Upload
mildred-bailey
View
219
Download
1
Tags:
Embed Size (px)
Citation preview
•Welcome to Chapter 3a – Tiered Medical Plan Options•Please remember:
• All Chapters provided in the 2016 Employee Presentation are intended to be part of a module series
• There are 6 chapters• Follow along with and compile these into your own
presentation (see below) in the order they are presented
• Text items in red are variable. Please modify them as necessary in order to fit your customers’ needs
• Please pick and choose from the slides provided to create a custom presentation that is right for you and your customers. Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
1
Delete this slide before distribution
Delete this slide before distribution
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Catalyst® Plan: Pre-deductible Allowance – two payments
BENEFITS
EDGE® Plus PlanYou can receive care and services from anyone in or out of our network, but you save money when you use the network.
Pay less by using UnitedHealth Premium® Tier 1 providers. They have been recognized for providing value.
There’s coverage if you need to go out-of-network.Choose what’s best for you.
There’s no need to choose a primary care provider (PCP) or get referrals to see a specialist.Consider a PCP; they can be helpful in managing your care.
Preventive care is covered 100% in our network.
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.
Look for Premium Tier 1 network care first.
To help you save money, we make it easy for you to find Premium Tier 1 providers. They have been recognized for providing value.
Look for the Tier 1 symbol when doing a NETWORK search.
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
EDGE® Plus Plan, cont’d
BENEFITS
Also save with free-standing facilities in the network.
These are medical facilities in the network that are not connected to hospitals or another medical facility so they usually charge less.
They may include radiology centers, surgery centers, and more.
Look for the Tier 1 symbol when doing a NETWORK search.
Where you go for care can make a big difference in cost. You’ll pay a lower [co-pay] [and] [co-insurance] when you use Premium Tier 1 providers.
Premium Tier 1 providers are physicians in 27 different medical specialties who are recognized for meeting national standards for quality and local market benchmarks for cost- efficiency.
Pay less using Premium Tier 1 providers.
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Catalyst® Plan: Pre-deductible Allowance – two payments
BENEFITS
EDGE® Plus Plan, cont’d
CO-PAYMENT* PREMIUM TIER 1
PROVIDER IN THE NETWORK OUT OF NETWORK
PCP <$XX> <$XX> <$XX>
Specialist <$XX> <$XX> <$XX>
DEDUCTIBLE*
[Self <$XXXX> <$XXXX> <$XXXX>
[Family <$XXXX> <$XXXX> <$XXXX>
CO-INSURANCE* <XX%> <XX%> <XX%>
OUT-OF-POCKET LIMIT
[Self <$XXXX> <$XXXX> <$XXXX>
[Family <$XXXX> <$XXXX> <$XXXX>
Paying for care
*Preventive care is covered 100 percent so you won’t need to worry about these costs and payments.
Lowest cost option Highest cost option
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Catalyst® Plan: Pre-deductible Allowance – two payments
BENEFITS
Choice Plus Advanced Plan
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.
Look for Tier 1 network care first.
To help you save money, we make it easy for you to find Tier 1 providers. These providers have been recognized for providing value.
Look for the Tier 1 symbol when doing a NETWORK search.
You can receive care and services from anyone in or out of our network, but you save money when you use the network.
Pay less by using Tier 1 providers. They have been recognized for providing value.
There’s coverage if you need to go out-of-network.Choose what’s best for you.
There’s no need to choose a primary care provider (PCP) or get referrals to see a specialist.Consider a PCP; they can be helpful in managing your care.
Preventive care is covered 100% in our network.
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Choice Plus Advanced Plan, cont’d
BENEFITS
About PremiumTier 1 providers
These are physicians in 27 different medical specialties who are recognized for meeting national standards for quality and local market benchmarks for cost- efficiency.
Look for the Tier 1 symbol when doing a NETWORK search.
Where you go for care can make a big difference in cost. You’ll pay a lower [co-pay] [and] [co-insurance] when you use these Tier 1 providers.
UnitedHealth Premium® Tier 1 providers have been recognized for providing value.
[Tier 1 hospitals can charge less for the same services compared to other hospitals. Tier 1 hospitals are any hospitals that aren’t labeled Tier 2.]
Free-standing facilities and centers are medical facilities in the network that are not connected to hospitals or another medical facility. They usually charge less. They may include radiology centers, surgery centers, and more.
Pay less using our Tier 1 providers.
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Catalyst® Plan: Pre-deductible Allowance – two payments
BENEFITS
Choice Plus Advanced Plan, cont’d
CO-PAYMENT* TIER 1 PROVIDER IN THE NETWORK OUT OF NETWORK
PCP <$XX> <$XX> <$XX>
Specialist <$XX> <$XX> <$XX>
DEDUCTIBLE*
[Self <$XXXX> <$XXXX> <$XXXX>
[Family <$XXXX> <$XXXX> <$XXXX>
CO-INSURANCE* <XX%> <XX%> <XX%>
OUT-OF-POCKET LIMIT
[Self <$XXXX> <$XXXX> <$XXXX>
[Family <$XXXX> <$XXXX> <$XXXX>
Paying for care
*Preventive care is covered 100 percent so you won’t need to worry about these costs and payments.
Lowest cost option Highest cost option
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Catalyst® Plan: Pre-deductible Allowance – two payments
BENEFITS
Choice Premier Plan
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.
Look for Premium Tier 1 network care first.
To help you save money, we make it easy for you to find Premium Tier 1 providers. They have been recognized for providing value.
Look for the Tier 1 symbol when doing a NETWORK search.
You can receive care and services from anyone in or out of our network, but you save money when you use the network.
Pay less by using UnitedHealth Premium® Tier 1 providers. They have been recognized for providing value.
There’s coverage if you need to go out-of-network.Choose what’s best for you.
There’s no need to choose a primary care provider (PCP) or get referrals to see a specialist.Consider a PCP; they can be helpful in managing your care.
Preventive care is covered 100% in our network.
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Choice Premier Plan, cont’d
BENEFITS
Also save with free-standing facilities in the network.
These are medical facilities in the network that are not connected to hospitals or another medical facility, so they usually charge less.
They may include radiology centers, surgery centers, and more.
Look for the Tier 1 symbol when doing a NETWORK search.
Where you go for care can make a big difference in cost. You’ll pay a lower [co-pay] [and] [co-insurance] when you use Premium Tier 1 providers.
Premium Tier 1 providers are physicians in 27 different medical specialties who are recognized for meeting national standards for quality and local market benchmarks for cost- efficiency.
Pay less using Premium Tier 1 providers.
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Catalyst® Plan: Pre-deductible Allowance – two payments
BENEFITS
Choice Plus Premier Plan, cont’d
CO-PAYMENT* PREMIUM TIER 1
PROVIDER IN THE NETWORK OUT OF NETWORK
PCP <$XX> <$XX> <$XX>
Specialist <$XX> <$XX> <$XX>
DEDUCTIBLE*
[Self <$XXXX> <$XXXX> <$XXXX>
[Family <$XXXX> <$XXXX> <$XXXX>
CO-INSURANCE* <XX%> <XX%> <XX%>
OUT-OF-POCKET LIMIT
[Self <$XXXX> <$XXXX> <$XXXX>
[Family <$XXXX> <$XXXX> <$XXXX>
Paying for care
*Preventive care is covered 100 percent so you won’t need to worry about these costs and payments.
Lowest cost option Highest cost option
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Catalyst® Plan: Pre-deductible Allowance – two payments
BENEFITS
Choice Plus Direct PlanYou can receive care and services from anyone in or out of our network, but you save money when you use the network.
Pay less by using Tier 1 hospitals. They have been recognized for providing value.
There’s coverage if you need to go out-of-network.Choose what’s best for you.
There’s no need to choose a primary care provider (PCP) or get referrals to see a specialist.Consider a PCP; they can be helpful in managing your care.
Preventive care is covered 100% in our network.
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.
Look for Tier 1 network care first.
To help you save money, we make it easy for you to find Tier 1 hospitals. These providers have been recognized for providing value.
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Choice Plus Direct Plan, cont’d
BENEFITS
You also save by using free-standing facilities in the network.
These are medical facilities in the network that are not connected to hospitals or another medical facility, so they usually charge less.
They may include radiology centers, surgery centers, and more.
Where you go for care can make a big difference in cost. You’ll pay a lower [co-pay] [and] [co-insurance] when you use Tier 1 hospitals.
Tier 1 hospitals can charge less for the same services compared to other hospitals. Tier 1 hospitals are any hospitals that aren’t labeled Tier 2.
Pay less using our Tier 1 hospitals.
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Catalyst® Plan: Pre-deductible Allowance – two payments
BENEFITS
Choice Plus Direct Plan, cont’dCO-PAYMENT* TIER 1 HOSPITAL IN THE NETWORK OUT OF NETWORK
PCP <$XX> <$XX> <$XX>
Specialist <$XX> <$XX> <$XX>
DEDUCTIBLE*
[Self <$XXXX> <$XXXX> <$XXXX>
[Family <$XXXX> <$XXXX> <$XXXX>
CO-INSURANCE* <XX%> <XX%> <XX%>
OUT-OF-POCKET LIMIT
[Self <$XXXX> <$XXXX> <$XXXX>
[Family <$XXXX> <$XXXX> <$XXXX>
Paying for care
*Preventive care is covered 100 percent so you won’t need to worry about these costs and payments.
Lowest cost option Highest cost option
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Navigate® Advanced Plan
BENEFITS
This is plan that requires you to select a PCP. Your PCP will guide you through the health care system so you can get the right care at the right time.
•Pay less by using Tier 1 providers. They have been recognized for providing value.
•You need to select your personal PCP from the network. Each enrolled person must select a PCP.
•Save money by staying in our network. If you don’t use the network, you’ll have to pay for all of the costs.
•You need to get online referrals from your PCP to see a network specialist. If you see a network specialist without a referral, you will be responsible for the full cost of the service.
•Preventive care is covered 100% in our network.
For COVERAGE DETAILS, see your official health plan documents.
Your PCP will help you get the right care and save.
Find your PCP at welcometouhc.com/navigateadvanced
If you go out-of-network or see a specialist without a referrals, you will not be covered. You will have to pay the full cost of services. For COVERAGE DETAILS, see your official health plan documents.
NAVIGATE ADVANCED
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Your PCP:
Must be located in a town or city near where you (the subscriber) lives
Must be a general practice, family practice, pediatrician or internal medicine physician
Can be selected for the entire family or each covered dependent can select their own
When you sign up, have this information ready.
First name, last name and address
Physician ID number (you will find this number when you do a PCP search online)
Choosing your PCP
How can a PCP help you? Your PCP will get to know you and your health history.
They can help you prevent and catch health issues before they become more serious.
If you need special care, they can refer you to the right specialist.
One PCP can be selected for the entire family or each covered person can select their own. If you don’t select a PCP when you enroll, one will be assigned for you.
Find your PCP at welcometouhc.com/navigateadvanced
NAVIGATE ADVANCED
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Pay less using our Tier 1 providers.
Look for Premium Tier 1 network care first.
It’s easy for you to find Premium Tier 1 physicians. These providers have been recognized for providing value. Look for the Tier 1 symbol when doing a search.
Where you go for care can make a big difference in cost. You’ll pay a lower [co-pay] [and] [co-insurance] when you use these Tier 1 providers.
UnitedHealth Premium® Tier 1 providers have been recognized for providing value.
[Tier 1 hospitals can charge less for the same services compared to other hospitals. Tier 1 hospitals are any hospitals that aren’t labeled Tier 2.]
Free-standing facilities and centers are medical facilities in the network that are not connected to hospitals or another medical facility. They usually charge less. They may include radiology centers, surgery centers, and more.
NAVIGATE ADVANCED
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
You don’t need a referral for everything.Online referrals are required to see most specialists. But you may not need to receive one to see the following providers as long as they are in the network:
Obstetricians/gynecologists (OB/GYNs)
Behavioral health or substance use disorder clinicians
Convenience care clinics
Urgent care clinics
Emergency care at an emergency room
Your PCP must submit all referrals online.
A paper referral will not be considered a valid referral. You can check all of your referrals online at myuhc.com.
For a COMPLETE LIST of providers and services that need referrals, see your plan documents.
• This ends Chapter 3- Tiered Medical Plans• Please open Chapter 4- CDH Plans• Copy and paste slides from Chapter 4 to
your Master1. Click on the first slide and then press shift
while you click on the last slide2. Right click on the first slide and select copy3. Go to your Master (Chapter 1)4. Click below the thumbnail of the last slide in
that section5. Right click there and select Copy—Use
Source Formatting
• Delete any slides from Chapter 4 that do not apply to your customer’s needs
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.18
Delete this slide before distribution
Delete this slide before distribution