Get to know your benefits. State of Florida 2018 Benefits Guide. welcometouhc.com/florida

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1 Get to know your benefits. State of Florida 2018 Benefits Guide welcometouhc.com/florida

2 Knowing your benefits helps you make more informed choices. By understanding your benefits, you can select the coverage that best fits your needs. In this guide, you'll find information about your options and benefit extras to help make your choices easier. UnitedHealthcare is committed to providing you a smooth and simple enrollment experience with all the support you need. Want more information? Table of Contents BENEFITS PAGE NUMBER Health Plan Details 4 HMP Plan 5 HIHP Plan With HSA 6 HEALTH & WELLNESS RESOURCES Go Digital 7 Access to Support 8 ENROLLMENT What's Next 12 welcometouhc.com/florida Search for network providers. Learn about your benefits and more. Toll-free , TTY 711 Habla Español? Podemos ayudar.

3 Helpful highlights. Member Resources Make using your plan easier. Visit Member Resources for tips and tools to help you choose a doctor, manage your costs, know your care options and more. Get started at uhc.com/memberresources. UnitedHealthcare Health4Me Mobile App Download Health4Me to your smartphone and you ll get quicker access to your health plan details. It also lets you: Search for a network doctor, clinic or hospital. Find options for quick care such as a nearby clinic, urgent care or ER. Locate and share digital health plan ID cards. Compare costs and see provider reviews. View claims and account balances. Find pharmacies and fill prescriptions. Manage your plan online and on the go. Your member website: myuhc.com. 2

4 Helpful terms to know when choosing a plan. Benefits Health & Wellness Resources Enrollment Coinsurance Your share of the costs of a covered health care service, calculated as a percentage. Copayment or Copay A fixed amount of money you ll pay for a covered doctor visit. Covered Services The portion of a medical expense that the plan has agreed to pay for or reimburse. They include: Doctors office visits. Emergency services. Hospital care. Lab services. Pregnancy care services. Outpatient care services. Wellness services. Deductible The amount you ll need to pay before your plan will start to pay for covered services. Health Savings Account (HSA) An HSA is a personal savings account to help you save and pay for your health care. There s no "use-it-or-loseit" rule. You get to keep it even if you change plans, change employers or retire. The HSA option is only available for employees that elect the HIHP plan. Network A network is a group of health care providers and facilities that have a contract with UnitedHealthcare. Using the network may help lower your costs because these providers and facilities have agreed to provide services at a discount. Out-of-Pocket Limit The most you could pay during a coverage period (usually one year) for your share of the costs of covered services. After you meet this limit, the plan will usually pay 100 percent of the allowed amount. The out-ofpocket limit includes all of your network payments. Preventive Care Routine health care, including screenings, checkups and patient counseling to prevent or discover illness, disease or other health problems. FIND INSURANCE TERMS CONFUSING? Visit justplainclear.com. 3

5 HMO Plan HIHP Plan With HSA Plan DEDUCTIBLE WHAT YOU PAY IN THE NETWORK OUT OF THE NETWORK WHAT YOU PAY IN THE NETWORK OUT OF THE NETWORK EE None Not covered $1,350 Not covered Family None Not covered $2,700 Not covered COVERED SERVICES Doctors and Specialists Primary Care $20 copay Not covered 20%*** Not covered Specialist $40 copay Not covered 20%*** Not covered Preventive Care Screenings and Counseling $0 copay* Not covered 100% covered Not covered Emergency Care Urgent Care Visit $25 copay Not covered 20%*** Not covered Emergency Room $100 copay/100% $100 copay/100% 20%*** 20%*** Hospitalization In-patient $250 copay Not covered 20%*** Not covered Outpatient $0 copay Not covered 20%*** Not covered Vision Optometrist $40 copay Not covered 20%*** Not covered Ophthalmologist $40 copay Not covered 20%*** Not covered OUT-OF-POCKET LIMIT EE $1,500 Not covered $3,000 Not covered Family $3,000 Not covered $6,000 Not covered GLOBAL OUT-OF-POCKET LIMIT EE $7,350 Not covered $3,000 Not covered Family $14,700 Not covered $6,000 Not covered *100% covered. **Met by medical copays. ***Of eligible expenses. ****Global network, out-of-pocket max met by Rx only or medical and Rx copays. This information does not replace your official health plan documents. Please see your official health plan documents for all coverage details, which includes limitations and exclusions. See back page for all legal statements. 4

6 HMO Plan. Use our national network to help save money. Save money by staying in our network. A network is a group of health care providers and facilities that have a contract with UnitedHealthcare. You can receive care and services from anyone in our network. If you don t use the network, you ll have to pay for all of the costs. There s no need to select a primary care physician (PCP) or get referrals to see a specialist. Consider choosing a PCP. Your PCP can be your partner in managing your care. They can help you avoid duplicating tests and services and connect you to a specialist. The network can help lower your costs. The doctors and facilities in our network have agreed to provide you services at a discount. We have: 884,689 physicians and health care professionals.* 5,634 hospitals.* 67,000+ pharmacies.* Search the network at welcometouhc.com/florida. *As of 3/31/17. Preventive care is covered 100 percent in our network. 1 DETAILED BENEFITS on Page 4. How paying for network care works. Copayment 1 You pay Deductible + 1 You pay 100% + Coinsurance 1 You pay a percentage of the cost After reaching the out-of-pocket limit Plan pays 100% of covered expenses The fixed amount you pay for each covered doctor visit or prescription. The amount you pay before your insurance plan pays a portion. The percentage you pay after you reach your deductible. Out-of-pocket limit The most you pay for health care in one plan year (includes all of your network payments). For all of the COVERAGE DETAILS, see your official health plan documents. 1 Age-appropriate preventive care services are covered 100 percent when received in the plan network. You may be required to receive approval for some services before they can be covered. 5

7 HIHP Plan With HSA with a Health Savings Account (HSA). Get a plan with network freedom and an HSA. Save money by staying in our network. A network is a group of health care providers and facilities that have a contract with UnitedHealthcare. You can receive care and services from anyone in our network. There s no need to select a primary care physician (PCP) or get referrals to see a specialist. Consider choosing a PCP. Your PCP can be your partner in managing your care. They can help you avoid duplicating tests and services and connect you to a specialist. Preventive care is covered 100 percent in our network. 1 DETAILED BENEFITS on Page 4. You can open an HSA. An HSA is a personal savings account to help you save and pay for your health care. It s your money. There s no use-it-or-lose-it rule. You get to keep it even if you change plans, change employers or retire. Set a goal, even a small one. Check with your employer to see if you can set up regular, pretax deposits through payroll deduction. Look for care in our network first. The doctors and facilities in our network have agreed to provide you services at a discount. We have: 884,689 physicians and health care professionals.* 5,634 hospitals.* 67,000+ pharmacies.* Search the network at welcometouhc.com/florida. *As of 3/31/17. If you go out of the network, your costs may be higher. Out-of-network providers can even bill you for amounts higher than what your plan will cover. For all of the COVERAGE DETAILS, see your official health plan documents. 1 Age-appropriate preventive care services are covered 100 percent when received in the plan network. You may be required to receive approval for some services before they can be covered. 6

8 Save on taxes. 2 You don t have to pay federal taxes or, in most cases, state income taxes when you deposit money into your HSA, let it collect interest or use it for qualified expenses. The 2018 IRS HSA deposit limits are: Individual $3,450 3 Family $6,900 3 Paying for prescriptions. You will have to pay the full cost of your covered prescriptions until you ve paid the deductible. You can use your HSA to help pay. After the deductible, you will pay coinsurance. For more details, see your official health plan documents. You own the HSA. Use it to help save and pay. Qualified expenses: Doctor office visits. Prescriptions. Eyeglasses and contacts. Dental care and braces. Chiropractic services and more. How paying for network care works with an HSA. STEP 1 Your deductible You pay for all services, including prescriptions, until you meet your deductible. You can use an HSA to help pay it. STEP 2 Your coinsurance After you reach the deductible, you share the costs with the plan. You can use an HSA to help pay your share. STEP 3 Your out-of-pocket limit When you reach the limit, you are done paying. The plan will pay 100 percent of covered services for the rest of the plan year. Pay with your HSA or pay another way Your plan pays 80% + You pay 20% You are done paying Preventive care is covered 100 percent when you use a network doctor. 4 DETAILED BENEFITS on Page 4. 2 Precise HSA tax effects depend on federal law. We recommend that you see your tax advisor for specific tax advice. 3 This includes all deposits, including any contributions your employer makes. 4 Age-appropriate preventive care services are covered 100 percent when received in the plan network. You may be required to receive approval for some services before they can be covered. 7

9 Get access to support and care at any time. Need help? We re on it. We know that managing your health plan benefits and your health isn t always easy. That s why we have a team of people dedicated to helping you. From understanding your claims to estimating costs ahead of time, we re here to help. Contact us for help with a personal touch. Call the number listed on your health plan ID card. You may want to know: Is this treatment covered? How much will I have to pay for a test my doctor wants me to get? What does this charge mean on my bill? And why is it this amount? Can you help explain my benefits and what I need to do? If I need to find a new doctor, can you help me? 1 Prescription services may not be available in all states. 8

10 We re here to help. Whether it s finding care or managing a complex health condition, you ll get help whenever you need it. Here are some of the programs and services that are available as part of your health plan with no additional cost to you. Have a health plan question? Just ask. We are here to help you find information and resources plain and simple. Have questions about your health care benefits? Need help resolving a claim? Not sure where to go for care? Have questions about a recent screening or test? Can t find a doctor? As a member, you can call , TTY 711. Talk to a registered nurse 24/7. When a health question comes up, you can talk with a registered nurse any time, day or night. He or she can help: Choose appropriate medical care. Understand a wide range of symptoms. Determine if the emergency room, a doctor visit or self-care is right for your needs. Find doctors or hospitals that meet your needs and preferences. Locate an urgent care center and other health resources in your area. As a member, you can connect with a nurse by calling the number on your health plan ID card or logging in to myuhc.com. Talk to a registered nurse 24/7. When a health question comes up, you can talk with a registered nurse any time, day or night. He or she can help: Choose appropriate medical care. Understand a wide range of symptoms. Determine if the emergency room, a doctor visit or self-care is right for your needs. Find doctors or hospitals that meet your needs and preferences. Locate an urgent care center and other health resources in your area. As a member, you can connect with a nurse by calling the number on your health plan ID card or logging in to myuhc.com. 9

11 Get support throughout your pregnancy. The Healthy Pregnancy Program is a personalized maternity wellness program. Throughout your pregnancy, you can receive additional support, education and answers to questions about pregnancy. You can enroll by calling the number on your health plan ID card. Call to talk to a maternity nurse. Get support during and after pregnancy from an experienced maternity nurse who provides assistance, guidance, answers and education. Get help if you have work-related or personal issues. Behavioral Health Solutions gives you confidential help with: Depression, stress and anxiety. Relationship difficulties. Child and elder care support. Substance use, recovery and more. Visit liveandworkwell.com to learn more. 10

12 What comes next? Choose a plan. As you consider your benefits, think about how often you go to the doctor and the total cost of your benefits, including how much you pay in monthly premiums. Before coverage starts. While we re setting up your insurance: SEARCH OUR NETWORK for providers near you at welcometouhc.com/florida. Once coverage begins. WATCH THE MAIL for your welcome kit and ID card. START USING YOUR PLAN once your coverage starts. GET STARTED ONLINE at myuhc.com and download the Health4Me app to help manage your health and benefits. 1. Go to myuhc.com. 2. Click on Register Now. Use your plan. Here are some great ways to use your plan throughout the year: SCHEDULE A PREVENTIVE EXAM, flu shot or other preventive screening service. USE OUR RESOURCES to help stay healthier and save money. ESTIMATE YOUR COSTS before you get care with myuhc.com or the Health4Me app. GET ON-THE-GO ACCESS to health and account info, tools and resources with the Health4Me app. CALL US FOR HELP when you need us. MANAGE YOUR PLAN AND HEALTH ONLINE at myuhc.com. Do you need more help? uhc.com welcometouhc.com/florida Toll-free , TTY 711 Habla Español? Podemos ayudar. 11

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16 This information is not intended as legal or tax advice. Please contact a competent legal or tax professional for personal advice on eligibility, tax treatment and restrictions. Federal and state laws and regulations are subject to change. Certain preventive care services are provided as specified by the Patient Protection and Affordable Care Act (ACA), with no cost-sharing to you. These services are based on your age, gender and other health factors. UnitedHealthcare also covers other routine services that may require a copay, coinsurance or deductible. The UnitedHealthcare plan with Health Savings Account (HSA) is a high deductible health plan (HDHP) that is designed to comply with IRS requirements so eligible enrollees may open a Health Savings Account (HSA) with a bank of their choice or through Optum Bank, Member of FDIC. The HSA refers only and specifically to the Health Savings Account that is provided in conjunction with a particular bank, such as Optum Bank, and not to the associated HDHP. For a complete description of the UnitedHealth Premium program, including details on the methodology used, geographic availability, program limitations and medical specialties participating, please see myuhc.com. 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. Please discuss with your doctor how the program information provided is right for you. The NurseLine Care Coordination Nurse, and Cancer Nurse Advocate services are for informational purposes only, and should not be used for emergency or urgent care situations. In an emergency, call 911 or go to the nearest emergency room. Nurses cannot diagnose problems or recommend specific treatment and are not a substitute for your doctor s care. These services are not an insurance program and may be discontinued at any time. They are included as part of your health plan. Disease Management programs and services may vary on a location-by-location basis and are subject to change with written notice. UnitedHealthcare does not guarantee availability of programs in all service areas and provider participation may vary. Certain items may be excluded from coverage and other requirements or restrictions may apply. If you select a new provider or are assigned to a provider who does not participate in the Disease Management program, your participation in the program will be terminated. Self-Funded or Self-Insured Plans (ASO) covered persons may have an additional premium cost. Please check with your employer. Mastercard is a registered trademark of MasterCard Worldwide. App Store is a registered trademark of Apple, Inc. Android and Google Play are trademarks of Google, Inc. This communication is not intended as legal or tax advice. Please contact a competent legal or tax professional for personal advice on eligibility, tax treatment and restrictions. Federal and state laws and regulations are subject to change. The information in this guide is a general description of your coverage. It is not a contract and does not replace the official benefit coverage documents which may include a Summary of Benefits and Coverage and Certificate of Coverage/Summary Plan Description. If descriptions, percentages, and dollar amounts in this guide differ from what is in the official benefit coverage documents, the official benefits coverage documents prevail. Administrative services provided by United HealthCare Services, Inc. or their affiliates. 10/ United HealthCare Services, Inc. (ES )