. (CMSI) will provide additional information on the HEP program • The Partnership Plan 2.0 has a dedicated team of individuals who are your point of contact throughout the process. You will not be lost in the shuffle with questions or concerns about enrollment, billing, or claims 1 Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Most Questioned B Benefits Benefit In-Netwo In work C Cove verage Out-of-Network C rk Covera rage Preventive Care: No Copay Deductible Plus Coinsurance Adult and Pediatric Immunizations/Vaccines No Copay Deductible Plus Coinsurance Primary Care and Specialist Sick $0 (Preferred)/$15 Copay Deductible Plus Coinsurance Visits Naturopathic Physician Visits $15 Copay Deductible Plus Coinsurance $250 Copay $250 Copay Emergency Room *Waived if Admitted *Waived if Admitted Urgent Care Center $15 Copay Deductible Plus Coinsurance Routine Vision Exam & $0 (Preferred)/$15 Copay Deductible Plus 50% Coinsurance Refraction - 1 Exam Per Calendar Year - 1 Exam Per Calendar Year $15 Copay Office Infertility Services No Copay Inpatient and Deductible Plus Coinsurance Outpatient Hospital No Copay Deductible Plus Coinsurance - Unlimited Visits - 30 Visits Per Calendar Year Outpatient PT/OT *Medical necessity required *Medical necessity required 2 Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Most Questioned B Benefits – Contin inued Benefit In In-Netwo work C Cove verage Out-of-Network C rk Covera rage Deductible Plus Coinsurance No Copay - 30 Visits Per Calendar Year if the - Unlimited Visits if the treatment is treatment is related to one of the related to one of the specific diagnoses specific diagnoses outlined in the Speech Therapy outlined in the SPD. All other physician- SPD. All other physician prescribed prescribed speech therapy has a 30 speech therapy has a 30 visit per visit per calendar year limit and year combined In-and-Out-of-Network requires Prior Authorization limit and requires Prior Authorization Acupuncture $15 Copay Deductible Plus Coinsurance - 20 Visits Per Calendar Year Combined In- and Out-of-Network Durable Medical Equipment No Copay Deductible Plus Coinsurance Foot Orthotics No Copay Deductible Plus Coinsurance Nutritional Counseling No Copay Deductible Plus Coinsurance - 3 Visits per person per calendar year  Out-of-Network Deductible: $300 (individual) / $900 (family) *Deductible is Plan Year Out-of-Network Coinsurance: 80/20  Out-of-Network Out-of-Pocket Maximum: $2,300 / $4,900 (includes deductible)   In-Network Out-of-Pocket Maximum: $2,000 / $4,000 *For a complete listing of covered services, please review the Summary Plan Description (SPD), available on the State Comptroller’s website for the Partnership Plan. See page 12 for website information. 3 Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Tiered PC PCP P an and S Special alis ist Copay ay o If a member utilizes a “Preferred” Primary Care Physician (PCP) or a specialist in one of the 10* specialties below in Connecticut ONLY the copay will be as follows: – Allergy & Immunology -- Ophthalmology* – Cardiology -- Orthopedic Surgery – Endocrinology -- Rheumatology – ENT -- Urology – Gastroenterology -- OB/GYN o “Preferred” (two solid blue hearts ) - $0 Copay o “Non-Preferred” (less than two solid blue hearts) - $15 Copay o Deductible and Coinsurance for Out-of-Network providers o Any specialist type not listed above that is In-Network will be a $15 copay *Ophthalmology providers do not follow the blue heart designation. You can find a list of “Preferred” Ophthalmology providers on the dedicated website for Partnership Plan members (see page 11 for website information) 4 Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Provide der N Network Information – Lo Loca cal Local N Networ ork: : “Oxford F Freedom” m” As a UnitedHealthcare/Oxford member, you will have access to a large network of providers in the Connecticut, New York* and New Jersey tri-state area. In the tri-state, you will utilize the Oxfor ord F Freedom om network. Oxford members can seek services from any participating Oxfor ord F Freedom om provider in Connecticut, New York * and New Jersey without a referral . When seeking services from a Primary Care Physician (PCP), or a specialist in one of the 10 specialties on page 4, please remember to pay attention to the physician’s heart status for your cost-share.  Note: When speaking to your physician about their participation status, please use “ Oxford d Freedom om ,”, not “the State Plan” *The following counties in New York are considered within the Oxford Freedom network area: New York, Bronx, Dutchess, Kings, Nassau, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Sullivan, Ulster and Westchester. All other counties in New York would be considered out of the Oxford Freedom area, so members would utilize the UnitedHealt lthc hcare C Choi oice Plus s national network (see next page for information on Choice Plus) Sear arch f for l local O al Oxfor ord F Freedom om prov oviders o online: – Visit https://connect.werally.com/plans/oxhp – Select “Freedom” from the list of Oxford Networks – Click on “Change Location” to search by an address or zip code – then click “Update Location” – You can then search by specialty, provider name or practice name – then click “Search” – On the results page, you will have filter options on the left-hand side to narrow your search even further  Look for the two solid blue hearts for Connecticut PCP and specialists in the 10 specialties for a $0 copay 5 Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Provide der N Network Information – Nat ational al Nat ational N l Net etwork: : “UnitedHealt lthcar are Choice e Plus” s” When traveling outside of the tri-state area, if you live out of the area, or if you have a child attending school out of the area, you also have seamless access to the UnitedHealt althcar are C Choi oice P Plus national network. By finding one of our UnitedHealt althcare C Choice P Plus physicians, your services will be treated just as if you were still at home. Please note that office visits for providers outside of Connecticut are not subject to the tiered benefit level, and visits for non-routine services will apply a member cost-share.  Please note only those providers located outside the tri-state service area are considered participating Choice Plus providers for Oxford members *The following counties in New York are considered within the Oxford ford F Freedom network area: New York, Bronx, Dutchess, Kings, Nassau, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Sullivan, Ulster and Westchester. All other counties in New York would be considered out of the Oxford F d Freedo dom area, so members would utilize the UnitedHealt lthc hcare C Choi oice P Plus national network. Sear arch f for C ChoicePlus p prov oviders o online: – Visit: https://connect.werally.com/plans/uhc/1 – Choose “Choice Plus” from the list of available plans – Click on “Change Location” to search by an address or zip code near you – then click “Update Location” – You can search by provider name or provider specialty by entering your search criteria in the rectangular box and hitting “Search”. You can also search a list of providers by specialty, service type, condition, etc. by selecting one of the blue boxes below – On the results page, you will have filter options on the left-hand side to narrow your search even further 6 Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.