Partnersh nership Plan 2.0 Unite tedHe dHealth thcare - - PowerPoint PPT Presentation

Partnersh nership Plan 2.0

Unite tedHe dHealth thcare are/Oxford Oxford welcomes es You to the State te of Connecticut ecticut Partne ners rship hip Plan 2.0

Benef efits its: The Partnership Plan 2.0 offers a rich plan design, featuring the same no no-referral ferral Point-of-Service (POS) plan design offered to state employees, providing:

• In- and Out-of-Network coverage
• 100% coverage for In-Network preventive care
• Coverage for naturopaths, chiropractic care and acupuncture
• An extensive local and national network through UnitedHealthcare/Oxford
• Health Enhancement Program (HEP)
• Dedicated Service Team
• The Healt

alth h Enhancem emen ent 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

• 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

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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Most t Que uest stione ioned d Benefi nefits ts

Benef efit it In In-Netw twork Cover erage age Out-of

• f-Ne

Netw twor

• rk Cover

erage age Preventive Care: Adult and Pediatric No Copay Deductible Plus Coinsurance Immunizations/Vaccines No Copay Deductible Plus Coinsurance Primary Care and Specialist Sick Visits $15 Copay Deductible Plus Coinsurance Naturopathic Physician Visits $15 Copay Deductible Plus Coinsurance Emergency Room $35 Copay

*Waived if Admitted

$35 Copay

*Waived if Admitted

Urgent Care Center $15 Copay Deductible Plus Coinsurance Routine Vision Exam & Refraction $15 Copay

• 1 Exam Per Calendar Year

Deductible Plus 50% Coinsurance

• 1 Exam Per Calendar Year

Infertility Services $15 Copay Office No Copay Inpatient and Outpatient Hospital Deductible Plus Coinsurance Outpatient PT/OT No Copay

• Unlimited Visits

Deductible Plus Coinsurance

• 30 Visits Per Calendar Year

Speech Therapy No Copay

• Unlimited Visits

Deductible Plus Coinsurance

• 30 Visits Per Calendar Year

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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Most t Que uest stione ioned d Benefi nefits ts – Continued ntinued

Benef efit it In In-Netw twork k Cover erag age Out-of

• f-Ne

Netw twor

• rk Cover

erag age Chiropractic No Copay

• Unlimited Visits

Deductible Plus Coinsurance

• 30 Visits Per Calendar Year;

*Medical necessity required

Acupuncture

• 20 Visits Per Calendar Year

Combined In- and Out-of-Network

$15 Copay Deductible Plus Coinsurance Durable Medical Equipment No Copay Deductible Plus Coinsurance Foot Orthotics No Copay Deductible Plus Coinsurance Nutritional Counseling

• 3 Visits per person per calendar

year

No Copay Deductible Plus Coinsurance

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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

• Out-of-Network Deductible: $300 (individual) / $900 (family)
• 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 10 for website information.

Provide vider r Netw twork

• rk Inform

formati tion

• n – Loc
• cal

al

Local Network rk: “Oxford Freedom”

As a UnitedHealthcare/Oxford member, you will have access to one of the largest networks in the Connecticut, New York* and New Jersey tri-state area. In the tri-state, you will utilize the Oxfor

• rd

d Freed eedom

• m
• network. Oxford members can seek services from any participating Oxfor
• rd

d Freed eedom

• m provider in

Connecticut, New York * and New Jersey without a referral.  Note: When speaking to your physician about their participation status, please use “Oxford

• rd

Freed eedom

• m,”, 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 United tedHea ealt lthcare e Choic

• ice

e Plus us national network.

Searching hing for Local Providers ders

To search for your physician, or any participating physician, online:

– Visit https://www.oxhp.com/Member/MemberPortal/ – In the upper right-hand corner, click on “Find a Physician or Facility” – Select “Freedom” from the list of Oxford Networks – You can search for Physicians or Facilities, and search for both by Location, Name or Oxford Provider ID by clicking

• n the appropriate radio button

– Complete the required fields marked with an asterisk - at minimum - and click “Search”

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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Provi vide der r Netw twork

• rk Inform

formati tion

• n – Nationa

ional

Nationa nal Network rk: : “UnitedHealthcare Choice ce Plus”

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 United edHe Healthc althcar are e Choi

• ice Plus national
• network. By finding one of our UnitedHe

tedHealthc althcare Choice ice Plus physicians, your services will be treated just as if you were still at home.  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 rd Freedom dom 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 Oxfor

• rd

d Freedom dom area, so members would utilize the United tedHea ealt lthcare e Choic

• ice

e Plus us national network.

Sear arching ing for Prov

• vide

iders s Out of the Area ea To search for a Choice Plus physician online:

– Visit https://connect.werally.com/?showBackButton=true – You can search by provider name or provider specialty by entering your search criteria in the rectangular box and hitting “Search” *You can narrow your search by changing the zip code – You can also search a list of providers by specialty, service type, condition, etc. by selecting one of the blue boxes

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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Clinica ical l Programs rams

• All Partnership Plan 2.0 members have access to the following programs:

*For more in-depth information on any of these programs, please see the enclosed “State of Connecticut Partnership Plan Health, Wellness and Clinical Management Programs” handout

• All Partnership Plan 2.0 members also have access to the Rally

ly Web b Porta tal on oxfordhealth.com

– For additional information on Rally please visit http://partnershipstateofct.welcometouhc.com and put your cursor over “Online Tools & Resources”, then click on “Your Member Website” – Additionally, after your effective date, you may log into your account, then click on the “Health and Wellness” tab

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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

UnitedHealthcare/Oxford Clinical Programs

PHS 2.0: Personal Health Support Nurse Team CKS: Comprehensive Kidney Solutions NL: Oxford On-Call Nurse Line TRS: Transplant Resource Services WC: Telephonic Wellness Coaching UBH: Full Care Management TDS: Treatment Decision Support HPP: Healthy Pregnancy Program CHD: Congenital Heart Disease MIP: Managed Infertility Program CSP: Cancer Support Program NRS: Neonatal Resource Services CRS: Cancer Resource Services HeN: HealtheNotes

Prior r Au Authori horizati zation

• n

The following services require prior authorization*:

Air Ambulance Oral Surgery Chemotherapy Organ Transplant Colonoscopy Orthoptic Exercises Dialysis Outpatient Physical and Occupational Therapy Durable Medical Equipment Over $500 Outpatient Surgery High Cost Diagnostic Imaging (MRI, CT Scan, etc.) Private Duty Nursing Infertility Treatments Skilled Nursing Facility Admission Inpatient Admissions Specialized Formula Inpatient Hospice Specialized Infant Formula Inpatient Mental Health / Substance Abuse Specialty Hospital Admission Inpatient / Outpatient Sleep Study Substance Abuse Residential Treatment

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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

*Please note, this list is not complete and is subject to change. It is best to have your physician call UnitedHealthcare/Oxford for confirmation prior to services being rendered  Members who obtain non-emergency services from a Non-Network Provider without obtaining the required Prior Authorization may be subject to a penalty equal to $500 or 20% of the cost of such services, whichever is

• less. To inquire if a specific procedure that you are interested in is covered and/or requires prior authorization,

please obtain the procedure code from your physician and call Customer Service at the numbers on slide 9

Transi siti tion

• n of Care
• Transitional care is a process in which a member may be allowed to access non-network providers on

an In-Network basis to continue a course of treatment during a transitional period. Transitional Care is sometimes referred to as “Continuity of Care”

• If a member is currently undergoing treatment for a life threatening or disabling disease or condition,
• r is in their second or third trimester of pregnancy, and their physician is not participating with

UnitedHealthcare/Oxford (Oxford Freedom Network) as of the effective date of the plan, members can qualify to continue using their physician for 60 days after transition at the In-Network level of care

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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Type Form m Used ed Subje ject to Med. d. Crit iter eria ia? Oxfor

• rd will

l approve Trans ansit itio ional al Car are e if New w memb mber er enrollme

• llment

Transitional Care Agreement Form for New Member

*Form can be provided upon request

No The member meets criteria relating to:

• Life threatening disease/condition
• Disabling disease/condition
• Second or third trimester of pregnancy
• Provider signs the Transitional Care

Agreement Form for New Member and agrees to Oxford's policies and procedures

• MD review is not required to certify

Conta ntact ct Informat formation ion

UnitedHe tedHealthc althcare/Ox /Oxfor ford Contac tact Infor

• rma

matio ion UnitedHealthcare/Oxford has proudly served the State of Connecticut since 2005 with a designated service team. The following numbers are staffed by individuals who understand the State’s benefits, and are there to help you through this process. Custome tomer Service ice Access ss: 8:00am am – 6:00pm m EST Prior

• r to Effec

ectiv ive Date te: 800-760-4566

• When prompted, state “Become a Member”
• Hold the line and the next available representative will answer your call

After er Effec ectiv ive Date: te: 800-385-9055

• Hold the line and the next available representative will answer your call

Memb mber er Webs ebsite ites: Partnership Plan Dedicated Site: http://partnershipstateofct.welcometouhc.com/home

• Contains information regarding the Partnership Plan, HEP information, how to search for a provider, links to
• ther vendors in Partnership and more

Oxford Secure Member Portal: https://www.oxfordhealth.com/

• Secure site for members to look up claims information, wellness information, order ID cards and more after

the effective date of the plan

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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Ad Addit itional ional Contact ntact Inform formati tion

• n

Oxford’s Mental Health Site - https://www.liveandworkwell.com/public/

• Secure site for members to search for a mental health provider near them and find reference information on

mental health assistance

To Perform a mental health provider search on LiveandWorkWell.com:

• Click on “Find a Provider” in the upper right box
• On the next page, click on “Search for Mental Health Clinicians Near You”
• The following page will allow you to search for a Provider or a Facility by geographic location, or by Name
• The results page will let you further narrow down your search by level of the clinician (definitions provided online),

by treatment options, by availability and much more

For information pertaining to Oxford’s medical and administrative policies, please visit: https://www.oxhp.com/secure/policy/medical_administrative_policy_index.html To review in-depth coverage information, please visit the Comptroller’s website: http://www.osc.ct.gov/ctpartner/index.html

• Scroll to the bottom of the page and click on “Medical Documents”
• This will bring up the Summary Plan Description (SPD)

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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.