Changes for Connecticut Employers Renewing on or after Jan. 1, 2014

Transcription

1 Changes for Connecticut Employers Renewing on or after Jan. 1, 2014 As you know, many of the Affordable Care Act (ACA) provisions are being implemented on Jan. 1, 2014 and all Connecticut small group (1-50) plans will change. In 2014, our products will include essential health benefits (EHB) and have different cost-sharing choices. Changes to Connecticut Small Group (1-50) Plans Our current Oxford 1 Connecticut small group plan designs will be changing upon renewal, beginning with Jan. 1, 2014 effective dates through the end of We will be automatically renewing these plans into new ACA compliant plans. Employers may choose to renew into the proposed ACA compliant plan or, if they prefer, may also choose any of the other Oxford plans we offer in the Connecticut small group market. If no action is taken prior to renewal, these employers will be automatically renewed in the alternative plan described in their renewal packet and billed accordingly. In addition to EHB and ACA required changes, we are making other modifications that may affect your Connecticut small group clients upon renewal: Out-of-Network Reimbursement Amount Change: For plans with out-of-network benefits, beginning with renewals effective Jan. 1, 2014, reimbursement for out-of-network covered services delivered by nonparticipating providers will be based on 110 percent of the published rates allowed by Medicare. 2 This change will be made to all Connecticut small group plans with out-of-network coverage. 2 We have enclosed a document entitled Understanding Non-Network Expenses for you to share with your clients. Oxford USA: Employers with Oxford USA out-of-area coverage will be transitioned to an alternate Oxford Health Insurance, Inc. option that will provide out-of-area coverage. Dental or Vision Rider: For groups that have the added dental or vision rider as part of their medical plan, these options will no longer be available upon renewal. UnitedHealthcare offers many stand-alone specialty benefit options as well as pre-packaged specialty benefit options through Oxford Benefit Management (OBM). 3 Preferred Generics (also known as Mac-A): Beginning on Jan. 1, 2014, Connecticut small group members enrolled in an Oxford plan will experience a prescription drug change. If a generic prescription drug is available for a brand name drug, the member will pay the Tier 1 copayment for the brand name drug plus the cost difference between the brand as dispensed and the generic alternative. Groups will receive their renewal package 60 days in advance of their renewal date. The renewal package will provide a high-level comparison of the group s current plan design and the new, ACA compliant plan design, and updated rate information. We will also include a flier that describes the health reform impacts on benefits and coverage. In addition, employers will be able to view their Summary of Benefits and Coverage (SBC) 4 on IDEA 60 days prior to their renewal date. The SBC gives further plan details. As part of our standard protocols, brokers will receive a copy of their Connecticut small group client s 60 day renewal letter. We have enclosed copies of these materials for your reference: 2014 Connecticut Small Group Renewal Letter (60 day notice) Health Reform Impacts on Benefits and Coverage Renewal Insert Understanding Non-Network Expenses (MNRP) Overview 2014 Connecticut Small Group (1-50) Product Portfolio In accordance with the ACA, all of our 2014 Connecticut small group plans will 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. Enclosed, for your convenience, is the 2014 Connecticut Oxford small group product portfolio broken out by metallic level. We have also developed a new marketing brochure for this segment to help you explain our portfolio to prospective small group employers.

2 2014 Connecticut Oxford Small Group Product Portfolio by Metallic Level 2014 Connecticut Oxford Small Group Product Brochure Changes to Connecticut Fully-Insured Large Group (51+) Plans Employers will see an impact on the health coverage they offer their employees as a result of some of the changes under the ACA. As part of our large group renewal process, we will include a flier that discusses several of the provisions and health plan changes that have the greatest impact to employers. Examples of provisions that will impact both UnitedHealthcare and Oxford large group clients include: Expansion of benefits Employer and individual mandates Premium and rating changes Overview of Taxes and Fees Affecting Employers Reporting Requirements In addition to EHB and ACA-required changes, we are making other modifications that may affect your large group (51+) client upon renewal: Large group changes on the Oxford platform include: Oxford USA: Employers with Oxford USA out-of-area coverage will be transitioned to an alternate Oxford Health Insurance, Inc. option that will provide out-of-area coverage. Dental or Vision Rider: For groups that have the added dental or vision rider as part of their medical plan, these options will no longer be available upon renewal. Please note, your account representative will provide you with a quote for similar dental and vision plans through UnitedHealthcare Specialty Benefits. Out-of-Network Reimbursement Methodology Options in Connecticut: Beginning with renewals effective Jan. 1, 2014, and subject to final regulatory approval, large group (51+) employers enrolled in a Connecticut Oxford plan will have a choice of out-of-network reimbursement options for covered services delivered by nonparticipating physicians. Reimbursement may be based either on 110% or 140% of the published rates allowed by Medicare. UCR options will also be available. Large group changes on the UnitedHealthcare platform include: Vision Exam: For groups that have an embedded vision exam as part of their medical plan, this option will no longer be available upon renewal. The Standard Vision Program (SVP) for material discounts will also no longer be included for renewal dates beginning Jan. 1, Your account representative will provide you with a quote for vision plans through UnitedHealthcare Specialty Benefits. Be sure to check with your broker or UnitedHealthcare sales representative to find out about other options available for large group employers at renewal. We have enclosed copies of both the UnitedHealthcare and Oxford large group (51+) renewal inserts for your reference: 2014 Oxford Large Group (51+) Fully Insured ACA Renewal Insert 2014 UnitedHealthcare Large Group (51+) Fully Insured ACA Renewal Insert For the latest information on health care reform, visit our Resource Center at For specific questions, please contact your UnitedHealthcare sales representative. Thank you for your continued support. 1 Oxford HMO products are underwritten by Oxford Health Plans (CT), Inc. Oxford insurance products are underwritten by Oxford Health Insurance, Inc. 2 Subject to approval by regulators. If a Medicare based amount is not available, we will use a relative value scale based on difficulty, time, work, risk and resources of the service; the relative value scale may be provided by our affiliate OptumInsight. Please see your Certificate of Coverage for more information. 3 Oxford Benefit Management (OBM) packages are not available in all states and state-specific requirements may cause limitations or variations to the plans. Packaged Savings is not available for this product. Components are subject to change. UnitedHealthcare Life and Disability products are provided by UnitedHealthcare Insurance Company or its affiliates. UnitedHealthcare Dental plans are provided by or through UnitedHealthcare Insurance Company or its affiliates. UnitedHealthcare Vision plans are provided by UnitedHealthcare Insurance Company or its affiliates. UnitedHealthcare Vision benefits and administrative services are provided by or through Spectera, Inc. UnitedHealthcare Insurance Company is located in Hartford, CT. 4 As of Sept. 23, 2012, the Affordable Care Act (ACA) requires all health plan issuers and group health plans to provide new and renewing groups and members a Summary of Benefits and Coverage (SBC) for their health benefit plan. This notification provides information regarding when and how SBCs will be made available to you and when you need to provide it to your members. All assumed renewal plan SBCs are made available through IDEA and the Employer portal of oxfordhealth.com within 60 days of your renewal date. The information related to when you must provide the SBCs to your members is found directly on IDEA and the Employer portal. A paper copy is available upon request by calling Client Services. CT (10/9/13)

3 <Date> <BA Name> <Group Name> <Address> <City>, <State> <ZIP> RE: Renewal Information for: <Group Name>, Group #: <Group # >; <CSP Code> Dear <BA Name>, Thank you for allowing UnitedHealthcare to serve your health benefit plan needs. Your company's policy is scheduled to renew on <effective date>. This is a year of change and we have built tools to help you navigate that change and determine which plan(s) best meet your business needs. Your current Oxford 1 plan design will be changing and we are renewing your group coverage into a new Affordable Care Act (ACA) compliant plan. There are many changes this year to benefits and member cost shares. It is important that you fully understand your replacement coverage. Please review this renewal package and your Summary of Benefits and Coverage (SBC), 2 which you can now access using our Oxford small group online renewal tool, Idea Management System SM (IDEA). We have also enclosed information explaining how the ACA, including the addition of Essential Health Benefits (EHB), may impact your benefits and pricing. Our goal is to provide information that will help guide you in making your renewal choice for the coming year. You can choose to renew into your proposed ACA compliant plan or, if you prefer, you may also choose any of the other Oxford plans we offer in the Connecticut small group market. Please note that if no action is taken prior to renewal, you will be automatically renewed in the replacement plan described in your renewal packet and billed accordingly. Our Oxford portfolio includes a variety of products with a wide range of affordable and flexible health plan solutions. For your convenience, enclosed in this packet is a snapshot of our 2014 Connecticut small group product portfolio. We also offer dedicated service for members and employers, comprehensive online resources and health coach programs, plus a variety of disease management programs and services. We know how important it is to find the right physician. That s why we continue to offer our robust local Network as well as access to our national provider network when traveling outside of the Oxford service area: Our Network offers your employees access to more than 104,000 physicians and other health care professionals at more than 173,000 locations in the tri-state region of Connecticut, New York and New Jersey of which almost 30,000 have their practice in Connecticut. 3 The UnitedHealthcare Choice Plus national network is available with most plans and provides your employees seamless access to more than 726,000 physicians, 5,600 hospitals and 65,000 pharmacies across the United States. 4 We also understand how important it is for employers to have the ability to offer their employees a comprehensive benefit package. If you are interested in purchasing specialty benefits, look no further. UnitedHealthcare offers a full suite of dental, vision, life and disability products in addition to our medical products. Pre-packaged specialty benefits are available to Connecticut small group employers with more than two employees through OBM. This bundled solution combines dental and vision products with several health and wellness programs, including an Employee Assistance Program (EAP) with WorkLife services, health discounts and an optional life benefit. More details can be found at 5 (over)

4 Stand-alone specialty benefits are also available to Connecticut small group employers with more than two employees, which include basic life insurance, supplemental life insurance, dental insurance, vision insurance, short-term disability and long-term disability insurance. More details can be found at 5 Plus, you don t have to wait for your renewal period to add specialty products to your benefit package. You can add these benefits at any time. If you have any questions regarding your renewal, prefer to speak to someone directly, or if you would like more information on a specialty benefits quote, please contact your broker, or contact Client Services at or by at groupservices@oxfordhealth.com. We are also here to help you with our online systems and can provide copies of any materials you may not be able to access. We look forward to a continued and long-lasting relationship, serving you and your employees. Sincerely, Client Services Enclosures CC: <Broker> 1 Oxford HMO products are underwritten by Oxford Health Plans (CT), Inc. Oxford insurance products are underwritten by Oxford Health Insurance, Inc. 2 Please Note: As of Sept. 23, 2012, the Affordable Care Act (ACA) requires all health plan issuers (i.e., UnitedHealthcare and Oxford) and group health plans to provide new and renewing groups and members a Summary of Benefits and Coverage (SBC) for their health benefit plan. This notification provides information regarding when and how SBCs will be made available to you and when you need to provide it to your members. All assumed renewal plan SBCs are made available through IDEA and the employer portal of oxfordhealth.com within 60 days of your renewal date. If, for any reason, the assumed renewal SBC is not successfully loaded to IDEA or the employer portal, a hard copy will be mailed within 30 days of your renewal date. The information related to when you must provide the SBCs to your members is found directly on IDEA and the employer portal. A paper copy is available upon request by calling Client Services. 3 As of Dec. 31, 2012; represents all participating providers except ancillary providers. Dental and complementary and alternative medicine providers are included (~6 percent of the total without chiropractors who are considered specialists). Providers who are multiple boarded are counted multiple times. Tri-state 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 As of Q UnitedHealth Networks national network statistics. Not available with Primary Advantage or HMO products in Connecticut. 5 Oxford Benefit Management (OBM) packages are not available in all states and state-specific requirements may cause limitations or variations to the plans. Packaged Savings is not available for this product. OBM Benefit options may vary by group size. Components are subject to change. UnitedHealthcare Life and Disability products are provided by UnitedHealthcare Insurance Company or its affiliates. UnitedHealthcare Dental plans are provided by or through UnitedHealthcare Insurance Company or its affiliates. UnitedHealthcare Vision plans are provided by UnitedHealthcare Insurance Company or its affiliates. UnitedHealthcare Vision benefits and administrative services are provided by or through Spectera, Inc. UnitedHealthcare Insurance Company is located in Hartford, CT.

5 Renewal Rates and Plan Information 6 Below is a high level description of your plan changes as well as your renewal rates. Small group plan designs are now identified by four 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). Please review your SBC (available online) for more information about the benefits and member cost shares for this plan. You may also call Client Services to request a paper copy of your SBC. For additional details on rate changes, please visit uhc.com/rating. PLAN INFORMATION PLAN DESIGN EXISTING RENEWAL Metallic Level N/A <Data> Network <Data> <Data> Office Visit Copayment <Data> <Data> Package Description <Data> <Data> Prescription <Data> <Data> Out-of-Network Coinsurance <Data> <Data> Out-of-Network Deductible <Data> <Data> PREMIUMS EXISTING RENEWAL TOTALS <$> <$> PER MEMBER PER MONTH BASE RATE: <$> Member Level Rate Age Rates Age Rates Age Rates Age Rates Age Rates 0-20 <$> 30 <$> 40 <$> 50 <$> 60 <$> 21 <$> 31 <$> 41 <$> 51 <$> 61 <$> 22 <$> 32 <$> 42 <$> 52 <$> 62 <$> 23 <$> 33 <$> 43 <$> 53 <$> 63 <$> 24 <$> 34 <$> 44 <$> 54 <$> >63 <$> 25 <$> 35 <$> 45 <$> 55 <$> 26 <$> 36 <$> 46 <$> 56 <$> 27 <$> 37 <$> 47 <$> 57 <$> 28 <$> 38 <$> 48 <$> 58 <$> 29 <$> 39 <$> 49 <$> 59 <$> COMPLETING YOUR RENEWAL Our Renewal Account Executives work with Connecticut brokers and are available to help you through your renewal process. If you would like to work with one of our Renewal Account Representatives, please contact your broker and let them know. We understand you have many choices for your health care coverage and are here to help you select the best option to meet your company s particular health insurance needs. Details about your renewal can be reviewed and submitted through IDEA. Simply log onto the Employer portal of oxfordhealth.com, click on the My Account tab and you will see the IDEA link. Once in IDEA, you will be able to review your proposed plan as well as explore other available ACA compliant plan options. You will also be able to view the SBC for your ACA compliant replacement plan to help you better understand your group coverage. If you complete the renewal through IDEA, renewals can be submitted up to the last day of the month prior to your renewal date. (over)

6 OTHER CHANGES THAT MAY IMPACT YOUR RENEWAL In addition to the changes already discussed, below are some additional modifications that we wanted to bring to your attention as your make your 2014 plan choices: Out-of-Network Reimbursement Amount Change: For plans with out-of-network benefits, beginning with renewals effective Jan. 1, 2014, reimbursement for out-of-network covered services delivered by nonparticipating providers will be based on 110 percent of the published rates allowed by Medicare. 6,7 This change will be made to all Connecticut small group plans with out-of-network coverage. 7 We have enclosed a document entitled Understanding Non-Network Expenses for you to share with your employees. Oxford USA: Employees with Oxford USA out-of-area coverage will be transitioned to an alternate Oxford Health Insurance, Inc. option that will provide out-of-area coverage. Dental or Vision Rider: For groups that have the added dental or vision rider as part of the medical plan, these options will no longer be available upon renewal. UnitedHealthcare offers many stand-alone specialty benefit options as well as pre-packaged specialty benefit options through Oxford Benefit Management (OBM). ADDITIONAL INFORMATION Actuarial Value and Health Savings Accounts (HSAs): If you are currently offering or considering offering an HSA plan to your employees, you will need to understand how the contributions you make to your employees HSAs can affect the actuarial value of your health plan. If you would like more information on HSA Contribution Requirements under the ACA, please visit the Tools and Resources section of the employer portal of oxfordhealth.com. 6 Premium rates and/or product forms included herein have been filed and are subject to approval by regulators. We reserve the right to modify this quote and benefits described if needed, once final approval is received. 7 If a Medicare based amount is not available, we will use a relative value scale based on difficulty, time, work, risk and resources of the service; the relative value scale may be provided by our affiliate OptumInsight. Please see your Certificate of Coverage for more information. CT CTSG Renewal Letter (ABRP/IDEA)

7 Health Reform Impacts on Your Benefits Coverage and Cost uhc.com/reform United for Reform Resource Center With this renewal, we are required to make changes to your Oxford 1 benefit plan to comply with the Affordable Care Act (ACA). There are many ways this regulation may impact your benefits coverage and your cost. The provisions below are all effective for small groups on or after Jan. 1, 2014 for non-grandfathered plans. The 90 day waiting period is also effective for grandfathered plans. For complete plan details, please refer to your Summary of Benefits and Coverage (SBC). If you have any questions regarding your renewal, or if you would like more information, please contact your broker or call Client Services at Coverage Level Requirements Plan coverage requirements are identified by four 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. IMPACT: If your existing plan did not meet the required value, a plan change was required. Learn more at uhc.com/coverage Essential Health Benefits Coverage must provide for an Essential Health Benefits (EHB) package in 10 benefit categories, as follows: Ambulatory patient services Emergency services Hospitalization Laboratory services Maternity and newborn care Mental health and substance abuse services, including behavioral health treatment Prescription drugs Rehabilitative and habilitative services and devices Preventive and wellness services and chronic disease management Pediatric services, including oral and vision care Plans are required to cover pediatric dental and vision services, not generally covered previously under most typical small group employer plans. Deductible caps for small group plans in 2014 have been set at $2,000 for single coverage and $4,000 for family coverage, along with new accumulation rules for the maximum out-of-pocket. The final regulations issued by Health and Human Services allow a plan to exceed the federal cap on deductibles if the plan is unable to reasonably meet the required actuarial value for the plan s designated metallic benefit coverage level without an increase to the annual deductible. All plans that do contain any EHB must remove annual dollar and lifetime dollar limits for those services. (We removed lifetime dollar limits and most annual dollar limits from our Oxford benefit plans in 2010.) Health and Human Services allows reasonable departures of deductible caps, typically on Bronze plans and subject to state approval.ehb may vary by state. IMPACT: You will likely notice some changes to your plan and rates as a result. Learn more at uhc.com/essential Adjusted Community Rating Under the Adjusted Community Rating (ACR) provision, all enrollees in all non-grandfathererd health plans issued in a particular state are included as members of a single risk pool when developing rates and premiums. The use of actual or expected health status or claims experience is prohibited. If allowed by the state s rate setting requirements, rating factors such as age, geographic area and tobacco use may be used to vary premiums, within certain limits. IMPACT: You may notice changes to your rates as a result. There may be marketwide adjustments for risk adjustment and reinsurance programs. Learn more at uhc.com/rating

8 Health Reform Taxes and Fees To fund some of the changes mandated by the health reform law, several new taxes and fees will impact premiums and rates. The fees may vary by state and are used to fund research that evaluates and compares health outcomes, clinical effectiveness, risks and benefits of medical treatments and services, fund premium tax subsidies for low-income individuals and families, and to fund other requirements of the Affordable Care Act. Two of the more significant reform fees include the Insurer Fee (permanent) and the Transitional Reinsurance Fee ( ). IMPACT: The financial impact of these fees in 2014, based on the government rule and industry analysis, is about 2.5 percent for the Insurer Fee and about $5 per member per month for the Transitional Reinsurance Fee. Fees will be incorporated into premiums and prorated over 12 months.* Learn more at uhc.com/fees 90-day Waiting Period Employers will need to offer new employees health benefit coverage on or before day 90 of their employment. The 90 day waiting period limits apply to all group health plans, grandfathered and non-grandfathered, for the plan year on or after Jan. 1, IMPACT: If your waiting periods were non-compliant, they will be automatically updated to a compliant waiting period upon your renewal. Any Waiting Period greater than 90 days from date of event will be revised to Waiting Period = 90 days Any Waiting Period greater than 60 days with first of month administration will be revised to Waiting Period = 60 days Any Waiting Period greater than 2 months with first of month administration will be revised to Waiting Period = 2 months Educating employees Your employees may be confused and uncertain about the law and what it means. Through a selection of entertaining videos, employees will get simple facts and straight answers about the law. welcometouhc.com/healthcarereform This communication is not intended, nor should it be construed, as legal or tax advice. Please contact a competent legal or tax professional for legal advice, tax treatment and restrictions. Federal and state laws and regulations are subject to change. * The Insurer Fee for New York is 2.2 percent; for Connecticut, it is 2.3 percent. The per member per month Reinsurance Fee for New Jersey and Connecticut is $5.25. Oxford HMO products are underwritten by Oxford Health Plans (NY), Inc., Oxford Health Plans (NJ), Inc. and Oxford Health Plans (CT), Inc. Oxford insurance products are underwritten by Oxford Health Insurance, Inc. MS / Oxford Health Plans LLC. All rights reserved.

9 Understanding Out-of-Network Expenses We encourage you to take an active role in your health care and learn which doctors, health care professionals and facilities participate in our network so you can better understand expenses that may come with using nonparticipating (sometimes called non-network ) providers. oxfordhealth.com mobile From the convenience of your smartphone, you can have instant access to important benefit coverage information. Whether in the doctor s office, traveling or other occasions when you may not have access to a computer, you can simply enter oxfordhealth.com into your smartphone browser and log in for information about your Oxford benefits. The mobile site can be used to find doctors, hospitals, urgent care centers or convenient care clinics, view ID cards, check claims or update profile settings. Oxford On-Call has trained nurses to recognize urgent and emergency room symptoms. Using Oxford On-Call could save you money if you are able to wait for a next-day appointment or urgent care. Do not ignore an emergency. If a situation seems life threatening, take action. Call 911 or your local emergency number right away. Using our partifipating doctors and facilities Doctors and facilities (including laboratories) who participate in our network have agreed to provide services to you at a discount in exchange for obtaining access to provide you and other members with services. Through your Oxford medical plan you have access to our Network, which includes more than 104,000 physicians and other health care professionals at more than 173,000 locations in the tri-state region of Connecticut, New York and New Jersey - of which almost 30,000 of those physicians have their practice in Connecticut. 1 Most plans also provide access to our national UnitedHealthcare Choice Plus network of more than 720,000 physicians, 5,622 hospitals and 65,000 pharmacies when you are outside of the Oxford service area. 2 When you use our network, you are responsible for paying your in-network (sometimes called network ) copayment and out-of-pocket expenses such as deductibles and coinsurance rather than higher out-of-network deductibles and coinsurance. Why does the network change? To continue offering you the best value for your health care dollars, we regularly evaluate our network relationships to enhance our network s quality, convenience and affordability. As a result of this review, doctors, health care facilities and laboratories in our network may change. What you should do If you don t have a doctor, find a doctor now who participates in our network. You will save yourself time when you aren t feeling your best and need to see a doctor. If you have a doctor already, make sure your doctor participates in our network. To find out if your doctor or other health care professional participates in our network, use our online directory on the member portal of oxfordhealth.com or call the Customer Service telephone number on the back of your health plan ID card. It is your responsibility to confirm that the doctor, facility or laboratory participates in our network in order to receive network benefits. Understand the costs for care outside our network Doctors, facilities and laboratories that may not participate in our network are free to set their prices for the care and services they provide. They do not offer services at a discounted rate because they do not participate in our network. When you use nonparticipating doctors, facilities and laboratories for anything other than emergency care, you may pay higher deductible and coinsurance amounts for similar services had you used a health care provider who participates in our network. If you have an out-of-network benefit 3, your Oxford medical plan only pays a portion of out-of-network charges, and it is your responsibility to pay the remainder of the charges. The amount above the allowed amount, which you are required to pay, may be significant and does not apply to your maximum out-of-pocket amount.

10 Reimbursement for out-of-network charges is based primarily on a percentage of the published rates allowed by Medicare. A description of your out-of-network reimbursement coverage can be found in your Certificate of Coverage. In states where we are permitted to pay you directly, you may receive a check for the portion of the charges that are covered by your benefit plan. You will need to forward the payment to the nonparticipating doctor or facility where services were performed. In some situations, nonparticipating providers may require you to pay the entire amount up front. What to do if you choose care outside our network If you choose to receive care from a nonparticipating doctor, facility or laboratory, before you receive care, we recommend you: Understand your benefits. Check your benefit plan documents to confirm that you have out-of-network benefits and understand the details of your out-of-network benefits, including understanding the difference between your in-network deductible and coinsurance, and your out-of-network deductible and coinsurance. Understand what you might have to pay. Ask the doctor or facility about their billed charges for the services you need. Call the Customer Service number on the back of your health plan ID card to have a customer service professional help you estimate how much your Oxford plan will pay. Some services require you to notify us first in order to receive out-of-network benefits. The network delivers real value The following examples show how your financial responsibility may be significantly lower when you seek care from a doctor in the network rather than outside the network. 4 Physician s office visit and facility claims examples for the Out-of-Network Reimbursement Program Please note this example is for illustration only; check your coverage documents for details specific to your plan. Example 1 Physician office visit claim Network Out-of-Network A: Billed charge amount $270 $270 B: Eligible expense (allowed amount) C: Network copayment/30% out-of-network coinsurance D: Additional enrollee responsibility Enrollee financial responsibility paid per contract $20 $150 (MNRP pricing) $45 (30% of B) $0 $120* $20 $165 Example 2 Facility claim Network Out-of-Network A: Billed charge amount $3,700 $3,700 B: Eligible expense (allowed amount) C: Network copayment/30% out-of-network coinsurance D: Additional enrollee responsibility Enrollee financial responsibility paid per contract $500 $1,740 (MNRP pricing) $522 (30% of B) $0 $1,960* $500 $2,482 *This amount does not apply to the maximum out-of-pocket. 1 As of June 2013; represents all participating providers except ancillary providers. Dental and complementary and alternative medicine providers are included (~6 percent of the total without chiropractors who are considered specialists). Providers who are multiple boarded are counted multiple times. Tri-state 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). 2 As of Q UnitedHealth Networks national network statistics. Not available with Primary Advantage and our small group HMO products in Connecticut. 3 Check your benefit plan documents to see whether out-of-network benefits are available to you. 4 These examples are not intended to be an exact calculation of claim payment and individual financial responsibility that may result from the services an enrollee receives. The amounts will vary depending on the actual services the enrollee receives, the enrollee s specific benefit plan copay and/or coinsurance design and changes to Medicare reimbursement methodology. Oxford Health Plans LLC. Oxford HMO products are underwritten by Oxford Health Plans (CT), Inc. Oxford insurance products are underwritten by Oxford Health Insurance, Inc CT / Oxford Health Plans LLC. All rights reserved.

11 2014 Connecticut Small Group (1-50) Oxford Products Please be advised that this guide is for informational purposes only. We reserve the right to correct any typographical errors. For a complete listing of all Connecticut small group (1-50) products, please contact your sales representative. Deductible Coinsurance Maximum Out-of-Pocket Maximum Copayment Per Occurrence 2014 Plan Name Network/ Plan Type Network Out-of-Network Network Out-of-Network Single (Family is 2X) Single (Family is 2X) Network Out-of- Network Single (Family is 2X) Single (Family is 2X) PCP 1 Spec Urgent Care ER Inpatient Hospital 2 Freestanding Outpatient Facility Hospital- Based Outpatient Facility 2 Lab/X-ray Major Diagnostic 2 MRI, CT Freestanding Major Diagnostic 2 MRI, CT Hospital Deductible Type 3 Rx Platinum Plans Plan PPO (20) HMO (21) Plan PPO (22) Plan PPO (23) HMO (24) Gold Plans Primary Advantage (19) HMO HSA (16) HMO (15) Plan PPO (14) Plan PPO (13) Value Option (6) Silver Plans Plan 50 PPO (9) Primary Advantage (10) Plan PPO (11) HSA PPO (12) HSA PPO (7) HMO HSA (8) Smart HSA (18) Bronze Plans HSA PPO (1) HSA PPO (2) HSA PPO (3) HMO HSA (8) Gated Gated $0 $3, % 80% $1,000 $6,000 $15 $25 $75 $ % 100% $ % 100% $75 Embedded 8,9 $0 N/A 100% N/A $1,000 N/A $15 $25 $75 $ % 100% $ % 100% $75 Embedded 8,9 $0 $1, % 60% $1,000 $2,000 $20 $35 $75 $ % 100% 100% 100% 100% 100% Embedded 8,9 $250 $2,500 90% 80% $1,000 $8,500 $15 $25 $75 $150 $250 $150 $250 90% $35 $75 Embedded 8,9 $250 N/A 90% N/A $1,000 N/A $15 $25 $75 $150 $250 $150 $250 90% $35 $75 Embedded 8,9 $1,000 N/A 90% N/A $3,000 N/A $20 D + $35 D + $75 D + $150 D + $250 D + 90% D + $200 D + $35 D + $35 D + $75 $1,250 N/A 100% N/A $3,000 N/A 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Non- Embedded Non- Embedded $1,500 N/A 100% N/A $4,000 N/A $20 $35 $75 $ % 100% $ % 100% $75 Embedded 3,5 $1,500 $4, % 80% $4,000 $8,000 $20 $35 $75 $ % 100% $ % 100% $75 Embedded 3,5 $1,500 $4, % 80% $4,000 $8,000 $25 $40 $75 $ % 100% 100% 100% 100% 100% Embedded 3,5 $1,500 Facility $4, % 80% $6,250 $12,800 $25 $40 $75 $ % 100% 100% 100% 100% 100% Embedded 7,9 $1,000 $4,000 50% 50% $6,250 $12,800 $30 50% 50% N/A 50% 50% 50% 50% 50% 50% Embedded 3,5 $2,500 N/A 80% N/A $5,000 N/A $20 D + $45 D + $75 D + $150 D + $250 D + $150 D + $250 D + $45 D + $45 D + $75 $4,000 $8, % 80% $6,250 $12,800 $30 $45 100% N/A 100% 100% 100% 100% 100% 100% Embedded 3,5 $1,500 $3,000 80% 60% $6,250 $8,000 80% 80% 80% N/A 80% 80% 80% 80% 80% 80% $2,000 $4,000 90% 70% $6,250 $12,800 90% 90% 90% N/A 90% 90% 90% 90% 90% 90% $2,000 N/A 90% N/A $6,250 N/A 90% 90% 90% N/A 90% 90% 90% 90% 90% 90% $2,000 $3, % 80% $4,000 $5,000 D + $20 D + $35 D + $75 D + $150 D + $ % D + $ % 100% D + $75 $3,500 $7,000 60% 50% $6,250 $12,800 60% 60% 60% N/A 60% 60% 60% 60% 60% 60% $4,000 $8,000 70% 50% $6,250 $12,800 70% 70% 70% N/A 70% 70% 70% 70% 70% 70% $5,000 $10, % 80% $6,250 $12, % 100% 100% N/A 100% 100% 100% 100% 100% 100% $5,000 N/A 100% N/A $6,250 N/A 100% 100% 100% N/A 100% 100% 100% 100% 100% 100% Connecticut Small Group (1-50) Pharmacy Options Connecticut Small Group (1-50) Pharmacy Options Mail Order Deductible Member Copayment 2014 Plan Deductible Member Copayment Mail Order ( Plan Code (90 Day Individual Family Tier 1 Tier 2 Tier 3 Code Individual Family Tier 1 Tier 2 Tier 3 Day Supply) Supply) 1 Same as Medical Same as 30% Max 50% Max $15 $25 $40 2.5x 7 $100 N/A $15 Medical $200 $ x 2 Same as Medical Same as 30% Max 50% Max $10 $25 $40 2.5x 8 $50 N/A $15 Medical $200 $ x 3 N/A N/A $15 $25 $40 2.5x 9 $50 N/A $15 $25 $40 2.5x 4 Same as Medical Same as Medical $15 30% Max $200 50% Max $ x 10 $100 N/A $15 $25 $40 2.5x 5 N/A N/A $15 30% Max $200 50% Max $ x 20% Max 40% Max 11 N/A N/A $10 6 $150 N/A $15 $25 $40 2.5x $200 $ x Non- Embedded Non- Embedded Non- Embedded Non- Embedded Non- Embedded Non- Embedded Non- Embedded Non- Embedded Non- Embedded 2,11 1,4 2,11 1,4 1,4 1,4 1,4 1,4 1,4 1,4 1,4 1 Primary care physicians (PCP) include Family Practice, Internal Medicine, Obstetrics-Gynecology and Pediatrics. 2 Facility and hospital copayments are in addition to any plan deductible and coinsurance. Facility and hospital copayments do not apply to the deductible and continue to be required after the deductible is satisfied. These copayments may also be referred to in plan documents as per-occurrence copayments or per-occurrence deductibles. 3 Plans with non-embedded reflect family deductible and maximum out-of-pocket meaning no single in the family has satisfied the deductible or maximum out-of-pocket until the entire family amount has been met. Embedded deductibles mean all individual deductible amounts will count toward the family deductible, but an individual will not have to pay more than the individual deductible amount. Note: For HSAs, copayments will not apply until after the deductible has been satisfied. In 2014, maximum HSA contribution is $3,300 single/$6,550 family. These amounts are subject to change by IRS and do not include catch-up contributions for subscribers aged 55 and over. Oxford HMO products are underwritten by Oxford Health Plans (CT), Inc. Oxford insurance products are underwritten by Oxford Health Insurance, Inc Oxford Health Plans LLC. All rights reserved. CT

12 2014 Connecticut Small Group (1-50) Health Plan Portfolio (Oxford Product Offerings) Robust Benefits, Broad Network, Innovative Online Tools Offering a variety of plan designs, ranging from open access to primary care-centric

13 Giving you comprehensive benefits, freedom and flexibility Businesses today are faced with a lot of difficult decisions. Finding the right health care benefits plan should not be one of them. Shopping for value does not mean you have to settle for average. We re committed to finding solutions to fit the health care needs of Connecticut small group (1-50) employers. Our Oxford portfolio includes a variety of products with a wide range of affordable and flexible health plan solutions. Choose from open access plans, referral-based plans, in-network only options or consumer-driven products. We also have a variety of specialty benefit options for employers to couple with our medical plans so you have the ability to offer your employees a comprehensive benefit package. Delivering on what you value most You value: A national network for care Premiere local provider network Access to programs and services designed to enhance employee health Outstanding customer service Tools that simplify administration for employers Oxford plans offer: Most plans give your employees seamless access to our national UnitedHealthcare Choice Plus Network of more than 726,000 physicians, 5,600 hospitals and 65,000 pharmacies 1 when they are outside the tri-state area 2 of Connecticut, New York and New Jersey. All Oxford plans offered to small group (1-50) employers in Connecticut are offered with the Network, which includes almost 30,000 physician locations in Connecticut. See below for network details. Personal services that offer support through nurses, counselors, care managers and online wellness programs. Reliable, personal service and support for employers and employees. Self-service and online administration available through oxfordhealth.com. Benefits administrators can check employee eligibility, enroll employees or dependents, and perform monthly bill inquiries, among many other time saving functions. Valued Specialty Benefits With our Specialty Benefits, including dental, vision, life and disability, members have: Plan designs to meet diverse needs Online resources for maximum freedom and flexibility Reliable Support Program Oxford On-Call provides nurses that are available 24 hours a day, seven days a week by phone to help manage illness or injury. Broad National Network Our network provides the right access to the right care and covers 99 percent of the U.S. population in 96 percent of all U.S. counties. 726,537 physicians nationwide 18,393 CT Network physicians Premier Local Network The Network offers your employees access to more than 104,000 physicians and other health care professionals at more than 173,000 locations in the tri-state region of Connecticut, New York and New Jersey - of which almost 30,000 of those physicians have their practice in Connecticut. 3

14 Connecticut Small Group Plan Highlights Products with Low Level of Member Involvement Plan PPO Our Plan PPO products offer combined in- and out-of-network coverage, and do not require a referral for specialist visits. These plans also provide access to the national UnitedHealthcare Choice Plus Network when outside the Oxford service area. Products with Moderate Level of Member Involvement Plan Value Option HMO Our Plan Value Option plans offer combined in- and out-of-network coverage, and do not require a referral for specialist visits. The deductible on these plans applies to the inpatient facility charges only. Members enrolled in the Plan Value Option also have access to the national UnitedHealthcare Choice Plus Network when outside the Oxford service area. We offer traditional HMO plans for those who like to stay in-network and have their care coordinated by a primary care physician (PCP). Our HMO plans allow members to receive covered services from the participating PCP of their choice and do not require a referral for specialist visits. Products with High Level of Member Involvement Oxford HSA PPO HMO HSA HMO HSA Primary Advantage The Oxford HSA PPO is a consumer-driven health plan made up of two 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 pay for eligible medical and pharmacy expenses, including their deductible, or save it for future expenses. This plan also gives members the choice to go in- or out-of-network for care, and referrals are not required for specialist visits. HMO HSA plans are a great choice for those who like to stay in-network and have their care coordinated by a primary care physician (PCP). This plan couples a traditional HMO 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 pay for eligible medical and pharmacy expenses, including their deductible, or save it for future expenses. Members enrolled in the HMO HSA are not required to obtain a referral for specialist visits. HMO HSA plans are a great choice for those who like to stay in-network and have their care coordinated by a primary care physician (PCP). This plan couples a traditional HMO 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 pay for eligible medical and pharmacy expenses, including their deductible, or save it for future expenses. Members enrolled in the HMO HSA are required to obtain a referral for specialist visits. The Primary Advantage product puts an emphasis on benefits where health care encounters are most prevalent: preventive care, services provided by a primary care physician (PCP) or OB/GYN, and Tier 1 prescription drugs, which are available through low copayments and 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.

15 A Complete and Flexible Health Plan Portfolio 2014 Connecticut Small Group (1-50) Health Plan Portfolio You want to offer benefits that attract employees and keep them healthy. UnitedHealthcare, and its Oxford products, provide a variety of health plans that help you achieve your goals while educating and engaging employees in making wise health care choices to help control costs. Think about what you value most in a health plan and use the grid below to help you determine which Oxford product has the features and benefits you are looking for. Increasing Level of Member Involvement Member Role / Level of Member Involvement Low Moderate High Products Plan PPO Plan Value Option HMO Oxford HSA PPO HMO HSA HMO HSA Primary Advantage Network Coverage Out-of-Network Coverage Account-based Plan Primary Care Physician (PCP) Referrals Required Online Tools and Technology Member Support Programs Health & Wellness Programs No-Fee UnitedHealthcare Benefit Services (FSA, Pre-Tax, COBRA for 2 99) Metallic Tier Platinum Gold, Platinum Bronze, Silver, Gold, Platinum Relative Premium $$$$ $$$ $$ $$ $$ $ $ KEY Our Best, Largest Better Plus Better, More Good Basic Not Available Included Our Best, Largest: Network with access to the national UnitedHealthcare Choice Plus Network Better Plus: Network access only 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, 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. Please speak to your Oxford sales representative for specific plan designs by metallic level.

16 Supporting the health of your organization 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 address behavior change. Personalized content and tools Making the best health care decisions is important, so we provide easy-to-understand health information, tools and trackers on the Health & Wellness tab on the Member portal of oxfordhealth.com from a variety of credible sources. Based on an employee s age, gender, health and claims records, they ll see messages, reminders and online health programs personalized for their health status. Members can manage their medical records online at oxfordhealth.com using the secure Personal Health Record to track their personal medical history. This enables them to more effectively manage their health and have more meaningful discussions with their physician. oxfordhealth.com mobile From the convenience of their smartphone, Oxford plan members can have instant access to important benefit coverage information. Whether in the doctor s office, traveling or other occasions when members may not have access to a computer, they can simply enter oxfordhealth.com into their smartphone browser and log in for information about their Oxford benefits. The mobile site can be used to find doctors, hospitals, urgent care centers or convenient care clinics, view ID cards, check claims or update profile settings. Health assessment 4 The health assessment, available on the Member portal of oxfordhealth.com in English and in Spanish, is a widely recognized health awareness tool from the University of Michigan Health Management Research Center that assesses individual health status. It is a comprehensive, confidential online health questionnaire designed to analyze lifestyle behavior and identify individual health risks. Upon completion of the questionnaire, individuals receive a personalized health report that provides preventive steps and recommendations to improve or maintain overall health and well-being. Online health programs Using data extracted from the Personal Health Record, the online programs create personalized health improvement plans that help activate and encourage individuals to embrace behaviors that can lead to a healthier lifestyle. Plus, the online programs offer tracking tools, quizzes and behavioral resources designed to help the individual achieve positive outcomes. These are the online programs that address the following: exercise weight management smoking cessation diabetes lifestyle nutrition stress management heart health lifestyle Oxford Healthy Mother, Healthy Baby This program complements the care expectant members receive from their doctors with educational information on prenatal and postnatal care, as well as childhood immunizations. Health discount program We understand that rising health care costs nationwide affect our members. So, we try to help you stretch your health care dollars by creating programs that aim to save you money while also improving your health. Our Healthy Bonus discount program offers members access to discounts and special offers on a wide variety of health-related products that can help them make the best kind of investment: a healthy lifestyle. For a current listing of our Healthy Bonus offers and discounts, visit Research Supports Wellness Programs A study on costs and savings associated with workplace disease prevention and wellness programs found that medical costs fall by about $3.27 for every dollar spent on wellness programs and that absenteeism costs fall by about $2.73 for every dollar spent. (National Business Group on Health Studies)

17 Oxfordhealth.com for Employers Get things done quickly, conveniently and on your own time You ll be surprised how much can be done with just a few simple keystrokes. Our website, oxfordhealth.com, is designed to make it easy for you to keep track of your company s health care coverage, download forms, conduct real-time transactions and provide members the online tools they need to take control of their health. From the Transactions tab you have the ability to perform the typical, day-to-day functions that come with managing your company s health care coverage. All of this can be done on your own time, when it s most convenient for you. Use the Transactions tab to: Check: Billing, eligibility and benefits Enroll: Employees, dependents and spouses, as well as to 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. When you refer your employees to our online resources, you re helping them to take part in managing their health benefits and take advantage of the health and wellness information on the site. Renewing your plan through oxfordhealth.com When the time comes to renew your plan, you can do so easily, quickly and efficiently with our online renewal application, Idea Management System sm (IDEA). Simply log in to oxfordhealth.com 60 days prior to your renewal and click on the link to IDEA that will be posted under the message center. IDEA allows you to review, compare and modify your current plan(s) at your convenience. As you make modifications to your plan, IDEA will automatically generate a new Summary of Benefits and Coverage (SBC) based on those revisions. The SBC will update instantly each time a change is made.