A plan designed to work for you.

Transcription

1 YOUR ADVANTAGE: A plan designed to work for you Benefit Plan NMRHCA

2 Plan Benefits and Features Group Medicare Advantage PPO Plans

3 Your Medicare Advantage plan The advantages of a single plan. Medicare Advantage (Part C) plans are provided through private insurers, like UnitedHealthcare. They include Part A and Part B coverage and often Part D all in one plan. Medicare Advantage plans also generally offer additional benefits beyond doctor and hospital visits. One ID card for all services All the benefits of Part A Hospital stays Skilled nursing Home health All the benefits of Part B Doctor s visits Outpatient care Screenings and shots Lab tests Prescription drug coverage Included in many Medicare Advantage plans Additional benefits, programs and features May be bundled with the plan 3

4 Your PPO Providers This plan lets you see doctors, specialists and hospitals in or out of our network for the same cost share as long the provider accepts Medicare and the plan. Even though you are not required to see a network doctor, your doctor may already be part of our network. To find out, consult our online Provider Directory at If your doctor is in the network, he or she must accept this plan if you are a current patient. If your doctor is not in our network, he or she may choose not to treat you unless it is an emergency. If you need help finding a doctor, we're here to help. Just call us. 4

5 UnitedHealthcare Group Medicare Advantage PPO plans Benefit Coverage Plan I $2,500 Out of Pocket Maximum Plan II $2,800 Out of Pocket Maximum Primary care provider (PCP) office visit Specialist office visit Urgently needed care Inpatient hospitalization Outpatient surgery $5.00 copay in or out-of-network $25.00 copay $20.00 copay $250 copay per admit In our out-of-network $100 copay $5.00 copay in or out-of-network $25.00 copay $20.00 copay $250 copay per admit In our out-of-network $100 copay 5

6 Additional Benefits Benefit Coverage Plan I Plan II Acupuncture Chiropractic Care Routine Foot Care Routine Hearing Exam Hearing Aids $15.00 copay/ 20 visits in or out-of-network $20.00 copay/ 36 visits $25.00 copay/ 6 visits $0 copay In our out-of-network Plan pays up to $500 every 3 years $15.00 copay/ 20 visits in or out-of-network $20.00 copay/ 36 visits $25.00 copay/ 6 visits $0 copay In our out-of-network Plan pays up to $500 every 3 years 6

7 Your Part D Prescription Drug plan (PDP) Plan I Tier Prescription Drug Type Your Costs Full Coverage in the Gap Retail (30-day supply) Preferred Mail Order (90-day supply) Tier 1 Tier 2 Tier 3 Tier 4 Generic and some Brands Preferred Brands and some generics Non-Preferred Brands and some generics Specialty Drugs and some generics $15 copay $30 copay $35 copay $70 copay $70 copay $140 copay $70 copay $140 copay 7

8 Your Part D Prescription Drug plan (PDP) Plan li Tier Prescription Drug Type Your Costs In the coverage gap ($3,820) you pay 25% of brand name drugs and 37% of the price for generic drugs. $5100 Out of Pocket Max Retail (30-day supply) Preferred Mail Order (90-day supply) Tier 1 Tier 2 Tier 3 Tier 4 Generic and some Brands Preferred Brands and some generics Non-Preferred Brands and some generics Specialty Drugs and some generics $10 copay $20 copay $20 copay $40 copay $35 copay $70 copay $35 copay $70 copay 8

9 Virtual Visits $0 Copay Virtual Doctor Visits With Virtual Doctor Visits, you re able to live video chat with a doctor from your computer, tablet or smartphone anytime, day or night. You can ask questions, get a diagnosis, or even get medication prescribed * and have it sent to your pharmacy. All you need is a strong internet connection. Virtual Doctor Visits are good for minor health concerns like: Allergies, bronchitis, cold/cough Fever, seasonal flu, sore throat Migraines/headaches, sinus problems, stomach ache You can find a list of participating Virtual Doctor Visit providers by logging into your member website. Virtual Behavioral Health Visits Talk to a behavioral health specialist anytime using live video chat using your computer, tablet or smartphone anytime, day or night. Virtual Behavioral Health Visits may be best for: Initial evaluation Medication management Addiction Depression Trauma and loss Stress or anxiety You can find a list of participating Virtual Behavioral Visit providers by logging into your member website. * Doctors can t prescribe medications in all states. 9

10 Fitness Program SilverSneakers gives you access to: Trained instructors for support Classes designed for all fitness levels and abilities Exercise equipment and other amenities at 14,000+ participating locations* On-demand workout videos plus health and nutrition tips Group fitness outside traditional gyms *At-home kits are offered for members who want to start working out at home or for those who can t get to a fitness location due to injury, illness or being homebound. 10

11 Learning Courses Renew Magazine Rewards Health Topic Library Photo Gallery Every day is an opportunity to Renew. We all want to live a healthier, happier life and Renew by UnitedHealthcare can be your guide. With Renew, our member-only Health & Wellness Experience, you ll have access to inspiring lifestyle tips, learning activities, videos, recipes, interactive health tools, rewards and more all designed to help you live your best life at no additional cost to you. To learn more about Renew by UnitedHealthcare, sign in to your plan website and go to Health & Wellness. Interactive Quizzes & Tools Brain Games Health News, Articles & Videos Streaming Music Coloring Pages Recipe Library 11

12 Solutions for Caregivers * Extra support for those who take care of others Get helpful advice and decision-making support from a professional care manager. Have a registered nurse perform an in-person health overview of the person you are caring for. Work together to create a custom plan that may address both your needs and the needs of the person you are caring for. Get help to find and arrange community-based programs and services for your specific needs. Access educational resources, discounted products and services online. *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. 12

13 UHCRetiree.com After you get your member ID card, you can use it to register online at UHCRetiree.com. After you register, you can: Find providers or pharmacies in your area View plan documents Review your Drug List (Formulary) Sign up to go paperless Print a temporary ID card Learn about health and wellness topics and sign up for healthy challenges based on your interests and goals 13

14 Thank You We look forward to welcoming you to our Medicare family.