Welcome to Unity Health Insurance

Transcription

1 Welcome to Unity Health Insurance

2 New Member Checklist z Check out the checklist! z Enrolling in your health plan shouldn t be difficult. Use this list to check off each step you complete. Review the new member z information. You ll be sure to find some key benefits you won t want to miss. Examine the frequently asked questions. ey can guide you through the answers to questions you may have. We re excited to have you as a new member. To make your enrollment experience as easy as possible, we ve put together some information to help you through the steps. Select a primary care physician All members must have a primary care physician (PCP). Your PCP helps coordinate your care and can help with most of your health concerns. Select a PCP for you and for all of the members of your family that will be covered under your health plan. You can find a list of participating PCPs at unityhealth.com/findadoctor. If you would like a UW Health PCP but need help selecting one, contact the UW Health Welcome Center at (608) or (800) e Welcome Center is a service that assists members who wish to transfer their care to UW Health. Welcome Center staff can help you choose a PCP that best fits your needs, transfer your medical records from a previous physician, assess your needs as a new patient and schedule your appointments with your new care team. For more information, visit unityhealth.com/welcomecenter. Complete your enrollment application and return to your HR department Fill out your application and return it to your HR department. Be sure to choose a PCP for each member or indicate Welcome Center under Clinic and PCP Name if you have contacted the UW Health Welcome Center. Fill out the Health Care Transition Form (if applicable) If you are currently getting care from a specialist that is not a Unity participating provider, complete and return the Health Care Transition Form available at unityhealth.com/memberforms. Our medical management team will help you transfer your specialty care.

3 Member Tools and Information Learn more about these tools and other important member information at unityhealth.com/welcome Getting Connected Your New Member Materials Once you are enrolled, you will receive your new member information. is includes your I.D. cards as well as information on where to find resources and tools online. Be sure to review this information carefully. It will help you make the most of your health plan. Your Provider Network When you need care, visit your primary care physician (PCP). He / she can help with most of your health concerns. Our network provides access to leading local health care professionals as well as guaranteed access to UW Health s more than 1,300 health care professionals. For a list of participating providers, just visit unityhealth.com/findadoctor. Health and Wellness Whether you re currently active or simply looking to make some lifestyle changes, we want you to take advantage of the program tools and resources available at unityhealth.com/healthandwellness. Health FirstSM offers discounts on wellness products from participating vendors. unityhealth.com/healthfirst Fitness FirstSM for Kids rewards your children ages five to 18 with prizes for being active. unityhealth.com/fitnessfirstkids 9 Months & MoreSM provides education and guidance through your pregnancy and the delivery of your baby. You are eligible for a gi a er completing the program! unityhealth.com/9mm Health management programs provide support and guidance to help you manage chronic conditions like asthma, diabetes, low back pain and more. unityhealth.com/healthmanagement Your Prescription Drug Benefits We want you to receive the most value from your prescription drug benefits. Here are some tips to help you Our drug formularies promote the use of the safest, most effective and cost-effective medications. To help determine what drugs to include, we work with the physicians who take care of our members. Drug formularies can be found by visiting unityhealth.com/formulary. Our Choice90 Program makes it easy to give you a 90-day supply of the medicine you get most o en. For more information, visit unityhealth.com/choice90. For more information on your prescription drug benefits, visit unityhealth.com/pharmacy. Protecting Your Privacy Our Notice of Privacy Practices explains our privacy practices, legal duties and your rights regarding how your medical and financial information may be used and disclosed. It also includes how you may access your medical information. To view the Notice, visit unityhealth.com/privacy.

4 New Member Checklist You won t want to miss the key benefits listed inside under Member Tools and Information. Also, examine the Frequently Asked Questions on the back page, to help guide you. Review your Prescription Drug Formulary If you are taking any medications, review the formularies to see if they are covered. You can find the formularies at unityhealth.com/formulary. If your medications are not listed on the formulary, call our Pharmacy Program at (888) or speak with your doctor to learn about other options. To change your medications, you will need a new prescription from your doctor. If your medication requires a prior authorization you should ask your doctor about changing to a different medication or have him / her send a prior authorization request form. If you are in the process of identifying and making appointments with a new PCP, you can request a New Member Drug Supply from Unity s Pharmacy Services. is request must be done within your first 90 days as a Unity member. Visit unityhealth.com/pharmacy for more information. Sign up for MyChart at unitymychart.com MyChart helps you access your Unity health insurance and your UW Health medical information online. Request an account by visiting unitymychart.com. With MyChart, you can access your benefit information, authorizations, claims and more at any time. Plus, if you receive care from a UW Health provider, you can also see portions of your medical information. If you had a MyChart account with a provider other than UW Health, you ll want to sign up through unitymychart.com which allows you access to Important plan documents Claims and Explanation of Benefits (EOBs) Historical costs from past medical visits, treatments or procedures Amount you have paid toward your deductible, maximum out-of-pocket expenses and benefit accumulations A tool to determine costs you may incur prior to receiving health care services and more! If you already have a UW Health MyChart account, you don t need to sign up. Once you re enrolled with us, you ll have access to both your Unity insurance information and portions of your UW Health medical record including allergies, immunizations, prescriptions, diagnoses and lab results. rough MyChart, UW Health patients can also schedule simple appointments, send messages to your doctor and complete an e-visit for simple health problems. Learn more at unityhealth.com/evisit! You may access your child s health information by requesting an account through MyChart. Note: there are restrictions to the information available for you to view depending on your child s age. For more information, visit the list of FAQs found at unitymychart.com.

5 Frequently Asked Questions As a new member, you probably have some questions. Here are some answers to our frequently asked questions. You can find additional FAQ s at unityhealth.com/welcome/faq. Does my new PCP need my medical records? It s helpful for your new PCP to review your medical history. After you choose your PCP, call the clinic to discuss the process. You may need to sign a release to have your records transferred. What if I need to see a specialist? You should work with your PCP to determine the appropriate specialist. Unity does not require you to receive a referral prior to accessing in-network specialists. What if I need behavioral health services? For assistance coordinating mental health, alcohol or drug treatment services, please call (800) You may also visit unityhealth.com/findadoctor/behavioralhealth for more information. What is a prior authorization? Some services and supplies covered by your insurance plan must have prior authorization. This means that you, your nurse, or your doctor must fill out a Prior Authorization Request Form before you can have the treatment to determine if it will be covered. Do I need Prior Authorization for certain services? Yes. Specific types of services require prior authorization before the services are received. For a list of services requiring prior authorization, visit unityhealth.com/priorauth. How do I sign up for MyChart? Unity members 18 and older may request an account at unitymychart.com. What are my wellness program options? Unity members have many program tools and resources available to help them achieve their health and wellness goals. For a full list of classes, healing therapies and healthy eating options, visit unityhealth.com/healthandwellness. What is considered Preventive Care? Preventive screenings are an important way to help identify and treat potential health problems before they develop or get worse. Many of the top risk factors leading to illness and premature death can be prevented by receiving regular preventive care. Under the Affordable Care Act, most preventive health care services are covered at no cost to you when delivered by a provider within your Unity network. For a list of covered services, visit unityhealth.com/preventiveservices. However, if a new or existing health problem is discussed during a preventive health care visit, a separate office visit will be billed as required by national coding and billing guidelines. This means that you may be subject to out-of-pocket charges (copay, coinsurance or deductible) for these additional services. What is considered an emergency or urgent care situation? A medical emergency is a major problem that must be treated right away because of Serious jeopardy to a person s health or to the health of an unborn child Serious impairment to a person s bodily functions Serious dysfunction of one or more of a person s body organs or parts Some examples of emergencies include Heart attack Stroke Sudden asthmatic attack Sudden and / or extensive bleeding Urgent care services are health problems that are not life-threatening, but should be treated right away. Examples include minor cuts, sprains and ear infections. What if I need emergency care, urgent care or care outside of the service area? If it is an emergency, get help first. Emergency services are covered, but you will need to pay your copay, deductible and / or coinsurance if applicable. If you go to urgent care, you must pay your copay if applicable. You might have to pay for other out-of-pocket costs. Services from an out-of-network provider are covered up to the usual, customary and reasonable charge (UCR). Charges in excess of UCR may be billed by an out-of-network provider but do not apply to the annual out-of-pocket limit. What is medical management? As part of the managed care process, we work with our participating physicians to help ensure that the care your doctor recommends meets our guidelines. This process is called medical management, care management or utilization management and is conducted by nurses and doctors. Your PCP is responsible for providing primary care services and for coordinating your health care. At times when you need specialty care, your PCP can refer you. In-network referrals to a participating provider do not require our approval. However, certain services or supplies require prior authorization. Working through your PCP for referrals, when needed, assures that you receive appropriate and cost-effective services or supplies. One of the most important parts of care management involves your PCP or specialist working with our departments for medical management, pharmacy and behavioral health. These group efforts help ensure you receive the most effective and appropriate treatment available. What is complex case management? If you have a serious medical problem, you may qualify for complex case management services. Complex case management is a process where experienced case managers work with both you and your doctor. They can work with you to meet your health goals and help you navigate the health system and community resources. Your doctor may refer you to our care team or you may contact us at (608) UH01182 (0716) Unity Health Plans Insurance Corporation U N ITYH EALTH.COM

6 Staying Connected Your satisfaction is important to us. at s why we are committed to exceeding your expectations. Our customer service representatives answer your questions the first time and genuinely care about providing the service you deserve. at s not something you can get just anywhere. Whether you wish to send a message through MyChart or want to talk on the phone, Unity s Customer Service staff are waiting to help. Plus, they are available via our online chat feature at unityhealth.com/members. Call us at (800) , send a message or chat with us weekdays from 7 a.m. to 7 p.m.! We want to stay in touch with you. Be sure to like us on Facebook at facebook.com/unityhealth or follow us on Twitter at twitter.com/unityhealthplan. ese are just the highlights. To learn more about other programs and services available to you, please visit unityhealth.com. Unity Health Insurance is a Qualified Health Plan issuer in the Health Insurance Marketplace. Unity Health Insurance does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. If you need this printed material interpreted or in an alternative format or if you need assistance using any of our services, contact Unity Customer Service at (800) or (608) (TDD / TTY only). U N ITYH EALTH.COM

7 Employee Application Please Complete Entire Form in BLACK INK. Name of Employer Group: Hours Worked Date Employed: Per Week: / / Employment Status: Active Retired LOA COBRA / Continuation Effective Date / / and Term Date: / / Plan Requested: HMO POS PPO Group Number: Group Number: Group Number: Type of Coverage: Employee Employee and Spouse Employee and Child(ren Family Reason for Enrollment: (check appropriate box) Requested Effective Date of Coverage: / / New Hire Marriage Birth, adoption / placement for adoption Loss of other coverage Open enrollment Add / delete dependents Name change / address change / PCP change Part-time to full-time employment Rehire (date): / / Return from layoff (date): / / Transfer to disability segment *For loss of other coverage, please complete: (date of change: / / ) Late applicant COBRA / State Continuation election Transfer to retiree segment Other Insurance Company Phone # Subscriber # Effective Date of Coverage Termination Date Names of those covered under policy: FOR EMPLOYER USE EMPLOYMENT INFORMATION: 840 Carolina Street Sauk City, WI (800) Fax (608) unityhealth.com EMPLOYEE INFORMATION (Please do not use abbreviations or nicknames on this application) Employee s Last Name First Name MI Social Security Number or Tax ID Number (SSN / TIN is required for IRS tax reporting regarding your health plan.) Street Address Apt. # City State Zip Code County Mailing Address (if different) City State Zip Code County Date of Birth Gender Marital Status Single Divorced Primary Language Spoken / / M F Married English Spanish Other (provide date when marriage occurred) Home Phone # ( ) Work Phone # ( ) Cell Phone # ( ) Applicant s Address: *Primary Care Physician (PCP) and Clinic: *If you want Unity to assign you to a Clinic or a PCP, indicate ASSIGN Current Patient? Yes No UH00674 (rev 09 16)

8 DEPENDENT INFORMATION Please list all other members to be covered: Dependent s Last Name First Name MI Social Security Number or Tax ID Number (SSN / TIN is required for IRS tax reporting regarding your health plan.) Street Address (if different than employee) Apt. # City State Zip Code County Mailing Address (if different than employee) City State Zip Code County Relationship Date of Birth / / *Primary Care Physician (PCP) and Clinic: *If you want Unity to assign you to a Clinic or a PCP, indicate ASSIGN Gender M DEPENDENT INFORMATION Please list all other members to be covered: F Current Patient? Yes No Dependent s Last Name First Name MI Social Security Number or Tax ID Number (SSN / TIN is required for IRS tax reporting regarding your health plan.) Street Address (if different than employee) Apt. # City State Zip Code County Mailing Address (if different than employee) City State Zip Code County Relationship Date of Birth / / *Primary Care Physician (PCP) and Clinic: *If you want Unity to assign you to a Clinic or a PCP, indicate ASSIGN Gender M DEPENDENT INFORMATION Please list all other members to be covered: F Current Patient? Yes No Dependent s Last Name First Name MI Social Security Number or Tax ID Number (SSN / TIN is required for IRS tax reporting regarding your health plan.) Street Address (if different than employee) Apt. # City State Zip Code County Mailing Address (if different than employee) City State Zip Code County Relationship Date of Birth / / *Primary Care Physician (PCP) and Clinic: *If you want Unity to assign you to a Clinic or a PCP, indicate ASSIGN Gender M DEPENDENT INFORMATION Please list all other members to be covered: F Current Patient? Yes No Dependent s Last Name First Name MI Social Security Number or Tax ID Number (SSN / TIN is required for IRS tax reporting regarding your health plan.) Street Address (if different than employee) Apt. # City State Zip Code County Mailing Address (if different than employee) City State Zip Code County Relationship Date of Birth / / *Primary Care Physician (PCP) and Clinic: *If you want Unity to assign you to a Clinic or a PCP, indicate ASSIGN Gender M F Current Patient? Yes No UH00674 (rev 09 16)

9 OTHER INSURANCE INFORMATION: Will you or any of your dependents continue to have other insurance after the Unity Health Insurance effective date of this policy? If Yes, complete Names of those covered under policy Employer Insurance Company Subscriber # Group # Effective Date of Coverage Insurance Company Phone # Termination Date Are you or your spouse or child(ren) covered by Medicare (Parts A, B, C, or D)? Yes No If yes, please list name(s): Reason for Medicare: Age 65 Disability End Stage Renal Disease Disability and ESRD Part A Effective Date: Part B Effective Date: Part C Effective Date: Part D Effective Date: Are you or any dependents listed above involved in a Workers Compensation case? Yes No If Yes, indicate who is involved and start date / accident date: Workers Compensation Condition: Insurance Company Name: Insurance Company Address (where claim is sent): Insurance Company Phone Group # Effective Date: Term Date (if applicable): WAIVER of GROUP COVERAGE: I hereby elect not to apply for group health plan coverage. I hereby waive group health plan coverage for: Myself Spouse Children or other eligible dependents Reason for waiving coverage I / we will be covered under another health benefit plan that is not sponsored by my employer. Name of Insurance Co.: I would have to pay more than 10 percent of my annualized gross income towards health insurance Other reason for waiving: I certify that I have been given the opportunity to apply for the Unity group health benefit plan coverage for which I am eligible. I decline to enroll for such coverage as indicated above, on behalf of the persons listed above. I understand that I may be able to obtain coverage at a later time for reasons listed in the Notice of Special Enrollment Rights. If circumstances in the Notice of Special Enrollment Rights do not apply then me and / or the persons listed above may be considered Late Applicants subject to either a 12 month delayed effective date, or, if my employer has an Open Enrollment Period, may be able to apply for coverage at Open Enrollment. I certify that the information above is, to the best of my knowledge and ability, complete and true. Applicant s Signature: Date UH00674 (rev 09 16)

10 I acknowledge that I have read and completed the entire Application. If I received assistance in reading or completing this Application, I have identified the person(s) who assisted me. I agree that the answers are, to the best of my knowledge and ability, complete and true. I understand that my answers, together with any supplements or additional pages, are the basis for the certificate or policy that is issued. I agree that no insurance will be effective until the date specified by the insurance company on the certificate or policy. I understand that any material misstatement or omission relied upon by the insurer may result in denial of claim and / or rescission of coverage. I further understand that this contract can be voided if within the first 24 months from the date of the policy or certificate it is determined that I or a dependent made an intentional misrepresentation in the application. I understand that it may be a crime to submit an application or file a claim based on a false or deceptive statement. I further understand it may be a crime to submit an application that is intended to mislead an insurer or conceal significant information about the applicant. I understand that I may request a copy of this Application and the notice of the company s privacy practices. I agree that a photocopy is as valid as an original. A legible facsimile or electronic signature shall have the same force as the original. I understand that enrollment and / or eligibility for benefits may be conditioned upon my willingness to provide written authorization permitting Unity to obtain medical records from health care providers who have treated me, my spouse or any dependents applying for coverage under this application. If medical records are needed, Unity will provide me with an authorization form. Applicant s Signature: Date NOTICE OF SPECIAL ENROLLMENT RIGHTS If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing towards your or your dependents other coverage). However, you must request enrollment within 31 days after your or your dependents other coverage ends (or after the employer stops contributing toward the other coverage). In addition, if you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 31 days after the marriage, birth, adoption or placement for adoption. UH00674 (rev 09 16)

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12 Preventive Services Covered under the Affordable Care Act Under the Affordable Care Act, some preventive health care services are covered at no cost to you when delivered by a provider within your Unity Health Insurance network. However, if a new or existing health problem is discussed during a preventive health care visit, a separate office visit will be billed as required by national coding and billing guidelines. This means that you may be subject to out-of-pocket charges (copay, coinsurance or deductible) for these additional services. Unity Health Insurance covers routine physical exams, routine gynecological exams, routine child health exams and immunizations related to the preventive services covered under the Affordable Care Act for covered children up to age 26. Covered Preventive Services for Adults Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked Alcohol Misuse screening and counseling Aspirin use to prevent cardiovascular disease for men and women of certain ages Blood Pressure screening for all adults Blood Pressure screening outside the clinical setting for adults age 40 or older Cholesterol screening for adults of certain ages or at higher risk Colorectal Cancer screening for adults over 50 Depression screening for adults Diabetes (Type 2) screening for adults with high blood pressure Diet counseling for adults at higher risk for chronic disease Falls Prevention exercise or physical therapy and vitamin D supplementation to prevent falls in community-dwelling adults aged 65 yrs and older who are at increased risk for falls Hepatitis B screening for non-pregnant adults at high risk for infection Hepatitis C screening for adults at a higher risk and a one-time screening for all adults born 1945 through 1965 HIV screening for everyone ages 15 to 65, and others at increased risk Immunization vaccines for adults doses, recommended ages, and recommended populations vary: Hepatitis A Hepatitis B Herpes Zoster Human Papillomavirus Measles, Mumps, Rubella Meningococcal Pneumococcal Tetanus, Diphtheria, Pertussis Influenza (Flu Shot) Varicella Lung Cancer screening of adults aged 55 to 80 years with a history of smoking Obesity screening and counseling for all adults Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk Skin Cancer counseling for children, adolescents and young adults age who have fair skin Syphilis screening for all adults at higher risk Tobacco Use screening for all adults and cessation interventions for tobacco users Covered Preventive Services for Women, Including Pregnant Women Anemia screening on a routine basis for pregnant women Bacteriuria urinary tract or other infection screening for pregnant women Breast Cancer Genetic Test Counseling (BRCA) for women at higher risk for breast cancer Breast Cancer Mammography screenings every 1 to 2 years for women over 40 Breast Cancer Chemoprevention counseling for women at higher risk Breast Feeding comprehensive support and counseling from trained providers, and access to breastfeeding supplies, for pregnant and nursing women Cervical Cancer screening for sexually active women Chlamydia Infection screening for younger women and other women at higher risk Contraceptions: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a health care provider for women with reproductive capacity (not including abortifacient drugs). This does not apply to health plans sponsored by certain exempt religious employers. Domestic and interpersonal violence screening and counseling for all women Folic Acid supplements for women who may become pregnant Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes Gonorrhea screening for all women at higher risk Hepatitis B screening for pregnant women at their first prenatal visit continued on back UH01084 (0916) Unity Health Plans Insurance Corporation

13 Human Immunodeficiency Virus (HIV) screening and counseling for sexually active women Human Papillomavirus (HPV) DNA test every three years for women with normal cytology results who are 30 or older Low-Dose Aspirin use as a preventive medication for pregnant woman who are high risk for preeclampsia (after 12 weeks of gestation) Osteoporosis screening for women over age 60 depending on risk factors Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk Sexually Transmitted Infections (STI) counseling for sexually active women Syphilis screening for all pregnant women or other women at increased risk Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users Well-woman visits to obtain recommended services for women under 65 Covered Preventive Services for Children Alcohol and Drug Use assessments for adolescents Autism screening for children at 18 and 24 months Behavioral assessments for children age 0 to 17 years Blood Pressure screening for children age 0 to 17 years Cervical Dysplasia screening for sexually active females Congenital Hypothyroidism screening for newborns Depression screening for adolescents Developmental screening for children under age 3 Dyslipidemia screening for children at higher risk of lipid disorders age 1 to 17 years Fluoride Application to the primary teeth of all infants and children starting at the age of primary tooth eruption Fluoride Chemoprevention supplements for children starting at 6 months without fluoride in their water source Gonorrhea preventive medication for the eyes of all newborns Hearing screening for all newborns Height, Weight and Body Mass Index measurements for children age 0 to 17 years Hematocrit or Hemoglobin screening for children Hemoglobinopathies or sickle cell screening for newborns Hepatitis B screening for non-pregnant adolescents at high risk for infection HIV screening for adolescents at higher risk Immunization vaccines for children from birth to age 18 doses, recommended ages, and recommended populations vary: Diphtheria, Tetanus, Pertussis Haemophilus influenzae type b Hepatitis A Hepatitis B Human Papillomavirus Inactivated Poliovirus Influenza (Flu Shot) Measles, Mumps, Rubella Meningococcal Pneumococcal Rotavirus Varicella Iron supplements for children ages 6 to 12 months at risk for anemia Lead screening for children at risk of exposure Medical History for all children throughout development age 0 to 17 years Obesity screening and counseling Oral Health risk assessment for young children age 0 to 10 years Phenylketonuria (PKU) screening for this genetic disorder in newborns Sexually Transmitted Infection (STI) prevention counseling and screening for adolescents at higher risk Skin Cancer counseling for children, adolescents and young adults age who have fair skin Tobacco use counseling and education for school-aged children and adolescents Tuberculin testing for children at higher risk of tuberculosis age 0 to 17 years Vision screening for all children This list was updated November For more detailed information on preventive care, visit HealthCare.gov or contact Customer Service at (800) Source:

14 e-visits An e-visit is an electronic visit between you and a UW Health care provider about a non-emergency health care concern. As part of the e-visit, you answer questions about certain symptoms you have. Your answers, along with your medical record, help the UW Health care provider treat you. e-visits are a convenient, fast and private way for you to receive care for some common conditions. You can complete an e-visit for any of the following symptoms: 쐍 Cough 쐍 Diarrhea 쐍 Headache 쐍 Heartburn 쐍 Low back pain 쐍 Red eye 쐍 Sinus problems 쐍 Frequent or painful urination (women only) 쐍 Vaginal discomfort or discharge e-visit Availability To complete an e-visit, you must be 18 years of age or older and have a UW Health primary care physician. Allow minutes to complete your e-visit; you re not able to save a dra and continue at a later time. e-visit Steps 1. Log into your MyChart account at unitymychart.com 2. On the MyChart homepage, select e-visits from the dashboard 3. Select a condition from a list of choices 4. Select Start e-visit e-visit Cost e cost of your e-visit will be displayed when you select e-visit within MyChart. You may be asked to provide your credit card information before you can complete an e-visit, depending on your plan.* If your e-visit is cancelled before you click submit, you will not be charged. Also, if it is determined that you should be seen in person instead of treated by e-visit, you will not be charged. * Depending on your plan, you may be billed separately based on your Summary of Benefits and Coverage. e fee does not include the cost of other services such as prescription drugs, laboratory tests or X-rays, if needed. e-visit Response Time A UW Health care provider will review your answers along with your medical record and respond within two hours for e-visits submitted between 9 a.m. 8 p.m. Monday to Friday and 9 a.m. 4 p.m. Saturday and Sunday. e-visits submitted a er 8 p.m. on weekdays or 4 p.m. on weekends will be responded to by 10 a.m. the next morning. UH01361 (0916) Unity Health Plans Insurance Corporation