Get benefits that make it easier to focus on your health ......Get benefits that make it easier to focus on your health, not your health care. Tolleson Union High School District All

Get benefits that make it easier to focus

on your health, not your health care.

Tolleson Union High School District

All set, you will see your new pay plan under frequency when you are in the enrollment portal next week. If it’s not correct, please email me to change it so I can reset your enrollment.Thank you,

HEALTH BENEFITS 7/1/16

Value Pharmacy Network

PPO Base

HDHP I

HDHP II

Benefits to help you stay healthy

Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

What We Will Cover Today

Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth

Group.

Prescription Coverage with OptumRX

This impacts ALL Members Go to Myuhc.com to

Locate a Pharmacy

Price a medication

Refill Mail Order

See your PDL

Listing

See your no-cost

Contraceptive List

See your Preventive

Drug List

See your

Specialty Drug

List

HEALTH BENEFITS OVERVIEW

This year your prescription coverage through OptumRX has changed to the Value Pharmacy Network. This allows both the district and the covered members to save $$$ with deeper negotiated discounts at specific pharmacies.

How does it work?

Fill your prescriptions at a participating Value Pharmacy Network locations such as:WalgreensFry’s Food and DrugWalmartSam’s Club

What happens if I try to fill a prescription at a non-network

pharmacy?• Non-network claims will be denied and you

have to pay full price for your medication. To take advantage of your pharmacy benefit, transfer your prescriptions to a participating Value Network Pharmacy

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiepYOomMbLAhXpnYMKHXMYBJAQjRwIBw&url=https://www.myallsavers.com/MyAllSavers/Home/FindDoc&bvm=bv.116954456,d.amc&psig=AFQjCNGOk4tMKREkKUcU8y8Dewb_2l4_rw&ust=1458251390433288

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiepYOomMbLAhXpnYMKHXMYBJAQjRwIBw&url=https://www.myallsavers.com/MyAllSavers/Home/FindDoc&bvm=bv.116954456,d.amc&psig=AFQjCNGOk4tMKREkKUcU8y8Dewb_2l4_rw&ust=1458251390433288


Group.

Value Pharmacy Network

CVS, Costco, Food City, Bashas, Osco, Kmart, Safeway

including others are Non-Network on effective 7/1/17

What happens if I try to fill a prescription at a non-pharmacy?

Non-network claims will be denied, and you will have to pay the full retail price for your medication. To take advantage of your pharmacy benefit transfer your prescription to a participating Value Network pharmacy.

How do I transfer to a Value Network Pharmacy?

Transferring prescriptions to a value Network pharmacy is easy. Simply provide your prescription bottle or prescription information to your new pharmacy. The pharmacist will transfer any remaining refills on the current prescription or get a new prescription from your doctor.


Group.

PPO Base Plan

With the Traditional Plan, you must use doctors or

hospitals in the National Choice Network.

There’s no coverage if you need to go out-of-

network except for emergencies.

There’s no need to choose a primary care

provider (PCP) or get referrals to see a

specialist.


Paying for network care

If you go out-of-network, your costs may be

higher. Out-of-network providers can bill you for

amounts higher than what your plan will cover.

For COVERAGE DETAILS, see your Summary

Plan Description.

CO-PAYMENT*

Virtual Visit $0

PCP Visit $35

PCP Visit - Tier 1 $20

Convenience Care $35

Specialist $55

Specialist – Tier 1 $40

Urgent Care $50

Emergency Room $500

Hospital Stay 20%*

DEDUCTIBLE Per Plan Year*

Individual $750

Family $2,250

CO-INSURANCE 20%

OUT-OF-POCKET LIMIT

Individual $3,000

Family $9,000


Group.

PPO Base Plan

Myuhc.com

•Price a medication

•Refill Mail Order

•PDL Listing

•No-cost Contraceptive List

•Preventive Drug List

•Specialty Drug List


How we cover prescriptions.Tier 1 - $0

Lower-cost

Medications

Tier 2 - $30 Midrange-cost

Medications

Tier 3 - $50Higher-cost

Medications

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiepYOomMbLAhXpnYMKHXMYBJAQjRwIBw&url=https%3A%2F%2Fwww.myallsavers.com%2FMyAllSavers%2FHome%2FFindDoc&bvm=bv.116954456,d.amc&psig=AFQjCNGOk4tMKREkKUcU8y8Dewb_2l4_rw&ust=1458251390433288

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiepYOomMbLAhXpnYMKHXMYBJAQjRwIBw&url=https%3A%2F%2Fwww.myallsavers.com%2FMyAllSavers%2FHome%2FFindDoc&bvm=bv.116954456,d.amc&psig=AFQjCNGOk4tMKREkKUcU8y8Dewb_2l4_rw&ust=1458251390433288


We need to encourage more informed healthcare decisions:

There’s a need to save for future health

care costs

This Plan allows you the option to open a health savings account (HSA)

High Deductible Health Plan (HDHP)


Employees on the HDHP I (employee only tier) are eligible to receive up to $700.00 in District Contributions. The District will preload up to $350.00 into eligible accounts which is pro-rated based on start date. To receive the additional $350.00 at the end of the plan year, eligible employees must complete activities as defined in the (P.R.E.P)Prevention Reward Employee Program.

High Deductible Health Plan (HDHP)


Group.

With the HDHP, you can use any doctor, or hospital

but you save money when you use our National

Choice Plus Network. You can also save money

when you use a health savings account (HSA) to

pay for qualified services.

Save money by staying in our network.



specialist.



If you go out-of-network, your costs may be higher.

Out-of-network providers can even bill you for

amounts higher than what your plan will cover. For

COVERAGE DETAILS, see your official health

plan documents.

HDHP 1

CO-PAYMENT*

Virtual Care 20%*

PCP 20%*

Convenience Care 20%*

Specialist 20%*

Urgent Care 20%*

Emergency Room 20%*

Hospital Stay 20%*

DEDUCTIBLE Per Calendar Year*

Individual $2,600

Family $5,200

CO-INSURANCE 20%

OUT-OF-POCKET LIMIT

Individual $4,500

Family $9,000


Group.

With the HDHP, you can use any doctor, or hospital

but you save money when you use our National

Choice Plus Network. You can also save money

when you use a health savings account (HSA) to

pay for qualified services.

Save money by staying in our network.



specialist.



If you go out-of-network, your costs may be higher.

Out-of-network providers can even bill you for

amounts higher than what your plan will cover. For

COVERAGE DETAILS, see your official health

plan documents.

HDHP II

CO-PAYMENT*

Virtual Care 20%*

PCP 20%*

Convenience Care 20%*

Specialist 20%*

Urgent Care 20%*

Emergency Room 20%*

Hospital Stay 20%*

DEDUCTIBLE Per Plan Year*

Individual $1,500**

Family $3,000

CO-INSURANCE 20%

OUT-OF-POCKET LIMIT

Individual $3,425**

Family $6,850

**Doesn’t apply if 2+ members

covered


Group.

Health Savings Accounts (HSA)


How we cover prescriptions.

Tier 1 - 0Lower-cost

Medications

Tier 2 - $30 Midrange-cost

Medications

Tier 3 - $50Higher-cost

Medications

Members are subject to their

Medical/Pharmacy deductible

before copay’s apply.

Medications listed on Expanded

Preventative Drug List are subject

to copays.

Select contraceptives are no cost


Group.

Health Savings Accounts (HSA)


It’s a real bank account with Triple Tax Benefits

You don’t pay federal, state or FICA tax on the money you

deposit. Your savings grows tax free and you can use tax

free money for qualified expenses.

You can build savings for retirement

No “use it or lose it” rule. You can invest savings.

The money is there when you need it

Use your UnitedHealthcare HSA MasterCard debit card to

pay at the pharmacy, doctor’s office. Or save it, the money in

your HSA is yours, so it stays with you if you change health

plans, employers, or retire.

Save your receipts for all qualified medical expenses

Non qualified expenses subject to a 20% tax penalty

2017 contribution limitsThe IRS limits how much you can put into your HSA each year. $3,400 for individual coverage•$6,750 for family coverageAre you 55 or older?You can put in an extra $1,000 this year.


Group.

HSA Eligibility

BENEFITS

You must be eligible to open or fund a Heath Savings Account (HSA)

You must be enrolled in a high-deductible health plan (HDHP).

You cannot be covered by any other traditional health coverage including Medicare or TRICARE

You are not claimed as a dependent on someone else’s tax return

Some other restrictions apply. Please consult a tax, benefits, or financial advisor.

You are not covered by a health care flexible spending account (FSA)

avyou receipts for all qualified medical expenses

Doctor office visits

Prescriptions

Eyeglasses and

contacts

Dental care and braces

Spouse and Children

Medicare and COBRA premiums

Qualified expenses:


Group.

Optum BankSM


• The national leader in HSA

banking with more than a million

accounts

• Access through myuhc.com or

optumbank.com

• Three different account types.

Health eAccess -Monthly

Maintenance Fee $1 if balance is

$1-$499, $0 if over $500

Health eSaver

Health eInvestor

Open your HSA with Optum BankSM, Member FDIC

An HSA MasterCard® debit card to make it easy to

pay

Checks (optional, $10 for 25)

Easy online bill payment and reimbursement

Investment options to grow your retirement

savings.

Payroll deduction: Pre-tax dollars are taken out of

your paycheck and deposited into your HSA.

.

Preventive care is covered 100% when you use a network doctor.

How the HDHP I (AKA 2600) Plan Works - Christopher

Chris chooses the HDHP II (2600) for himself :

• Completes PREP and the District contributes $700 to his HSA

•Save on taxes

Pay with your HSA or another way

Individual $1,350 / Family $2,750

Type of Cost HDHP I

Yearly Premium $0

HSA Contribution $0

HSA Contribution received from district

$700

Sick visit to PCP -$75

Preventive Care Visit $0

Urgent Care Visit -$125

HSA Balance at End of Year

$500

Money saved by enrolling in HDHP 1 over the Base Plan.

$3,116

($2,546+$700-$130)

How the HDHP II (AKA 1500) Plan Works - Jane

Jane chooses the HDHP II (1500) for herself:

•Save on taxes

•Save for retirement

Pay with your HSA or another way

Individual $1,350 / Family $2,750

Type of Cost HDHP II

Yearly Premium $0

HSA Contribution $0

HSA Contribution received from district

$0

Emergency Surgery -100,000

Out of pocket Max $3,425

Net Out of pocket $3,425

HSA Balance at End of Year $0

Money saved by enrolling in HDHP II over the Base Plan.

$2,121

($3,000-$3,425+$2,546)

Benefits to help you

stay healthy.

OTHER BENEFITS


Online access to care NETWORK


A virtual visit lets you see and talk to a

doctor from your mobile device or

computer

No driving or crowded waiting rooms - 24/7

access

Log in to myuhc.com or the Health4Me app to

learn more

HDHP member pays full cost of virtual visit until

deductible is met

UnitedHealthcare Preventive


Network preventive care is covered 100%

One physical checkup every year

One OB/GYN checkup every year (Pap Smear)

One screening for breast cancer every year

(mammogram)

Shots for measles and other childhood diseases

(Immunizations)

One colonoscopy cancer screening test every five

years Other preventive tests required by the Affordable

Care Act

Preventive Care website www.uhcpreventivecare.com

myuhc.com

OTHER BENEFITS

Find network providers 800,000+ doctors and health care professionals

Track claims and expenses.

Estimate health care costs

The UnitedHealth Premium® Designation Program shows you doctors who meet quality and cost-efficiency guidelines.

Check HSA balance

Reimburse yourself for qualified expenses paid out-of-pocket

Manage HSA investments

Pay health care bills

Discounts on acupuncture, chiropractic care, massage therapy and natural medicine


Group.

Manage your health benefits

and HSA at myuhc.com.®

Health4MeTM mobile app

OTHER BENEFITS


Group.

Healthy Pregnancy Program Access

nurses. Get information to help you

identify health risks and get a

complimentary gift

Breathe easier – Asthma Program

Get help managing your asthma and

avoiding your triggers to reduce missed

days at work or school.

Help living with illnesses and conditions

Enroll in these programs by

calling the number on your

health plan ID card.

OTHER BENEFITS


Group.

Call or web chat with a registered nurse,

master’s-level counselor, or legal or financial

professional 24/7

3 face-to-face visits with network clinician

Help coping with grief, stress, relationship

issues, and more

Financial management information

Legal support

Find a doctor or counselor

Help is a call away.

Care24® Nurseline is open 24/7

1-866-271-7340

Questions?


Group.

Documents

Get benefits that make it easier to focus on your health ......Get benefits that make it easier to focus on your health, not your health care. Tolleson Union High School District All