UnitedHealthcare Group Medicare Advantage (HMO) Take advantage of our large provider network. Your Plan Explained

Your Plan Explained UnitedHealthcare® Group Medicare Advantage (HMO) Take advantage of our large provider network. UHEX12HM3330590_000 Y0066_110531_...
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Your Plan Explained

UnitedHealthcare® Group Medicare Advantage (HMO) Take advantage of our large provider network.

UHEX12HM3330590_000 Y0066_110531_134847

Your Medicare. This brochure explains your Medicare Advantage plan, a type of health plan also known as Medicare Part C. Medicare Advantage plans combine your Medicare Part A (hospital) and Medicare Part B (doctor and out-patient) coverage. They also provide additional benefits that can help improve your health and wellness. Your Medicare Advantage plan also includes prescription drug coverage. You have to be enrolled in Medicare Part A and purchase Medicare Part B to be eligible to enroll in this plan. If you’re not sure if you are enrolled, check with your local Social Security office. You must continue paying your Medicare Part B premium to keep your coverage under this group-sponsored plan. If you stop your payments, you may be disenrolled from this plan. No physicals or health questions are required to enroll, and pre-existing conditions do not affect your eligibility. All Medicare Advantage plans are offered by private companies, like UnitedHealthcare® Insurance Company, who are required to offer coverage that is as good as Original Medicare or better. The government pays us a fixed fee for your care. UnitedHealthcare then handles the payments to doctors and hospitals.

Your UnitedHealthcare.

Hospital

Doctors

Additional Benefits

Drugs

Choosing the right health care plan is a big decision. It involves looking at the costs, benefits, access to doctors and other health care services and so much more. We want to help you get the most out of your health care dollar so you can feel good about your health plan choice.

Five reasons to choose a UnitedHealthcare® plan.

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Get coverage from a National Leader – With over 25 years of experience, UnitedHealthcare is one of the nation’s largest providers of health care coverage for older adults. Nationally, we serve one in five people eligible for Medicare.1

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Help controlling your care costs – This plan helps limit your out-of-pocket expenses by providing an annual limit and affordable copays. Flexibility – We understand that your choice of doctors, hospitals and other health care providers is important. With this plan, you have a large network of doctors, hospitals and other health care providers affiliated with the plan. There’s a good chance your doctor is already part of our network. You can also get your prescriptions filled through a national network of more than 65,000 pharmacies.

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 dditional health and wellness programs that make a difference – This plan offers the same benefits as A Medicare Parts A and B, plus extras that contribute to your health and wellness.



 edicated Customer Service – We have created a helpful customer service team that has been trained D on your specific group-sponsored plan. With one simple phone call, you can get answers to all your health plan benefit questions. 3

Your Plan. Your plan is a Health Maintenance Organization (HMO) plan. This type of plan provides care through a network of local doctors and hospitals. Your Primary Care Physician (PCP) may oversee your care and, in some cases, refer you to specialists as necessary. When you sign up for a UnitedHealthcare Group Medicare Advantage (HMO) plan, all of your health care coverage is combined into a single plan. You get coverage for hospital care, doctor care and prescription drugs. All from one company, with one member ID card. It’s an easier way for you to manage your benefits.

Plan highlights:

• You have the flexibility to choose your own doctor from our large network. In fact, there’s a good chance your doctor is already a part of our network.



• To receive plan benefits, you must receive services from inside the network.



• If your doctor or hospital is “in-network” (has a contract with UnitedHealthcare for this plan) they must accept this plan.



• If your doctor or hospital is “out-of-network” (does not have a contract with UnitedHealthcare for this plan), you must pay the full cost for all services.



• You can enjoy predictable copays (a flat dollar amount) or coinsurance (a percentage) that represent your share of the cost.



• There is a limit on your out-of-pocket spending for the year.



• Worldwide Emergency and Urgently Needed Services are covered and never require prior authorization.

Frequently asked questions. In-Network

Out-of-Network

Yes

No

Standard plan copay or coinsurance applies

You must pay the full cost for services

Do I need to choose a Primary Care Physician (PCP)?

Yes

N/A

Do I need a referral to see a specialist?

Yes

N/A

Will the doctor or hospital accept my plan? What is my copay or coinsurance?

For more information about your plan details including copays, plan benefits and prescription drug coverage — refer to the Benefit Highlights brochure or Summary of Benefits. 4

Your Doctor. Seeing a doctor is easy. When you enroll in this plan, you have access to a broad network of doctors and hospitals. Providing members with a large network of health care providers is just another example of how we help you take control of your health care decisions, by increasing your options and choices in getting care. With our large network, most likely your doctor is already part of the plan.

To find doctors or hospitals in our network, see the online Provider Directory at www.UHCRetiree.com. This directory is updated regularly to provide you with the current listing of network providers. If you would like help finding a network doctor or to request a written copy of the Provider Directory, please call Customer Service.

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Your Additional Benefits and Programs. Your plan provides the same coverage as Medicare Parts A and B, plus many additional benefits and programs that contribute to your health and wellness. They may include:

NurseLine Services SM

Speak with a registered nurse, 24 hours a day, 7 days a week.

• Discuss your health and diet.



• Review or discuss your medications.



• Receive information about illnesses and injuries.



• Get tips on working with your doctor.

SilverSneakers® Fitness Program Stay physically fit and active with the SilverSneakers Fitness Program. This fitness program is available to you at no additional cost. With the SilverSneakers Fitness Program you’ll receive:

• A basic fitness center membership at more than 11,000 participating locations.



• Access to all amenities, programs and services that are standard with a basic fitness center membership.



• Nationwide access to any participating fitness location (find locations at www.silversneakers.com).



• Many women-only locations, including Curves,® are available nationwide.

If the nearest participating location is 15 miles or more away from your home, you can register for the SilverSneakers® Steps program. This is a personalized program that provides tools such as resistance bands, exercise DVDs and “how-to” material to help you measure, track and increase your daily activity. The products and services described below are neither offered nor guaranteed under our contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to the UnitedHealthcare grievance process.

Solutions for Caregivers Providing care for a loved one can be demanding and overwhelming. This plan gives you access to Solutions for Caregivers – a program that supports you, your family and your loved ones. Services provided by Solutions for Caregivers include:

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• On-site assessment and development of a personalized care plan for you or your loved one.



• Unlimited phone access to a Care Specialist who can provide counsel on individual, medical, financial, safety, emotional and social needs.



• Connections with professionals, including home health aides, nurses, lawyers and financial advisors.

Your Prescription Drug Coverage. Your plan includes Medicare Part D prescription drug coverage, so there’s no need to get a stand-alone Medicare Part D plan. Members can fill their prescriptions at more than 65,000 network pharmacies. As with stand-alone Medicare Part D plans, you pay some of the cost of your drugs (a copay or coinsurance) and the plan pays the rest. The amount you pay depends on the drugs you take.

Please note – if you enroll in a separate Medicare Part D plan after you enroll in this plan, you may be disenrolled from your group-sponsored medical and/or prescription drug coverage.

Save on prescription drug costs. UnitedHealthcare is always looking for ways to save our members money. We have worked with many of our network pharmacies to provide the Pharmacy Saver program. Hundreds of generic drugs now cost as low as $2 for a one-month supply. In addition to savings, Pharmacy Saver offers convenience, with many national and local pharmacies to choose from. To look up qualifying drugs, participating pharmacies and prices, go to: www.UnitedPharmacySaver.com. You may also save money on your prescription drugs when you use mail service. See your Summary of Benefits to learn if your plan offers savings through a mail service pharmacy.

More ways to save. Your plan’s formulary (drug list) includes 100 percent of the drugs covered by Medicare Part D. Please review this plan’s drug list to be sure your prescription drugs are covered (not all drug lists are the same). This drug list is organized into different categories called “tiers.” In general, the lower the tier, the lower your cost for the drug. Many drugs on the drug list have other generic and brand name drug choices in lower tiers that treat the same conditions, but cost less. If you’re taking a Tier 2 or Tier 3 drug, you may be able to switch to a lower-tier (Tier 1 or Tier 2) drug and save money. Talk to your doctor to find out if there is an effective lower-tier drug for your current medication.

Tier Tier 1

Your cost Low

Description Includes most generic prescription drugs. For the lowest out-of-pocket expense, you and your doctor should decide if Tier 1 medications are right for your treatment.

Tier 2

Includes many common brand name drugs and some higher-cost generic prescription drugs.

Tier 3

Includes non-preferred generic and non-preferred brand name drugs. Tier 3 drugs usually have lower-cost choices in Tier 1 or Tier 2 that can treat the same condition.

Tier 4 (Specialty Tier)

High

Includes unique or very high-cost drugs. You pay a high copayment or a percentage of the total cost, called coinsurance. 7

List of commonly used drugs. Shown here are some of the most commonly used drugs covered by this plan. This is not a complete drug list. To make sure your drugs are covered and to find out tier information, please call Customer Service. Or visit us online at www.UHCRetiree.com.

Drug Name Acetaminophen/Codeine Actonel Acyclovir Advair Diskus Aggrenox Alendronate Sodium Allopurinol Amiodarone HCl Amitriptyline HCl Amlodipine Besylate Amlodipine Besylate/Benazepril HCl Amoxicillin Amoxicillin/Potassium Clavulanate Anastrozole Asacol Atelvia Atenolol Avapro Avodart Azithromycin Azor Baclofen Benazepril HCl Benicar Benicar HCT Boniva Budeprion SR Bupropion HCl Buspirone HCl Bystolic Carbidopa/Levodopa Carisoprodol Cartia XT Carvedilol Bold = Brand name drug 8

Cefuroxime Axetil Celebrex Cephalexin Ciprofloxacin HCl Citalopram Hydrobromide Clindamycin HCl Clobetasol Propionate Clonidine HCl (Weekly Patch) Colcrys Combivent Crestor Cyclobenzaprine HCl Cymbalta Detrol la Dexilant Diclofenac Sodium Digoxin Diltiazem CD Diltiazem HCl Diltiazem HCl ER Diovan Diovan HCT Divalproex Sodium Donepezil HCl Dorzolamide HCl/Timolol Maleate Doxazosin Mesylate Doxycycline Hyclate Enablex Enalapril Maleate Endocet Estradiol Evista Exforge Famotidine

Fexofenadine HCl Finasteride (5mg Tablet) Fluconazole Fluocinonide Fluticasone Propionate Furosemide Gabapentin Gemfibrozil Glimepiride Glipizide Glyburide Glyburide/Metformin HCl Humalog Hydralazine HCl Hydrochlorothiazide Hydrocodone/Acetaminophen Hydroxychloroquine Sulfate Hydroxyzine HCl Ibuprofen Isosorbide Mononitrate Isosorbide Mononitrate ER Klor-Con 10 Klor-Con 8 Klor-Con M20 Lansoprazole Lantus Levaquin Levetiracetam Levothroid Levothyroxine Sodium Levoxyl Lexapro Lidoderm Lipitor

Drug Name – continued Lisinopril Lisinopril/Hydrochlorothiazide Losartan Lovastatin Lovaza Lumigan Lunesta Lyrica Matzim LA Megestrol Acetate Meloxicam Metformin HCl Metformin HCl ER Methocarbamol Methotrexate Methylprednisolone Metoclopramide HCl Metoprolol Succinate ER Metoprolol Tartrate Metronidazole Mirtazapine Mirtazapine ODT Morphine Sulfate ER Namenda Naproxen Naproxen DR Nasonex Nexium Niaspan Nifediac CC Nifedical XL Nifedipine Nifedipine ER

Nitrofurantoin Nitrostat Novolog Omeprazole Oxybutynin Chloride Oxycodone HCl Oxycodone/Acetaminophen Pacerone (200mg Tablet) Pantoprazole Sodium Paroxetine HCl Plavix Polyethylene Glycol 3350 Potassium Chloride ER Pradaxa Pravastatin Sodium Prednisone Premarin Proair HFA Promethazine HCl Propranolol HCl Propranolol HCl ER Proventil HFA Quinapril HCl Ramipril Ranitidine HCl Risperidone Risperidone ODT Ropinirole HCl Seroquel Seroquel XR Sertraline HCl Simvastatin Singulair

Sotalol HCl Spiriva Handihaler Spironolactone Sulfamethoxazole/Trimethoprim Synthroid Tamsulosin HCl Terazosin HCl Timolol Maleate Toprol XL Torsemide Tramadol HCl Travatan Z Trazodone HCl Triamcinolone Acetonide Triamterene/Hydrochlorothiazide Tricor Uroxatral Valacyclovir HCl Venlafaxine HCl Venlafaxine HCl ER Ventolin HFA Verapamil HCl Verapamil HCl ER Vigamox Voltaren (Gel) Vytorin Warfarin Sodium Welchol Zetia Zolpidem Tartrate Zostavax Zyprexa

Bold = Brand name drug Trademarks for the drugs listed above are owned by third parties with whom this plan has no affiliation. This is not a complete drug list. Please note that the drug list is updated periodically throughout the year, and the list of covered drugs may change as drugs are added or deleted from the list. To find out if your drugs are covered, call Customer Service. 9

Next Steps. 1. UnitedHealthcare will make sure you are eligible for the plan. 2. In about 4-6 weeks, you will receive your new member ID card. 3. Once you are officially enrolled in the plan, you will receive a Welcome Kit. 4. Begin using your new member ID card on your effective date.

Important Notes. The Centers for Medicare and Medicaid Services, (CMS) requires that we provide our members with new or updated plan materials.

• Evidence of Coverage (EOC) – included in your Welcome Kit, provides complete details about the benefits and services included with your new plan.



• Annual Notice of Changes (ANOC) – mailed every year before your renewal, describes changes to your benefits for the next year.



• Updated Pharmacy and Provider Directories – mailed every 1-3 years.

Providing you with new and updated plan information can help you understand your plan better, so you can take advantage of all the benefits available to you. Remember, if you drop your group-sponsored retiree health coverage, you may not be able to re-enroll. Limitations and restrictions vary by plan sponsor.

Questions?

Call Customer Service toll-free:

1-877-714-0178, TTY 711

8 a.m. – 8 p.m. local time, 7 days a week

When calling Customer Service, let the representative know that you are calling about a group-sponsored plan. Your group number can be found on the Benefit Highlights brochure or Summary of Benefits.

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Notes

1

2010 UnitedHealth Group Annual Report

OptumHealthSM is a health and well-being company that provides information and support as part of your health plan. NurseLineSM nurses cannot diagnose problems or recommend specific treatment and are not a substitute for your doctor’s care. NurseLineSM services are not an insurance program and may be discontinued at any time. SilverSneakers® is a registered mark of Healthways, Inc. Healthways, Inc., is an independent company. The SilverSneakers® program is made available as part of this plan’s benefits to those insured through this plan. UnitedHealthcare does not endorse and is not responsible for the services or information provided by this program. Always consult your physician before you begin SilverSneakers or any physical fitness program. Solutions for Caregivers assists in coordinating community and in-home resources. The final decision about your care arrangements must be made by you. In addition, the quality of a particular provider must be solely determined and monitored by you. Information provided to you about a particular provider does not imply and is in no way an endorsement of that particular provider by Solutions for Caregivers. The information on and the selection of a particular provider has been supplied by the provider and is subject to change without written consent of Solutions for Caregivers. UnitedHealthcare® Medicare Advantage plans are insured through UnitedHealthcare Insurance Company and its affiliated companies, a Medicare Advantage organization with a Medicare contract. Members may enroll in the plan only during specific times of the year. Contact UnitedHealthcare for more information. You must have both Medicare Parts A and B to enroll in the plan. The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party. Limitations, copayments, and restrictions may apply. You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your Medicaid Office. You must use contracted network pharmacies to access your Part D prescription drug benefit except under non-routine circumstances, in which case quantity limitations and restrictions may apply. HMO members must use plan providers except in emergency or urgent care situations or for out-of-area renal dialysis. If you obtain routine care from out-of-network providers neither Medicare nor UnitedHealthcare® Medicare Advantage plans will be responsible for the costs. Retiree plan prospects must meet the eligibility requirements to enroll for group coverage.

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