Your Plan Explained

UnitedHealthcare Group Medicare Advantage (PPO) Plan

®

Exclusively for State Health Benefit Plan Retirees.

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Your Medicare.



 his brochure explains the Medicare Advantage plans being offered to State T Health Benefit Plan (SHBP) retirees. Medicare Advantage is 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, then provide additional benefits that contribute to improving your health and wellness. These Medicare Advantage plans also include prescription drug coverage.

You must purchase Medicare Part B to be eligible to enroll in this plan. If you’re not sure you are enrolled, check with your local Social Security office. You must continue to pay your Medicare Part B premium to Social Security to be eligible to participate in one of the SHBP Medicare Advantage PPO plans. If you don’t continue to pay your Part B premiums, you will lose your coverage under the UnitedHealthcare Group Medicare Advantage plan under SHBP. SHBP will roll your coverage to a non-Medicare option under SHBP and you will pay 100 percent of the cost of the premiums.





Hospital Doctors



Drugs



Extras

Your UnitedHealthcare. 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 you to feel good about your plan choice, and to help you get the most out of your health care dollar.

Five reasons to choose a UnitedHealthcare plan. 1. A  company you know and trust – 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 2. H  elp controlling your care costs – Your plan helps limit your out-of-pocket expenses by providing an annual limit and affordable copays. 3. F  lexibility – We understand that your choice of doctors, hospitals and other health care providers is important. With this plan, you will have access to a national contracted network through UnitedHealthcare. Plus, you can see non-contracted providers as long as they participate in Medicare. You can also get your prescriptions filled through a national network of more than 60,000 chain pharmacies and more than 650 local independent pharmacies. 4. Additional health and wellness programs that make a difference – This plan offers the same coverage as Medicare Parts A and B, plus extras that contribute to your health and wellness. 5. D  edicated Customer Service – We have created a helpful customer service team that has been trained on your specific employer group-sponsored plans. With one simple phone call, you can get answers to all your health plan benefit questions.

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Your State Health Benefit Plan (SHBP) Plan. Your SHBP plan is a Preferred Provider Organization (PPO) plan. This type of plan helps keep health care decisions in your hands. It is similar to your former Private Fee-For-Service plan, except there is no deeming. You can see any provider that participates in Medicare. You can also take advantage of our large group of in-network doctors. If a doctor is “in-network”, that means they have a contract with UnitedHealthcare for this plan. You also have the flexibility to see doctors that are “out-of-network.” These doctors do not have a contract with UnitedHealthcare for this plan. Unlike most PPO plans, in this plan you pay the same costs in and out-of-network. When you sign up for the SHBP UnitedHealthcare Group Medicare Advantage (PPO) plan, all of your health care coverage is combined into a single plan. You get coverage for hospital care, and 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:



• Your benefits cover health services provided to you by any doctor or medical professional who participates in Medicare.





• You can enjoy predictable copayments (a flat dollar amount) or coinsurance (a percentage) that represents your share of the cost. This helps make budgeting for health care costs easier.





• You can take advantage of a $0 copayment for some Medicare-covered preventive services including an Annual Wellness Visit.





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

Frequently asked questions.

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

In-Network

Out-of-Network

Yes

Has the choice to accept plan (except for emergencies)

You pay the same copay or coinsurance whether you see a provider in or out-of-network

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

No

No

Do I need a referral to see a specialist?

No

No

For more information about your plan details including copays, plan benefits and prescription drug coverage — refer to the Benefit Highlights booklet. 3

Your Extra Benefits. Your plan provides the same coverage as Medicare Parts A and B, plus many extra benefits that contribute to your health and wellness. See the member benefits materials to learn more about the added benefits included with your plan. They may include:

• Routine annual physicals



• Membership in a fitness program designed for seniors



• Health and well-being programs



• A Caregiver support program

Your Doctor. Seeing a doctor is easy. With our large network, most likely your doctor is already part of the plan. However, even if your doctor is not part of our network, we have made it easy for your doctor to accept this plan.

• Different from PFFS plans, PPO plans have been around a long time. Doctors are used to working with PPOs.



• We pay what Medicare pays so your doctor will receive the same payment as under Medicare.



• If your doctor does not accept Medicare assignment, we will pay the remaining charges.

To find out about the doctors or hospitals in your network, see the online Provider Directory at www.UHCRetiree.com/shbp. This directory is updated regularly to provide you with the current listing of network providers.

If you would like help finding a doctor or to request a written copy of the Provider Directory, please call Customer Service.

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Your Prescription Drug Coverage. Your plan includes Medicare Part D prescription drug coverage, so you SHOULD NOT enroll in a stand-alone Medicare Part D plan. This is very important as it will disenroll you from this SHBP plan and you will not be able to re-enroll back into the SHBP group coverage. Members can fill their prescriptions at more than 60,000 national chain pharmacies and more than 650 local independent pharmacies. Under this plan offered through the State Health Benefit plan, 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 will lose your SHBP coverage.

For additional information about your prescription drug coverage, please see the Prescriptions and Pharmacies brochure in your kit.

Questions? Already a member? Call Customer Service toll-free about your plan:

1-877-246-4190, TTY 711

8 a.m. – 8 p.m. local time, 7 days a week Not a member yet? Call Customer Service toll-free about your plan:

1-877-755-5343, TTY 711

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

When you contact Customer Service, have your group number available. You can find your group number on the front of the Benefit Highlights booklet.

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Notes

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1

2008 UnitedHealth Group Annual Report

UnitedHealthcare® Medicare Advantage plans are offered by UnitedHealthcare Insurance Company and its affiliated companies, a Medicare Advantage organization with a Medicare contract. Limitations, copayments and coinsurance may apply. Benefits may vary by employer group.