Plan Guide Hawaii. Plans Effective July 1, 2010 For businesses with up to 50 employees

Transcription

1 Plan Guide Hawaii Plans Effective July 1, 2010 For businesses with up to 50 employees

2 Why choose UnitedHealthcare? Better information alerts individuals and their doctors of health risks or opportunities to take action and lets employers track results. Better decisions are possible because we can give individuals, doctors and employers the insights they need to make better informed choices. Better health is our shared goal: to help individuals live healthier lives and organizations be more productive. Health plans should be about more than just benefit coverage. It s about being there when you and your employees need us and providing the service that you expect and need. Here are just some of the reasons to choose UnitedHealthcare. 1 A lot of doctors and hospitals We offer one of the largest national physician and hospital networks available with more than 632,000 physicians and 5,060 hospitals. 2 No referrals; see the specialist you want With most of our plans, we don t require referrals to see a specialist, and your employees don t have to choose a primary care doctor. 3 24/7 support Your employees coverage includes a variety of support tools to help them get answers to their health care questions, such as our Care 24 program, which puts employees in touch with a registered nurse. 4 Help finding the right doctor Not all health care and doctors are the same. Our member websites and Customer Care services help your employees find the doctors who are right for them. 5 Wellness programs We provide a wide range of wellness programs and services to help your employees get healthy and stay healthy, including an online personal health assessment, member discounts, online health coach and weight loss programs. 6 Dedicated customer service Highly trained customer care professionals are a phone call away and will assist your employees when they need them. 7 Centers of Excellence network If your employees have a serious illness, they will have access to national leading health care facilities and health care providers. 8 Personal member support We provide personal support services for your employees, such as Care Coordination, Healthy Pregnancy Program, Employee Assistance and Behavior Health benefits. 9 Benefit administration Simplify your benefits administration with Employer eservices, your online, real-time resource to help you quickly manage eligibility, billing, reporting, online enrollment and more at employereservices.com. 10 Understanding health care We created Health Care Lane, healthcarelane.com, to help your employees better understand health care terms and products, as well as all the tools we make available to help people manage their, and their family s, care and well-being. 11 Member experience To help your employees manage their health care, we provide myuhc.com, DocGPS, Quicken Health Expense Tracker SM, Treatment Cost Estimator and a Personal Health Record. * myuhc.com is the award-winning member website available with most UnitedHealthcare benefit plans. Some plans will require use of another member website, but will often include many of the same capabilities.

3 Useful terms and symbols Coinsurance: The money you have to pay for health services after you have paid the deductible Copayments: The fee paid for a doctor visit, hospital stay or other service Deductible: The amount of money you pay before your insurance starts to pay Eligible expense: A service or product recognized by the IRS that is purchased to help treat a medical condition or prevent a disease Employee contribution: The money an employee pays to be covered by a health plan; also called premium Flexible Spending Account (FSA): An employersponsored account in which pre-tax funds are set aside from an employee s paycheck each year. FSA funds can be used for eligible medical expenses, dependent care or commuter expenses, as determined by the IRS Health Maintenance Organization (HMO): A kind of health insurance plan that usually requires members to receive services through doctors, labs, and hospitals that contract or work with the HMO and laboratories that have contracts with an insurance company; also called in-network provider and participating network provider Non-network provider: Doctors, hospitals, and other health care professionals who do not participate in our network and may provide services at a higher cost Out-of-pocket maximum: The most you have to pay for health services; once paid, the insurance company pays 100 percent of eligible health care costs Point-of-service (POS): A health benefit plan that allows the covered person to choose to receive service from a participating or non-participating physician or other health care provider, with different benefit levels associated with the use of participating physicians or other health care providers Preferred Provider Organization (PPO): An organization where providers are under contract to provide care at a discounted or negotiated rate Health Reimbursement Account (HRA): Health care accounts that employers fund for covered workers or retired persons; IRS does not tax this money; also called Health Reimbursement Arrangements Health Savings Account (HSA): Health care bank accounts that let people put money aside tax free to pay for medical, dental and vision costs; IRS limits who can open and put money into HSA; money in HSA stays in the account until it is used Network provider: All the doctors, hospitals, nursing homes Important facts and information Call for service Visit the Web address Term definitions provided from the Just Plain Clear Glossary, a service of the UnitedHealth Group Health Literacy Council, February 2010.

4 Health Plans Options PPO Plan Pharmacy benefits are paid separately and do not apply to the annual deductible or out-ofpocket maximum. No referrals Nonnetwork coverage No primary doctor required Pharmacy Vision Spending account This is a traditional health plan with copayments, coinsurance and deductibles. Your employees have the freedom to see any doctor and visit any facility in our nationwide network, including specialists, without a referral and without choosing a primary care doctor. They can choose services outside our network, but payments will be higher. Here are some of the highlights: National network and non-network coverage Cost savings by going to a network doctor or facility No referrals required to see a network specialist Preventive care covered up to 100 percent when they see a network doctor Pharmacy benefits included Vision exam included, plus discounts on frames, glasses and lenses Member responsible for prior authorization or notification of some services (e.g., hospital stay) if using a network or non-network doctor Here s how the plan works. See benefit grid for details. 1 health Your employees will pay a copayment, coinsurance and/or deductible for eligible care services. 2 network It is the employee s responsibility to obtain approvals for both network and nonservices. 3 The plan will cover preventive care up to 100 percent when they see a network doctor. For more information, visit uhc.com or call Your employees are protected from major expenses with an out-of-pocket maximum. If their medical expenses reach the maximum, they are covered 100 percent for eligible services for the rest of the plan year (subject to plan limitations). Some plans may not be available in all counties in the state. See the product tables in this document for product availability by state/county.

5 YOUR BENEFITS UnitedHealthcare Options PPO Plan S02 Options PPO plan gives you the freedom to see any Physician or other health care professional from our Network, including specialists, without a referral. With this plan, you will receive the highest level of benefits when you seek care from a network physician, facility or other health care professional. In addition, you do not have to worry about any claim forms or bills. You also may choose to seek care outside the Network, without a referral. However, you should know that care received from a nonnetwork physician, facility or other health care professional means a higher deductible and Copayment. In addition, if you choose to seek care outside the Network, UnitedHealthcare only pays a portion of those charges and it is your responsibility to pay the remainder. This amount you are required to pay, which could be significant, does not apply to the Out-of-Pocket Maximum. We recommend that you ask the non-network physician or health care professional about their billed charges before you receive care. Some of the Important Benefits of Your Plan: You have access to a Network of physicians, facilities and other health care professionals, including specialists, without designating a Primary Physician or obtaining a referral. Benefits are available for office visits and hospital care, as well as inpatient and outpatient surgery. Care Coordination SM services are available to help identify and prevent delays in care for those who might need specialized help. Emergencies are covered anywhere in the world. Pap smears are covered. Prenatal care is covered. Routine check-ups are covered. Childhood immunizations are covered. Mammograms are covered. Vision and hearing screenings are covered. HILJMS0202

6 Options PPO Benefits Summary Types of Coverage Network Benefits / Copayment Amounts Non-Network Benefits / Copayment Amounts This Benefit Summary is intended only to highlight your Benefits and should not be relied upon to fully determine coverage. This benefit plan may not cover all of your health care expenses. More complete descriptions of Benefits and the terms under which they are provided are contained in the Certificate of Coverage that you will receive upon enrolling in the Plan. If this Benefit Summary conflicts in any way with the Policy issued to your employer, the Policy shall prevail. Terms that are capitalized in the Benefit Summary are defined in the Certificate of Coverage. Where Benefits are subject to day, visit and/or dollar limits, such limits apply to the combined use of Benefits whether in-network or out-of-network, except where mandated by state law. Network Benefits are payable for Covered Health Services provided by or under the direction of your Network physician. *Prior Notification is required for certain services. Combined Network and Non-Network Annual Deductible: $100 per Covered Person per calendar year, not to exceed $300 for all Covered Persons in a family. Combined Network and Non-Network Out-of- Pocket Maximum: $2,500 per Covered Person per calendar year, not to exceed $7,500 for all Covered Persons in a family.the Out-of-Pocket Maximum does include the Annual Deductible. Combined Network and Non-Network Maximum Policy Benefit: $2,000,000 per Covered Person. Combined Network and Non-Network Annual Deductible: $100 per Covered Person per calendar year, not to exceed $300 for all Covered Persons in a family. Combined Network and Non-Network Out-of- Pocket Maximum: $2,500 per Covered Person per calendar year, not to exceed $7,500 for all Covered Persons in a family.the Out-of-Pocket Maximum does include the Annual Deductible. Combined Network and Non-Network Maximum Policy Benefit: $2,000,000 per Covered Person. 1. Ambulance Services - Emergency only Ground Transportation: 10% of Eligible Expenses Air Transportation: 10% of Eligible Expenses 2. Dental Services - Accident only *10% of Eligible Expenses *Prior notification is required before follow-up treatment begins. 3. Durable Medical Equipment *10% of Eligible Expenses *Prior notification is required when the cost is more than $1, Emergency Health Services 10% of Eligible Expenses *Notification is required if results in an Inpatient Stay. Same as Network Benefit *Same as Network Benefit *Prior notification is required before follow-up treatment begins. *30% of Eligible Expenses *Prior notification is required when the cost is more than $1,000. Same as Network Benefit *Notification is required if results in an Inpatient Stay. 5. Eye Examinations Refractive eye examinations are limited to one every other calendar year from a Network Provider. Eye Examinations for refractive errors are not covered. 6. Home Health Care Network and Non-Network Benefits are limited to 150 visits for skilled care services per calendar year. 7. Hospice Care Network and Non-Network Benefits are limited to 360 days during the entire period of time a Covered Person is covered under the Policy. *No Copayment *No Copayment *30% of Eligible Expenses *30% of Eligible Expenses 8. Hospital - Inpatient Stay *10% of Eligible Expenses *30% of Eligible Expenses 9. Injections Received in a Physician's Office 10% per injection 30% per injection 10. Maternity Services Same as 8, 11, 12 and 13 *Notification is required if Inpatient Stay exceeds 48 hours following a normal vaginal delivery or 96 hours following a cesarean section delivery. Same as 8, 11, 12 and 13 *Notification is required if Inpatient Stay exceeds 48 hours following a normal vaginal delivery or 96 hours following a cesarean section delivery. 11. Outpatient Surgery, Diagnostic and Therapeutic Services Outpatient Surgery Outpatient Diagnostic Services For lab and radiology/xray: 10% of Eligible Expenses For mammography testing: 10% of Eligible Expenses No Benefits for preventive care, except for mammography testing. 30% of Eligible Expenses Outpatient Diagnostic/Therapeutic Services - CT Scans, Pet Scans, MRI and Nuclear Medicine Outpatient Therapeutic Treatments 12. Physician's Office Services 10% of Eligible Expenses. No Copayment applies for immunizations for children through age 5. 30% of Eligible Expenses. No Benefits for preventive care, except for Child Health Supervision Services. No Copayment applies for immunizations for children through age Professional Fees for Surgical and Medical Services 14. Prosthetic Devices

7 YOUR BENEFITS Types of Coverage Network Benefits / Copayment Amounts Non-Network Benefits / Copayment Amounts 15. Reconstructive Procedures *Same as 8, 11, 12, 13 and 14 *Same as 8, 11, 12, 13 and Rehabilitation Services - Outpatient Therapy Network and Non-Network Benefits are limited as follows: 60 visits of physical therapy; 60 visits of occupational therapy; 60 visits of speech therapy; 20 visits of pulmonary rehabilitation; and 36 visits of cardiac rehabilitation per calendar year. 17. Skilled Nursing Facility/Inpatient Rehabilitation Facility Services Network and Non-Network Benefits are limited to 120 days per calendar year. *10% of Eligible Expenses *30% of Eligible Expenses 18. Transplantation Services *10% of Eligible Expenses *30% of Eligible Expenses Benefits are limited to $30,000 per transplant. 19. Urgent Care Center Services Additional Benefits Blood and Blood Products Coverage for blood and blood products including blood costs, blood bank services and blood processing. Contraceptive Services and Supplies Same as Other Covered Health Services 10% of Eligible Expenses for Contraceptive supplies $5 Copayment for oral contraceptives $10 Copayment for diaphragms/cervical caps Same as Other Covered Health Services 30% of Eligible Expenses for Contraceptive supplies $8 Copayment for oral contraceptives $12 Copayment for diaphragms/cervical caps Diabetes Treatment 10% of Eligible Expenses *30% of Eligible Expenses *Prior notification is required when the cost is more than $1,000. Infertility Services Same as 11, 12 and 13 Same as 11, 12 and 13 Medical Foods Coverage is provided for Medical Foods and Lowprotein Modified Food Products prescribed for treatment of Inborn Error of Metabolism. Mental Health and Substance Abuse Services - Outpatient Must receive prior authorization through the Mental Health/Substance Abuse Designee. Any combination of Network and Non-Network Benefits for Mental Health Services and Substance Abuse Services is limited to 24 visits per calendar year. Twelve visits are available for treatment of either Mental Illness or Substance Abuse; the additional 12 visits are reserved for treatment of Mental Illness. Mental Health and Substance Abuse Services - Inpatient and Intermediate Must receive prior authorization through the Mental Health/Substance Abuse Designee. Any combination of Network and Non-Network Benefits for Mental Health Services and Substance Abuse Services is limited to 30 days per calendar year. Detoxification services are not included in this limitation. Mental Health Services - Serious Mental Illness Same 8, 12 and 13 Same as 8, 12 and 13 Spinal Treatment Benefits include diagnosis and related services and are limited to one visit and treatment per day. Network and Non-Network Benefits are limited to 24 visits per calendar year. Telehealth Services Same as Other Covered Health Services Same as Other Covered Health Services

8 Exclusions Except as may be specifically provided in Section 1 of the Certificate of Coverage (COC) or through a Rider to the Policy, the following are not covered: A. Alternative Treatments Acupressure; hypnotism; rolfing; massage therapy; aromatherapy; acupuncture; and other forms of alternative treatment. B. Comfort or Convenience Personal comfort or convenience items or services such as television; telephone; barber or beauty service; guest service; supplies, equipment and similar incidental services and supplies for personal comfort including air conditioners, air purifiers and filters, batteries and battery chargers, dehumidifiers and humidifiers; devices or computers to assist in communication and speech. C. Dental Except as specifically described as covered in Section 1 of the COC for services to repair a sound natural tooth that has documented accident-related damage, dental services are excluded. There is no coverage for services provided for the prevention, diagnosis, and treatment of the teeth, jawbones or gums (including extraction, restoration, and replacement of teeth, medical or surgical treatments of dental conditions, and services to improve dental clinical outcomes). Dental implants and dental braces are excluded. Dental x-rays, supplies and appliances and all associated expenses arising out of such dental services (including hospitalizations and anesthesia) are excluded, except as might otherwise be required for transplant preparation, initiation of immunosuppressives, or the direct treatment of acute traumatic Injury, cancer, or cleft palate. Treatment for congenitally missing, malpositioned, or super numerary teeth is excluded, even if part of a Congenital Anomaly. D. Drugs Prescription drug products for outpatient use that are filled by a prescription order or refill, except as required by law for contraceptives and diabetes supplies in (Section 1: What s Covered - Benefits) if this policy does not have a Prescription Drug Rider. Self-injectiable medications except as required by law for insulin in (Section 1: What s Covered - Benefits) if this Policy does not have a Prescription Drug Rider. This exclusion does not include growth hormone therapy when determined to be medically necessary. Coverage will be provided at the same level as any other Covered Health Service. Non-injectable medications given in a Physicians office except as required in an Emergency. Over the counter drugs and treatments except as required by law for diabetes supplies listed in (Section 1: What s Covered - Benefits) if this Policy does not have a Prescription Drug Rider. E. Experimental, Investigational or Unproven Services Experimental, Investigational or Unproven Services are excluded. The fact that an Experimental, Investigational or Unproven Service, treatment, device or pharmacological regimen is the only available treatment for a particular condition will not result in Benefits if the procedure is considered to be Experimental, Investigational or Unproven in the treatment of that particular condition. F. Foot Care Routine foot care (including the cutting or removal of corns and calluses); nail trimming, cutting, or debriding; hygienic and preventive maintenance foot care; treatment of flat feet or subluxation of the foot; shoe orthotics. G. Medical Supplies and Appliances Devices used specifically as safety items or to affect performance primarily in sports-related activities. Prescribed or non-prescribed medical supplies and disposable supplies including but not limited to elastic stockings, ace bandages, gauze and dressings, ostomy supplies, syringes and diabetic test strips. Orthotic appliances that straighten or re-shape a body part (including cranial banding and some types of braces). Tubings and masks are not covered except when used with Durable Medical Equipment as described in Section 1 of the COC. H. Mental Health/Substance Abuse Services performed in connection with conditions not classified in the current edition of the Diagnostic and Statistical Manual of the American Psychiatric Association. Services that extend beyond the period necessary for short-term evaluation, diagnosis, treatment, or crisis intervention. Mental Health treatment of insomnia and other sleep disorders, neurological disorders, and other disorders with a known physical basis. Treatment of conduct and impulse control disorders, personality disorders, paraphilias and other Mental Illnesses that will not substantially improve beyond the current level of functioning, or that are not subject to favorable modification or management according to prevailing national standards of clinical practice, as reasonably determined by the Mental Health/Substance Abuse Designee. Services utilizing methadone treatment as maintenance, L.A.A.M. (1-Alpha-Acetyl-Methadol), Cyclazocine, or their equivalents. Treatment provided in connection with or to comply with involuntary commitments, police detentions and other similar arrangements, unless authorized by the Mental Health/Substance Abuse Designee. Residential treatment services. Services or supplies that in the reasonable judgment of the Mental Health/Substance Abuse Designee are not, for example, consistent with certain national standards or professional research further described in Section 2 of the COC. I. Nutrition Megavitamin and nutrition based therapy. Nutritional counseling for either individuals or groups, except for treatment of diabetes. Enteral feedings and other nutritional and electrolyte supplements, including infant formula and donor breast milk except for Medical Foods described in (Section 1: What s Covered - Benefits). J. Physical Appearance Cosmetic Procedures including, but not limited to, pharmacological regimens; nutritional procedures or treatments; salabrasion, chemosurgery and other such skin abrasion procedures associated with the UnitedHealthcare Insurance Company removal of scars, tattoos, and/or which are performed as a treatment for acne. Replacement of an existing breast implant is excluded if the earlier breast implant was a Cosmetic Procedure. (Replacement of an existing breast implant is considered reconstructive if the initial breast implant followed mastectomy.) Physical conditioning programs such as athletic training, bodybuilding, exercise, fitness, flexibility, and diversion or general motivation. Weight loss programs for medical and non-medical reasons. Wigs, regardless of the reason for the hair loss. K. Providers Services performed by a provider who is a family member by birth or marriage, including spouse, parent or child. This includes any service the provider may perform on himself or herself. Services performed by a provider with your same legal residence. L. Reproduction Health services and associated expenses for infertility treatments, except for in vitro fertilization as provided in (Section 1: What s Covered - Benefits). Surrogate parenting. The reversal of voluntary sterilization. This exclusion does not apply to Benefits for elective abortions, vasectomies and tubal ligations. Coverage for these services will be provided at the level as any other Covered Health Services. M. Services Provided under Another Plan Health services for which other coverage is required by federal, state or local law to be purchased or provided through other arrangements, including but not limited to coverage required by workers compensation, no-fault automobile insurance, or similar legislation. If coverage under workers compensation or similar legislation is optional because you could elect it, or could have it elected for you, Benefits will not be paid for any Injury, Mental Illness or Sickness that would have been covered under workers compensation or similar legislation had that coverage been elected. Health services for treatment of military service-related disabilities, when you are legally entitled to other coverage and facilities are reasonably available to you. Health services while on active military duty. N. Transplants Health services for organ or tissue transplants are excluded, except those specified as covered in Section 1 of the COC. Any solid organ transplant that is performed as a treatment for cancer. Health services connected with the removal of an organ or tissue from you for purposes of a transplant to another person. Health services for transplants involving mechanical or animal organs. Any multiple organ transplant not listed as a Covered Health Service in Section 1 of the COC. O. Travel Health services provided in a foreign country, unless required as Emergency Health Services. Travel or transportation expenses, even though prescribed by a Physician. Some travel expenses related to covered transplantation services may be reimbursed at our discretion. P. Vision and Hearing Purchase cost of eye glasses, contact lenses, or hearing aids. Fitting charge for hearing aids, eye glasses or contact lenses. Eye exercise therapy. Surgery that is intended to allow you to see better without glasses or other vision correction including radial keratotomy, laser, and other refractive eye surgery. Q. Other Exclusions Health services and supplies that do not meet the definition of a Covered Health Service - see definition in Section 10 of the COC. Physical, psychiatric or psychological examinations, testing, vaccinations, immunizations or treatments otherwise covered under the Policy, when such services are: (1) required solely for purposes of career, education, sports or camp, travel, employment, insurance, marriage or adoption; (2) relating to judicial or administrative proceedings or orders; (3) conducted for purposes of medical research; or (4) to obtain or maintain a license of any type. Health services received as a result of war or any act of war, whether declared or undeclared or caused during service in the armed forces of any country. Health services received after the date your coverage under the Policy ends, including health services for medical conditions arising prior to the date your coverage under the Policy ends. Health services for which you have no legal responsibility to pay, or for which a charge would not ordinarily be made in the absence of coverage under the Policy. In the event that a Non-Network provider waives Copayments and/or the Annual Deductible for a particular health service, no Benefits are provided for the health service for which Copayments and/or the Annual Deductible are waived. Charges in excess of Eligible Expenses or in excess of any specified limitation. Services for the evaluation and treatment of temporomandibular joint syndrome (TMJ), whether the services are considered to be medical or dental in nature. Upper and lower jaw bone surgery except as required for direct treatment of acute traumatic Injury or cancer. Orthognathic surgery, jaw alignment, and treatment for the temporomandibular joint, except as a treatment of obstructive sleep apnea. Surgical treatment and non-surgical treatment of obesity (including morbid obesity). Growth hormone therapy; sex transformation operations; treatment of benign gynecomastia (abnormal breast enlargement in males); medical and surgical treatment of excessive sweating (hyperhidrosis); medical and surgical treatment for snoring, except when provided as part of treatment for documented obstructive sleep apnea. Oral appliances for snoring. Custodial care; domiciliary care; private duty nursing; respite care; rest cures. Psychosurgery. Speech therapy except as required for treatment of a speech impediment or speech dysfunction that results from Injury, stroke or Congenital Anomaly. This summary of Benefits is intended only to highlight your Benefits and should not be relied upon to fully determine coverage. This plan may not cover all your health care expenses. Please refer to the Certificate of Coverage for a complete listing of services, limitations, exclusions and a description of all the terms and conditions of coverage. If this description conflicts in any way with the Certificate of Coverage, the Certificate of Coverage prevails. Terms that are capitalized in the Benefit Summary are defined in the Certificate of Coverage. 02I_BS_PPO HILJMS0202 EBA _1105_rev01

9 Pharmacy benefit About our pharmacy benefit All products come with our easy-to-use pharmacy benefit. This includes: 64,000 network retail pharmacies that are available to you across the country Mail-order services that can give your employees up to a 90-day supply of their medication(s), often at a lower price than retail. And it s delivered to their home with free shipping. Your employees can use our member website to: Look up pharmacy benefit information Find network pharmacies Price medications and learn about lower cost options Refill prescriptions Review their prescription history For more information about pharmacy benefits, visit uhc.com or contact your broker or UnitedHealthcare representative at Understanding common pharmacy terms What is a Prescription Drug List? A prescription drug list (PDL) is a list of medications, products or devices that have been approved for your safety by the U.S. Food and Drug Administration. These medications and products are then placed into tiers. Since the PDL may change, we encourage your employees to visit myuhc.com or call the number on the back of their ID card for the most current information. What do the tiers mean? Medications listed in the PDL are placed into tiers. Each tier is given a copayment amount. Medications in tier 1 will have the lowest copayment. Not all drugs listed on the PDL are covered by all plans. Please check your official benefit plan information to find out what is covered under your plan. Some plans may require your employees to pay the entire cost of the medication until the plan deductible has been met. Tier 1 Lowest copayment Tier 2 Tier 3 Highest copayment Some pharmacy benefits may not be available in all counties in the state. See the product tables in this document for product availability by state/county.

10 Dental, Vision, Life and Disability Plans Provided by UnitedHealthcare Specialty Benefits We provide onestop shopping for all your medical and specialty plan needs. We insure more than 75,000 employers for dental, vision and disability. We have 6 million members for dental and 22 million members for vision. We have more than 121,000 dentist access points and 30,000 contracted vision providers. Benefits needs don t stop with just a health plan. But you don t want to get bogged down negotiating with multiple vendors or paying too much. With UnitedHealthcare, you have: Simplified administration from one carrier and one account team Plan designs that fit your needs Packaged Savings programs for extra savings Employer eservices (EmployereServices. com) for maximum freedom, flexibility Dental Regular dental care is now recognized as an important part of a total health and well-being program. Just ask the Surgeon General. We offer dental plans designed to deliver flexibility, convenience and choices at an affordable price. Vision Routine vision exams are important they may help with early detection of other medical problems. Now you can provide vision benefits that offer convenience and cost savings. Our plans include an eye exam once every 12 months, and lenses and frames once every 12 or 24 months. Contact lenses may be selected instead of spectacle lenses and frames once every 12 or 24 months. Life and disability Life We offer fully integrated life and disability insurance policies for you and your employees. Our plans are available on a stand-alone basis, or packaged with our health plans. Disability We offer group disability benefits, including short-term disability, long-term disability and voluntary disability. Optional enhancements, such as cost-of-living adjustment and catastrophic disability riders, are also available for certain group sizes. Packaged Savings The Packaged Savings program offers administrative credits to groups purchasing eligible specialty coverages with their health plan. The more coverages you bundle, the more you will save on your packaged price. For more information, visit uhc.com or or contact your broker or UnitedHealthcare representative at Some plans may not be available in all counties in the state. See the product tables in this document for product availability by state/county.

11 Flexible spending accounts Flexible spending accounts Today, flexible spending accounts (FSAs) are easier for employees to use, and they are enjoying red-carpet treatment in advertising and other promotions by grocery, drug and department stores required to identify FSA-eligible expenses at the cash register. In addition, FSA programs help pay for themselves because in many cases, the tax savings can recover all or some of the costs of administration. And, employees save because when they enroll and contribute to an FSA, it lowers their taxable income. We offer the following FSA products: Health care FSA copayments and deductibles, prescriptions, orthodontia and other dental work, vision exams, eyeglasses, contact lenses and more Dependent care FSA day care and similar expenses for children and adult dependents who are incapable of caring for themselves Commuter expense reimbursement account (CERA) mass transit, van pooling and parking expenses (administered through WageWorks) Limited-purpose FSA dental and vision only, for individuals who enroll in an HSA-eligible health plan Example of FSA tax savings An employee elects to have $100 withheld from every biweekly paycheck and deposited into his FSA. Employee saves Employer saves Federal income tax 25% $25.00 $0.00 State income tax 5% $5.00 $0.00 FICA 7.65% $7.65 $7.65 Tax savings every paycheck $37.65 $7.65 Total tax savings annually (26 pay periods) $ $ Hypothetical example for illustrative purposes only. Please consult a benefits and tax expert for your particular business situation. For more information, visit uhc.com or or contact your broker or UnitedHealthcare representative at Some plans may not be available in all counties in the state. See the product tables in this document for product availability by state/county.

12 Visit us at or contact your broker or UnitedHealthcare representative at Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates, and UnitedHealthcare Insurance Company of Ohio, UnitedHealthcare Insurance Company of Illinois, UnitedHealthcare Insurance Company of New York, UnitedHealthcare Insurance Company of the River Valley, Oxford Health Insurance, Inc., PacifiCare Life and Health Insurance Company or their affiliates. Health Plan coverage provided by or through UnitedHealthcare of Alabama, Inc., UnitedHealthcare of Arizona, Inc., UnitedHealthcare of Arkansas, Inc., UnitedHealthcare of Colorado, Inc., UnitedHealthcare of Florida, Inc., UnitedHealthcare of Georgia, Inc., UnitedHealthcare of Illinois, Inc., UnitedHealthcare of Kentucky, Ltd., United HealthCare of Louisiana, Inc., UnitedHealthcare of the Mid-Atlantic, Inc., UnitedHealthcare of the Midlands, Inc., UnitedHealthcare of the Midwest, Inc., United HealthCare of Mississippi, Inc., UnitedHealthcare of New England, Inc., UnitedHealthcare of North Carolina, Inc., UnitedHealthcare of Ohio, Inc., UnitedHealthcare of Tennessee, Inc., UnitedHealthcare of Texas, Inc., UnitedHealthcare of Utah, Inc., UnitedHealthcare of Wisconsin, Inc., UnitedHealthcare Plan of the River Valley, Inc., Neighborhood Health Partnership, Inc., Oxford Health Plans, Inc., Oxford Health Plans, Inc., Oxford Health Plans, Inc., PacifiCare of Arizona, Inc., PacifiCare of California, PacifiCare of Colorado, Inc., PacifiCare of Nevada, Inc.,PacifiCare of Oklahoma, Inc., PacifiCare of Oregon, Inc., PacifiCare of Texas, Inc., PacifiCare of Washington, Inc. Definity SM Health Savings Account (HSA) and/or Health Reimbursement Account (HRA) HSA: The Definity SM Health Savings Account (HSA) high deductible health plan (HDHP) is designed to comply with IRS requirements so eligible enrollees may open a Health Savings Account with a bank of their choice or through OptumHealth Bank, Member of FDIC. Definity HSA refers generally to the Definity SM HSA product, which includes a HDHP, although at times Definity HSA may refer only and specifically to the Definity Health Savings Account, provided in conjunction with OptumHealth Bank and not to the associated HDHP. HRA: UnitedHealthcare s Definity SM Health Reimbursement Account, or HRA, combines the flexibility of a medical benefit plan with an employer-funded reimbursement account. UnitedHealthcare Core SM : The UnitedHealthcare Core SM product is designed to accommodate a limited network of participating physicians, health care professionals, hospitals and facilities ( providers ). Except in emergency situations, members should confirm their provider is participating in this product before receiving services to receive the highest level of benefits. Network status may be determined by calling Customer Care at the number indicated on the medical ID card or visiting myuhc.com. UnitedHealthcare EDGE SM : UnitedHealthcare EDGE SM plans are only available in states that have implemented the 2007 Certificate of Coverage and have the UnitedHealth Premium designation program. Care24 : The Care24 Program integrates elements of traditional employee assistance and work-life programs with health information lines for a comprehensive set of resources. It is not a substitute for a doctor s or professional s care. Due to the potential for a conflict of interest, legal consultation will not be provided on issues that may involve legal action with UnitedHealthcare, or its affiliates, or any entity through which the caller is receiving UnitedHealthcare, or its affiliates, services directly or indirectly (e.g., employer or health plan). The Care24 Program and its components may not be available in all states or for all group sizes and are subject to change. Coverage exclusions and limitations may apply. Health discount program: The UnitedHealth Allies health discount program is administered by HealthAllies, Inc., a discount medical plan organization located at 505 N. Brand Blvd., Suite 850, Glendale, CA, 91203, The health discount program is NOT insurance. The health discount program provides discounts for certain health products and services. The health discount program does not make payments directly to the providers of health products and services. The program member is obligated to pay for all health products and services but will receive a discount from those providers who have contracted with the discount plan organization. The health discount program is offered to existing members of certain products underwritten or provided by UnitedHealthcare Insurance Company or its affiliates to provide specific discounts and to encourage participation in wellness programs. Health care professional availability for certain services may be dependent on licensure, scope of practice restrictions or other requirements in the state. UnitedHealthcare does not endorse or guarantee health products/services available through the discount program. This program may not be available in all states or for all groups. Components subject to change. Healthy Pregnancy Program: The Healthy Pregnancy Program follows national practice standards from the Institute for Clinical Systems Improvement. The Healthy Pregnancy Program cannot diagnose problems or recommend specific treatment. The information provided is not a substitute for your doctor s care. Ancillary / Specialty Benefits Entities UnitedHealthcare Vision coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by Spectera, Inc., United HealthCare Services, Inc. or their affiliates. Plans sold in Texas use policy form number VPOL.06 and associated COC form number VCOC.INT.06.TX. UnitedHealthcare Life and Disability products are provided by UnitedHealthcare Insurance Company and Unimerica Insurance Company; Unimerica Life Insurance Company of New York (NYC); and in California, Unimerica Life Insurance Company. UnitedHealthcare Dental coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by Dental Benefit Providers, Inc., Dental Benefit Administrative Services (CA only), United HealthCare Services, Inc. or their affiliates. Plans sold in Texas use policy form number DPOL.06.TX (11/15/2006) and associated COC form number DCOC.CER.06. Quicken and Quicken Health are trademarks, service marks or registered trademarks and/or service marks of Intuit Inc. Apple and iphone are registered trademarks of Apple Inc. GOOGLE and Android are trademarks of Google Inc. The Trademark BlackBerry smartphone is owned by Research In Motion Limited and is registered in the United States and may be pending or registered in other countries. UnitedHealthcare is not endorsed, sponsored, affiliated with or otherwise authorized by Research In Motion Limited United HealthCare Services, Inc. UHCHI