2018 Maine Small Group (1-50) Health Plan Portfolio.

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1 2018 Maine Small Group (1-50) Health Plan Portfolio.

2 What do you value in a health plan? Businesses today are faced with a lot of difficult decisions. Finding the right health care benefits plan should not be one of them. No matter how you get into the health care system, we can help make it simpler. UnitedHealthcare is committed to finding solutions to help fit the health care needs of Maine small group (1-50) employers. You want to offer benefits that help attract employees and keep them healthier. UnitedHealthcare provides a variety of health plans that help you achieve your goals while educating and engaging employees in making informed health care choices to help control costs. Our UnitedHealthcare portfolio includes a variety of products designed to be affordable and provide flexible health plan solutions. Choose from traditional open access plans, account-based, tiered benefit, limited network and higher cost share plans. We also Member Role/Level of Member Involvement Low Moderate Products Choice Plus FlexFree HSA Network Coverage Out-of-Network Coverage Cost-Efficient Network Account-Based Plan Hospital Tiering Primary Care Physician (PCP) Referrals Required Online Tools and Mobile Apps Member Support Programs Health and Wellness Programs No-Fee UnitedHealthcare Benefit Services (FSA, Pre-Tax, COBRA, for 2 99) Metallic Tier Silver, Gold, Platinum Silver Bronze, Silver, G Relative Premium $$$$ $$$ $$$ KEY Our Best, Largest Better, Plus Better, More Good Basic Not Available Included 3

3 integrate pharmacy benefits with our medical plans and offer a variety of specialty benefit options so you have the ability to offer your employees a comprehensive benefit package. In accordance with the Affordable Care Act (ACA), all of our Maine small group plans can also be identified by metallic benefit coverage levels: Bronze, Silver, Gold and Platinum. These designations indicate the relative value of the covered benefits, from Bronze (lowest) to Platinum (highest). All plans must meet standard requirements for affordability, essential health benefits and consumer protections. Each metallic level includes choices of benefits, plan types and price. Think about what you value most in a health plan and use the chart below to help you determine which product has the features and benefits you are looking for. High Primary Advantage Motion HSA Navigate Plus Navigate Plus HSA old Silver Silver, Gold Gold, Platinum Bronze, Silver $$$ $$$ $$ $$ 4

4 Maine Small Group Plan descriptions. Below are more detailed plan descriptions as depicted in the chart on the previous page. Products with low level of member involvement UnitedHealthcare Choice Plus This is a traditional health plan with copayments, coinsurance and deductibles. Members 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. Members can choose services outside our network, but their payments will be higher. Products with moderate level of member involvement UnitedHealthcare Choice Plus HSA Primary Advantage (Non-Gated) This consumer-driven health plan is made up of 2 parts: a high-deductible health plan and a Health Savings Account (HSA). With this plan, members can open and deposit money, before taxes, into an HSA, which is their own personal savings account. Members can use the money to help pay for eligible medical and pharmacy expenses, including their deductible, or save it for future expenses. Some plans offer office and facility copayments after the deductible. Referrals are not required for specialists. This is a network-only product that puts an emphasis on benefits where health care encounters are most prevalent: preventive care, services provided by a PCP or OB/GYN, and Tier 1 prescription drugs, which are available through low copayments and are not subject to a deductible. If a higher level of care is required, Primary Advantage provides members access to comprehensive coverage through a vast network of specialists and hospitals. These services are subject to a deductible; however, once the deductible has been met, benefits are covered through clearly defined copayments, a feature designed to add predictability to health care spending. A referral is not required for specialist visits. Products with high level of member involvement Motion HSA The UnitedHealthcare Motion program is a new option for employers that rewards employer groups and consumers for taking ownership of their health care resulting in healthier employees and lower costs. There are 2 HSA options with Motion embedded. A key component of UnitedHealthcare Motion is promoting and rewarding physical activity through the use of activity trackers. UnitedHealthcare Navigate Plus UnitedHealthcare Navigate Plus HSA FlexFree These plans provide the highest level of coverage when the member has a referral from their primary care physician prior to receiving services from another network physician, and a lower level of coverage if there is no referral. The lowest level of coverage applies if an out-of-network provider is used. These plans are structured the same as Navigate Plus but may be paired with a Health Savings Account (HSA). With this plan, members can open and deposit money, before taxes, into an HSA, which is their own personal savings account. Members can use the money to help pay for eligible medical and pharmacy expenses, including their deductible, or save it for future expenses. These plans feature no-additional-cost office visits and urgent care visits to cover employees occasional health care needs for sickness and minor injuries. 5

5 Network access. We know how important it is to find the right doctor. That s why we offer both a local and a large nationwide network to help you find one. Local Network: Maine employers enrolled in our UnitedHealthcare plans have access to 6,518 providers and 33 hospitals in the state.* Broad National Network: Our UnitedHealthcare national network provides access to 99 percent of the U.S. population in 96 percent of all U.S. counties. *As of 3/30/2016 and 6/30/ ,735 doctors 5,665 hospitals 67,000 pharmacies Virtual Visits No driving. No crowded waiting rooms. See a doctor when you need a doctor. When employees are sick they often miss work. If they are unable to see their own doctor, they may visit an urgent care or emergency department, which can be costly and time-consuming. With virtual visits, employees can see and speak to a doctor 24 hours a day/7 days a week using a mobile device or computer, all from the convenience of their home or office. If needed, a prescription* can be sent to their local pharmacy. Virtual visits are integrated into their medical benefits. The virtual visit provider groups we contract with deliver care using live audio and video technology based on quality standards aligned with American Medical Association (AMA) and Federation of State Medical Boards (FSMB) guidelines. *Prescription services may not be available in all states. 6

6 Helping deliver on what employers value most. You ll be surprised to learn how many tools UnitedHealthcare offers to help make your job easier. You Value: Benefit Plans Integrated Medical and Pharmacy Benefits Specialty Benefits Innovative Employer Tools UnitedHealthcare Offers: A variety of plan designs ranging from open access to primary care provider-centric to consumer-driven and more which can be sold as a package, allowing you to select the options that might work best with your employee population. All products come with our integrated pharmacy benefit. This includes 67,000 network retail pharmacies that are available to you across the country and 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. Help attract and retain employees by offering more options. UnitedHealthcare is able to offer you a selection of dental, vision, life and disability products in addition to our medical products. Employer eservices is designed to save time and money by streamlining online eligibility, enrollment, billing and reporting. Manage virtually every aspect of benefits administration online. 7

7 Helping deliver on what employees value most. What if you could help improve your employees health and well-being, increase productivity and job performance, and increase employee satisfaction and retention all at no additional cost to you? Understanding and identifying the health risks of your employees is the first step in creating a comprehensive wellness strategy that can help address behavior change. Your Employees Value: Cost Comparison Tools Mobile Access to Health Care Information Online Health and Wellness Tools Consumer Wellness Program 24/7 Access to Health Care Guidance Reliable Member Support Health Discount Program* UnitedHealthcare Offers: Our myhealthcare Cost Estimator tool provides information on procedures, providers, even estimated prices to encourage choices that help increase savings and improve health. The UnitedHealthcare Health4Me mobile app helps employees to find nearby providers, check the status of a claim, see an account balance or speak directly with a nurse. Our myclaims Manager helps your employees better understand their health care benefits, what their plan paid, and what they owe and why. And the Smart Patient app lets employees log health information such as blood pressure, cholesterol and body mass index (BMI), set reminders for medical appointments, use checklists to help them determine what to ask doctors and pharmacists, and more. Rally is an interactive health and wellness component of myuhc.com. By harnessing the power of data, social connections and rewards, consumers receive personal lifestyle plans that focus on goals, competition, tracking progress and healthy living all while earning Rally Coins. Rally offers a personalized interaction experience with: step-based Challenges, discussion Communities, individual action plans called Missions, health information and more. UnitedHealthcare Motion is a new program option for employers that rewards employer groups and consumers for taking ownership of their health care, resulting in healthier employees and lower costs. A key component of UnitedHealthcare Motion is promoting physical activity through the use of activity trackers. Speak with knowledgeable registered nurses 365 days a year 24/7 by phone or online chat to help manage illness or injury as well as maternity education support. UnitedHealthcare provides tools to help your employees stay healthy at uhcpreventivecare.com to find out which immunizations and screenings are recommended for all family members at different stages of their lives. We send special mailings HealtheNote Reminders on the topics of women s health, child and adolescent immunizations, coronary artery disease and diabetes to the homes of your employees who we think can benefit from this information. We also offer condition management programs to help members with chronic health issues, such as chronic kidney disease and heart failure enhance self-care, identify warning signs and access resources for assistance, reducing the need for urgent or emergency services. By developing trusted relationships we can reinforce and support physician treatment plans, and help members get the most out of their care encounters. And, all members (not just those in crisis) are able to tap into our Employee Assistance Program (EAP), 24 hours a day, 7 days a week, for information to help them make informed decisions about their health and well-being. Our health discount program helps employees and their families typically save 10 to 25 percent on a wide range of health- and wellness-related programs, products and services. Discounts are available for the member, spouse and dependents and include access to a robust network of 150,000 health care professionals, facilities and retailers including popular brands such as Jenny Craig, Nutrisystem, Anytime Fitness, Jazzercise and others. *Components are subject to change. 8

8 Awards and recognition. UnitedHealthcare s parent company, UnitedHealth Group, strives to deliver consistent performance, solid fundamental execution and an innovative approach to health insurance. We are privileged to be recognized with awards for our work. UnitedHealth Group was the top-ranking company in the insurance and managed care sector on Fortune s 2017 World s Most Admired Companies list. This is the seventh straight year UnitedHealth Group ranked No. 1 overall in its sector. (February 2017) UnitedHealth Group was recognized as one of America s 50 most community-minded companies for 2017 in the Civic 50. For the sixth consecutive year, the National Business Group on Health honored UnitedHealth Group with a Platinum award for being named one of the Best Employers for Healthy Lifestyles (2016). For more information, please contact your broker or UnitedHealthcare sales representative. UnitedHealthcare Motion is a voluntary program. The information provided under this program is for general informational purposes only and is not intended to be nor should be construed as medical advice. You should consult an appropriate health care professional before beginning any exercise program and/or to determine what may be right for you. Receiving an activity tracker and/or activation credit may have tax implications. You should consult an appropriate tax professional to determine if you have any tax obligations from receiving an activity tracker and/or activation credit under this program, as applicable. If any fraudulent activity is detected (e.g., misrepresented physical activity), you may be suspended and/or terminated from the program. If you are unable to meet a standard related to health factor to receive a reward under this program, you might qualify for an opportunity to receive the reward by different means. Contact us at X and we will work with you (and, if necessary, your doctor) to find another way for you to earn the same reward. Rally Health provides health and well-being information and support as part of your health plan. It does not provide medical advice or other health services, and is not a substitute for your doctor s care. If you have specific health care needs, consult an appropriate health care professional. Participation in the health survey is voluntary. Your responses will be kept confidential in accordance with the law and will only be used to provide health and wellness recommendations or conduct other plan activities. 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. Virtual visits are not an insurance product, health care provider or a health plan. Unless otherwise required, benefits are available only when services are delivered through a Designated Virtual Network Provider. Virtual visits are not intended to address emergency or life-threatening medical conditions and should not be used in those circumstances. Services may not be available at all times or in all locations. FORTUNE is a registered trademark of Time, Inc. FORTUNE and Time Inc. are not affiliated with, and do not endorse products or services of UnitedHealth Group. 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. Specialty benefits and programs may not be available in all states or for all group sizes. All UnitedHealthcare members can access a cost estimator online tool at myuhc.com. Depending on your specific benefit plan and the ZIP code that is entered, either the myhealthcare Cost Estimator or the Treatment Cost Estimator will be available. A mobile version of myhealthcare Cost Estimator is available in the Health4Me mobile app, and additional ZIP codes and procedures will be added soon. This tool is not intended to be a guarantee of your costs or benefits. Your actual costs and/or benefits may vary. When accessing the tool, please refer to the Terms and Conditions of Use and Why Your Costs May Vary sections for further information regarding cost estimates. Refer to your health plan coverage document for information regarding your specific benefits. Disclosure: The Health Discount Program is administered by HealthAllies, Inc., a discount medical plan organization. The Health Discount Program is NOT insurance. The discount program provides discounts at certain health care providers for medical services. The discount program does not make payments directly to the providers of medical services. The discount program member is obligated to pay for all health care services but will receive a discount from those health care providers who have contracted with the discount plan organization. HealthAllies, Inc., is located at P.O. Box 10340, Glendale, CA 91209, , ohacustomercare@optumhealth.com. 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. Currently, UnitedHealthcare Motion is not available for all small groups in Maine. It is available for Maine small groups who enroll in the Motion HSA plan. Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Health Plan coverage provided by or through UnitedHealthcare of New England, Inc MT / United HealthCare Services, Inc UHC MESG 1-50 Product Capabilities Brochure