Welcome to everything you value in a health plan.

Transcription

1 Welcome to everything you value in a health plan. Connecticut Small Group (1 50) Health Plan Portfolio Effective Jan. 1, 2018

2 Health plans to fit your needs. Our Oxford portfolio includes a wide range of flexible health plan solutions designed for affordability. You can choose a traditional open access plan, or pick from referral, account-based, tiered benefit, limited network or higher cost-share plans. So you can offer your employees a more comprehensive benefit package, we also integrate pharmacy benefits with our medical plans and offer a variety of specialty benefit options. Contents: Health plans at a glance Connecticut small group plan descriptions Network access Delivering on what employers value Delivering on what employees value

3 Health plans at a glance. 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. Increasing level of member involvement. Low Medium High Products Freedom Plan PPO HMO HSA PPO Non-Gated HMO HSA Liberty HMO Liberty HMO HSA Network coverage Out-of-network coverage Account-based plan Primary care physician (PCP) referral required Online tools and technology Member support programs Health and wellness programs No-fee UnitedHealthcare Benefit Services (FSA, Pretax, COBRA, for 2 99) Metallic tier 1 Silver Platinum Platinum Bronze Silver Bronze Silver Bronze Silver Premium relative to other plans $$$$ $$ $$ $$ $ $ Key Our Best, Largest Better, Plus Better, More Included Not available Freedom Network with access to the nationwide UnitedHealthcare Choice Plus Network. 2 Freedom Network access only. Liberty Network access only. 3

4 Connecticut small group plan descriptions. Below are more details about the plans depicted in the chart on the previous page. Products with LOW level of member involvement. Freedom Plan PPO These products offer combined in- and out-of-network coverage, do not require referrals for specialist visits and include an in-network deductible and coinsurance. These plans also provide access to the nationwide UnitedHealthcare Choice Plus Network 1 when outside the Oxford service area. 3 Products with MEDIUM level of member involvement. Oxford HMO These plans provide an opportunity to groups who are comfortable with in-network only products and enjoy the associated premium savings. Members enrolled in the Oxford HMO are not required to obtain a referral for specialist visits. Products with HIGH level of member involvement. Oxford HSA PPO These are consumer-driven health plans made up of two parts: a high-deductible health plan and an optional health savings account (HSA). With these plans, members are eligible to open an HSA and deposit money, before taxes, to pay for eligible medical and pharmacy expenses, including their deductible, or save it for future expenses. These plans also give members the choice to go in- or out-of-network for care, and referrals are not required for specialist visits. Some plans offer office and facility copayments after the deductible. Oxford Non-Gated HMO HSA These plans provide an opportunity to groups who are comfortable with in-network only products and enjoy the associated premium savings. This traditional HMO plan is HSA-compatible, so members can open and deposit money, before taxes, into their own personal savings account. Members can use the money to pay for eligible medical and pharmacy expenses, including their deductible, or save it for future expenses. Members enrolled in the Oxford Non-Gated HMO HSA are not required to obtain a referral for specialist visits. Oxford Liberty HMO These products provide in-network only benefits within the Oxford Connecticut Liberty Network of providers and associated premium savings for members. Members select a PCP of their choice and specialist visits require a referral. The Oxford Connecticut Liberty Network provides access to retail pharmacies, including major chains, mass merchants and supermarkets. Walgreens, Rite Aid and Walmart are just some of the pharmacies where Oxford Connecticut Liberty Network members can fill prescriptions. Prescriptions cannot be filled at CVS, Target or non-chain pharmacies. Oxford Liberty HMO HSA This product provides the same benefits as an Oxford Liberty HMO product, but may be paired with a health savings account (HSA) for members to use for eligible medical and pharmacy expenses. 4

5 Network access. We know how important it is to find the right doctor. That s why we offer local and nationwide networks, and the UnitedHealth Premium designation program, to help you find one. 4 Freedom Network Through our Freedom Network, employers enrolled in our Oxford plans have access to 20,324 individual providers 5 and 28 hospitals 6 in the state, plus an additional 57,090 providers in New York and 27,500 providers in New Jersey 7. Liberty Network Through our Oxford Connecticut Liberty Network, employers enrolled in our Oxford Liberty plans have access to 20,070 providers 8 and 28 hospitals 6 in the state, plus an additional 51,177 providers in New York and 24,900 providers in New Jersey 7. Broad national network Our UnitedHealthcare national network provides seamless access to care for 99 percent of the U.S. population in 96 percent of all U.S. counties. 9 UnitedHealth Premium designation program 4 This program recognizes doctors who meet standards for quality and cost-efficiency. We use evidence-based medicine and national industry guidelines to evaluate quality. The cost-efficiency standards rely on local market benchmarks for the efficient use of resources in providing care. This program applies to certain specialists and not to all providers. You can search for Premium designated providers within our doctor search tool at oxfordhealth.com. 911,440 doctors 5,647 hospitals Awards and recognition. At UnitedHealthcare, we strive to deliver consistent performance, solid fundamental execution and an innovative approach to health care. We are privileged to be recognized with awards for our work. UnitedHealthcare s parent company, UnitedHealth Group, was the top-ranking company in the insurance and managed care sector on Fortune s 2016 World s Most Admired Companies list. This is the seventh straight year UnitedHealth Group ranked No. 1 overall in its sector (February 2017). 10 UnitedHealth Group was recognized as one of America s 50 most community-minded companies for 2017 in the Civic 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). 12 5

6 Delivering on what employers value. You ll be surprised to learn how many tools we offer to help make your job easier. You value: Comprehensive benefit plans Integrated medical and pharmacy benefits Specialty benefits We offer: A variety of plan designs ranging from open access to primary care provider-centric to consumer-driven and more. All products come with our pharmacy benefit. This includes a network of retail pharmacies 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 standard shipping at no additional cost. A full suite of dental, vision, life and disability products. Innovative employer tools Our website, oxfordhealth.com, is designed to make it easier for you to keep track of your company s health care coverage, download forms and conduct real-time transactions. From the Transactions tab, you can perform the typical, day-to-day functions that come with managing your company s health care coverage. Check: Billing, eligibility and benefits. Enroll: Employees, dependents and spouses, as well as terminate members. Request: Subscriber and member lists, usernames, materials and ID cards. Change: Member information, addresses, usernames and passwords. The Tools & Resources tab is where you can find the information you need on Oxford policies, forms and benefit offerings. You can also use this tab to find materials that your employees rely on to help them get the care they need, stay healthy and make the most of their Oxford benefits. Simple, worry-free onboarding process Supportive customer service We ll handle many of the administrative tasks: Customer Service: Representatives available to answer your questions during open enrollment. Clear online and print communications. Oxford Express : Our 24-hour interactive voice response (IVR) system gives benefit administrators easy access to check member eligibility status and obtain billing and payment information. Reliable, personal service and support for employers and employees. 6

7 Delivering on what employees value. What if you could help improve your employees health and well-being, increase productivity and job performance, and boost 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 address behavior change. Your employees value: Mobile access to health care information Online health and wellness tools Physical fitness reimbursement 24/7 access to health care guidance Reliable member support (excluding periodic downtime for maintenance) We offer: The UnitedHealthcare Health4Me mobile app, which allows employees to find nearby providers, check the status of a claim, see an account balance or speak directly with a nurse. Rally, an interactive health and wellness component of your employees health plan website. By harnessing the power of data, social connections and rewards, your employees can receive personal lifestyle plans that focus on goals, competition, tracking progress and healthy living. Rally offers a personalized interaction experience that includes step-based Challenges, discussion Communities, individual action plans called Missions, health information and more. Sweat Equity Physical Fitness Reimbursement, which gives members the chance to get up to $200 every six months for fitting in regular workouts. It s a special thank-you to members for their efforts to lead a healthy life. 13 Knowledgeable registered nurses available 24 hours a day, seven days a week by phone or online chat to help manage illness or injury, or get maternity education support. Members can also call and listen to recorded messages on more than 1,100 health topics. Tools to help your employees stay healthy at uhc.com/preventivecare, including information about 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, diabetes and heart failure enhance selfcare, identify warning signs and access resources for assistance. This helps reduce the need for urgent or emergency services. Health discount program Our health discount program helps give your employees access to a wide range of health- and wellness-related programs, products and services, helping employees save money and gain healthy lifestyle information. 14 7

8 1 In accordance with the Affordable Care Act (ACA), all of our Connecticut small group plans can also be identified by metallic benefit coverage levels: Bronze, Silver, 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 (EHB) and consumer protections. Each metallic level includes choices of benefits, plan types and price. 2 Nationwide network may not be available for all groups. 3 Oxford service area includes Connecticut, New Jersey and certain New York counties (Ulster, Sullivan, Dutchess, Orange, Putnam, Rockland, Westchester, Bronx, New York, Queens, Kings, Richmond, Nassau and Suffolk). 4 For a complete description of the UnitedHealth Premium designation program, including details on the methodology used, geographic availability, program limitations and medical specialties participating, please visit UnitedHealthPremium.com. 5 Network Report, November This data represents all participating (network) providers except ancillary providers (i.e., laboratories, radiology centers, urgent care centers, hospitals etc.). Dental, behavioral health practitioners, complementary and alternative medicine providers are included. Providers who are board certified in more than one specialty, and/or practice at more than one location, are counted only once and at only one location. 6 Network Report, July This data represents all participating (network) facilities except long term care, rehab and veterans hospitals. 7 Network Report, December This data represents all participating (network) providers except ancillary providers (i.e., laboratories, radiology centers, urgent care centers, hospitals etc.). Dental, behavioral health practitioners, complementary and alternative medicine providers are included. Providers who are board certified in more than one specialty, and/or practice at more than one location, are counted only once and at only one location. 8 Network Report, November This data represents all participating (network) providers. National Network access not available with the Oxford Connecticut Liberty Network. 9 As of June 2017, UnitedHealth Networks national network statistics. 10 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. 11 As determined by an annual survey administered by True Impact and analyzed by VeraWorks. For more information, visit civic50/. 12 Awards criteria is based on a wide range of well-being contributors including job satisfaction, community involvement, financial security, emotional health and social connectedness. For more information, visit 13 Reimbursement amounts vary depending upon your plan. Plan participants should refer to their health plan documents or check with their benefits administrator to determine eligibility and how much they may be reimbursed. They may submit a request for reimbursement under the program once every six months. Plan participants should consult with an appropriate tax professional to determine if they have any tax obligations from receiving reimbursement under this program. 14 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, , Oxford HMO products are underwritten by Oxford Health Plans (CT), Inc. Oxford insurance products are underwritten by Oxford Health Insurance, Inc. Facebook.com/UnitedHealthcare Twitter.com/UHC Instagram.com/UnitedHealthcare YouTube.com/UnitedHealthcare MT Oxford CTSG 1-50 Product Capabilities Brochure CT / Oxford Health Plans LLC. All rights reserved R7