MEDICAL U n i t e d H e a l t h c a r e
U n i t e d H e a l t h c a r e T r a d i t i o n a l C h o i c e P l u s IN-NETWORK OUT-OF-NETWORK Calendar Year Deductible Calendar Year Out-of-Pocket $1,500/person $3,000/family $5,000/person $10,000/family $2,500/person $5,000/family $7,500/person $15,000/family Preventive Care 100% Covered Not Covered Primary Care Physician (PCP) Specialist Visit (SCP) Premium PCP-$30/All other PCP $40 Premium SCP-$40/All other SCP -$50 40% AD Urgent Care $50 Copay 40% AD Inpatient Hospital Services 40% AD Outpatient Hospital Services 40% AD Emergency Services $150 Copay, then Same as In-Network Benefit Pharmacy Medical Deductible and Out of Pocket Apply Tier 1 $15 Copay $15 Copay Tier 2 $30 Copay $30 Copay Tier 3 $60 Copay $60 Copay Mail Order 90-day Supply Tier 1 $37.50 Not Covered Tier 2 $75.00 Not Covered Tier 3 $150.00 Not Covered Employee Only $643.00 $393.54 $249.46 Employee & Spouse $1,512.00 $925.01 $586.99 Employee & Child(ren) $1,384.00 $847.03 $536.97 Family $1,995.00 $1,220.86 $774.14 11
U n i t e d H e a l t h c a r e C h o i c e P l u s C D H P w / H S A Calendar Year Deductible Calendar Year Out-of-Pocket IN-NETWORK $3,000/person $6,000/family $5,000/person $10,000/family OUT-OF-NETWORK $4,000/person $8,000/family $7,500/person $15,000/family Preventive Care 100% Covered Not Covered Primary Care Physician (PCP) Specialist Visit (SCP) 40% AD Urgent Care 40% AD Inpatient Hospital Services 40% AD Outpatient Hospital Services 40% AD Emergency Services Same as In-Network Benefit Pharmacy Medical Deductible and Out of Pocket Apply Tier 1 $10 AD $10 AD Tier 2 $25 AD $25 AD Tier 3 $50 AD $50 AD Mail Order 90-day Supply Tier 1 $20 AD Not Covered Tier 2 $50 AD Not Covered Tier 3 $100 AD Not Covered Employee Only $507.00 $375.11 $131.89 Employee & Spouse $1,193.00 $883.19 $309.81 Employee & Child(ren) $1,091.00 $807.65 $283.35 Family $1,572.00 $1,162.49 $409.51 12
U n i t e d H e a l t h c a r e U n i t e d H e a l t h c a r e s P r e m i u m P r o g r a m Most of us are pretty good at spotting quality in the things we buy: Cars need good gas mileage. Houses need roofs that don t leak. Clothing needs to be well-made. But when it comes to health care, it may be less clear what quality means or how to go about evaluating it. To help our members make more informed choices about their health care, the UnitedHealth Premium program recognizes doctors who meet quality and cost efficiency guidelines. You can find a doctor s Premium designation on myuhc.com. Quality, cost-efficient care is a long-term solution. Variations in care are a significant part of the problem in our current health care system. A study published in the New England Journal of Medicine* found that only 55% of U.S. patients receive the recommended care. We believe that by supporting and promoting doctors who meet national standardized measures for quality and local geographic area benchmarks for cost efficiency, as well as engaging consumers in the health care decisionmaking process, we can help to achieve better health outcomes while improving the experience and reducing costs. UnitedHealth Premium doctors: Follow evidence-based guidelines for care Are more likely to be aware of the latest research and clinical trials May have lower surgery repeat rates 13
U n i t e d H e a l t h c a r e P r e v e n t i v e S e r v i c e s UnitedHealthcare plans typically cover preventive services, as specified in the health care reform law, at 100% without charging a copayment, coinsurance or deductible, as long as they are received in the health plan s network. UnitedHealthcare also covers other routine services, which may require a copayment, coinsurance or deductible. Always refer to your plan documents for your specific coverage. Talk To Your Doctor Consult your doctor for your specific preventive health recommendations, as he or she is your most important source of information about your health. Summary of Preventive Care Services Benefit UnitedHealthcare is committed to advancing prevention and early detection of disease. The following is a high-level summary of the services covered under the preventive care services benefit shown by age/gender groups All Members Preventive medicine for adults; all standard immunizations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC). All Members at an Appropriate Age and/or Risk Status Screening for: Obesity Cholesterol level and lipids Colorectal cancer2 for ages 50+ Certain sexually transmitted diseases including HIV Cardiovascular Disease aspirin use counseling for ages 45+ High blood pressure Diabetes for certain populations Tobacco use Diet and nutrition Alcohol abuse Depression Women s Health Services Effective 9/23/10 Screening mammography for adult women Cervical cancer screening including Pap smears Genetic counseling for the BRCA breast cancer gene Counseling for cancer prevention strategies for women at high risk for breast cancer Screening for certain sexually transmitted diseases including HIV for certain populations Osteoporosis for certain populations 2 Pregnant women for: o Iron-deficiency anemia o Bacteria in urine o Hepatitis B virus o Rh incompatibility o Counseling to promote and aid with breast feeding The follow guidelines reflect the expanded Women s preventive health care services provided under the health reform law as of August 1, 2012. Please speak to your Health Benefits Administrator to confirm your specific plan coverage for: Yearly well-women visits Sexually transmitted infections counseling Contraception methods and counseling Gestational diabetes screening HIV screening and counseling Human papillomavirus testing (beginning at age 30, and for every 3 years thereafter) Breast-feeding support, supplies, including renting or purchase of specified breast feeding equipment from an approved vendor and counseling. Men s Health Screening for: Human Papillomavirus for males age 9-26 years Abdominal aortic aneurysm for men 65 75 years old who have ever smoked Children Services at each of these preventive visits vary based on age, but will include some of the following: Measurement of your child s head size Measurement oflength/height and weight Screening blood tests, if appropriate Providing age appropriate immunizations Vision screening Hearing screening Counseling on oral health Psychological and behavioral development assessment Counseling on the harmful effects of smoking and illicit use of drugs (for older children and adolescents) Counseling for children and their parents on nutrition and exercise Screening certain children at high risk for high cholesterol, sexually transmitted diseases, lead poisoning, tuberculosis and more. Preventive services that are covered with no cost share are those services described in the United States Preventive Services Task Force A and B recommendations, the Advisory Committee on Immunization Practices (ACIP) of the CDC, and HRSA Guidelines for women, as well as children, including the American Academy of Pediatrics Bright Futures periodicity guidelines. 14 To learn more about the preventive care services that may be right for you visit www.uhcpreventive.com
MEDICAL K a i s e r ( N o r t h w e s t ) O r e g o n
K a i s e r - ( N o r t h w e s t ) O r e g o n K a i s e r H M O PLAN FEATURES Deductible - Calendar Year Calendar Year Out-of-Pocket Lifetime Kaiser HMO $1,500/person $3,000/family $4,000/person $8,000/family Unlimited Preventive Care 100% Office Visits (Primary and Specialist) Urgent Care Inpatient Hospital Services Outpatient Hospital Services Emergency Room $20 Copay $20 Copay $50 Copay AD Pharmacy Generic Brand Non-Preferred Brand $10 Copay $30 Copay N/A Employee Only $493.14 $244.79 $218.92 Employee & Spouse $1,158.87 $644.40 $514.47 Employee & Child(ren) $1,060.24 $589.56 $470.68 Family $1,528.72 $850.06 $678.66 16
K a i s e r - ( N o r t h w e s t ) O r e g o n K a i s e r H D H P w / H S A PLAN FEATURES Deductible - Calendar Year Calendar Year Out-of-Pocket Lifetime Kaiser HDHP w/hsa $3,000/person $6,000/family $6,000/person $12,000/family Unlimited Preventive Care 100% Office Visits (Primary and Specialist) Urgent Care Inpatient Hospital Services Outpatient Hospital Services Emergency Room Pharmacy Generic Brand Non-Preferred Brand $10 Copay AD $20 Copay AD $40 Copay AD Employee Only $348.06 $244.79 $103.27 Employee & Spouse $817.94 $503.39 $314.55 Employee & Child(ren) $748.33 $601.69 $146.64 Family $1,078.99 $760.36 $318.63 17
MEDICAL K a i s e r - Wa s h i n g t o n
K a i s e r - W a s h i n g t o n K a i s e r - C o r e H M O PLAN FEATURES Deductible - Calendar Year Calendar Year Out-of-Pocket Lifetime Core HMO $1,500/person $3,000/family $4,000/person $8,000/family Unlimited Preventive Care 100% Office Visits (Primary and Specialist) Urgent Care Inpatient Hospital Services Outpatient Hospital Services Emergency Room $20 Copay $20 Copay $50 Copay AD Pharmacy Generic Brand Non-Preferred Brand $10 Copay $30 Copay N/A Employee Only $597.96 $332.50 $256.46 Employee & Spouse $1,405.22 $781.39 $623.83 Employee & Child(ren) $1,285.61 $714.88 $570.73 Family $1,853.68 $1,030.76 $822.92 19
K a i s e r - W a s h i n g t o n K a i s e r - C o r e H D H P w / H S A PLAN FEATURES Deductible - Calendar Year Calendar Year Out-of-Pocket Lifetime Core HDHP w/hsa $2,700/person $5,400/family $6,000/person $12,000/family Unlimited Preventive Care 100% Office Visits (Primary and Specialist) Urgent Care Inpatient Hospital Services Outpatient Hospital Services Emergency Room Pharmacy Generic Brand Non-Preferred Brand $10 Copay AD $20 Copay AD $40 Copay AD 20 Employee Only $359.75 $253.01 $106.74 Employee & Spouse $845.42 $520.31 $325.11 Employee & Child(ren) $773.46 $621.90 $151.56 Family $1,115.23 $785.90 $329.33
MEDICAL K a i s e r - C a l i f o r n i a
K a i s e r - C a l i f o r n i a K a i s e r - H M O PLAN FEATURES Deductible - Calendar Year Calendar Year Out-of-Pocket Lifetime Core HMO $1,500/person $3,000/family $4,000/person $8,000/family Unlimited Preventive Care 100% Office Visits (Primary and Specialist) Urgent Care Inpatient Hospital Services Outpatient Hospital Services Emergency Room $20 Copay $20 Copay Pharmacy Generic Brand Non-Preferred Brand $10 Copay $30 Copay N/A Employee Only $519.35 $288.79 $230.56 Employee & Spouse $1,220.47 $679.11 $541.36 Employee & Child(ren) $1,116.60 $621.04 $495.56 Family $1,609.98 $1895.61 $714.37 22
K a i s e r - C a l i f o r n i a K a i s e r - H D H P w / H S A PLAN FEATURES Deductible - Calendar Year Calendar Year Out-of-Pocket Lifetime Core HDHP w/hsa $3,000/person $6,000/family $5,9500/person $11,900/family Unlimited Preventive Care 100% Office Visits (Primary and Specialist) Urgent Care Inpatient Hospital Services Outpatient Hospital Services Emergency Room Pharmacy Generic Brand $10 Copay AD $30 Copay AD 23 Employee Only $376.96 $265.11 $111.85 Employee & Spouse $885.85 $545.19 $340.66 Employee & Child(ren) $810.46 $651.65 $158.81 Family $1,168.57 $823.49 $345.08
MEDICAL K a i s e r - H a w a i i
K a i s e r - H a w a i i K a i s e r H a w a i i 2 0 1 PLAN FEATURES Deductible - Calendar Year Medical -Calendar Year Out-of-Pocket Lifetime Core HMO $2,500/person $7,500/family None None Unlimited Preventive Care 100% Office Visits (Primary and Specialist) Urgent Care $20 Copay $20 Copay Inpatient Hospital Services 20% Outpatient Hospital Services 20% Emergency Room 20% Pharmacy Applies to Out of Pocket Max Tier 1 Tier 2 Tier 3 Tier 4 $3 Copay $15 Copay $50 Copay $200 Copay **Please note that Employer and Employee contributions will be based on salary per HI state requirements** Employee Only $348.32 $TBD $TBD Employee & Spouse $768.65 $TBD $TBD Employee & Child(ren) $691.78 $TBD $TBD Family $1,152.97 $TBD $TBD 25