All Savers Alternate Funding Case Submissin Checklist fr Preliminary Qute (General HB2015 r LSHP grups in TX, OK, and IA) All Savers PDF versins f the dcuments belw can be upladed t https://www.myallsavers.cm The fllwing items are required fr preliminary quting. All items are essential fr successful and timely turnarund n yur preliminary qute request. Incmplete items may cause delays. If yu are wrking with Underwriting n a pilt that has different requirements, please indicate that in the external ntes sectin f myallsavers.cm. Submissin Checklist fr Preliminary Qute Emplyer (additinal required infrmatin after street qute is cmpleted) this infrmatin can be prvided in the ntes sectin f myallsavers.cm Emplyer Tax Identificatin Number Name f current carrier Emplyee Applicatins (fr emplyees electing health cverage) PDF versins f the applicatins shuld be upladed t the grup recrd in myallsavers.cm Emplyee Name (first and last) Emplyee Gender Emplyee Date f Birth Emplyee Height and Weight Indicatin f dependents (spuse, children) Dependent(s) Gender Dependent(s) Date f Birth Dependent(s) Height and Weight ALL Medical Questins Answered and details prvided fr Yes answers Signed and Dated by the Emplyee 1/15 2015 United HealthCare Services, Inc. UHCEW729296-000
All Savers Alternate Funding Case Submissin Checklist fr Final Qute All Savers PDF versins f the dcuments belw can be upladed t https://www.myallsavers.cm The fllwing items are required fr final quting. All items are essential fr successful and timely turnarund n yur final rates request. Incmplete items may cause delays Submissin Checklist fr Final Qute Emplyer (additinal required infrmatin after street/preliminary qute is cmpleted) this infrmatin can be prvided in the ntes sectin f myallsavers.cm Emplyer Applicatin PDF versins f the emplyer applicatin shuld be upladed t the grup recrd in myallsavers.cm All questins answered cmpletely Signed and dated by bth emplyer and brker n all indicated pages Payment Authrizatin Frm (needed regardless f type f payment) Nte: The emplyer must sign and cmpletely fill ut the Authrizatin prtin if selecting EFT. First Mnth's Premium Check A cpy can be upladed t https://www.myallsavers.cm. Send the riginal binder check t: Euclid Managers 234 Spring Lake Drive Itasca IL 60143 Checks made payable t: UnitedHealthCare Services, Inc. PO Bx 19032 Green Bay WI 54307-9032 Recnciled Wage & Tax Reprt (mst recent) All pages must be included and all emplyees must be labeled accrding t their current emplyment status (Full-Time, Part-Time, Terminated, etc.) If grup is a new business and des nt yet have a W&T Reprt, please prvide the mst recent payrll reprt. If the grup is frm the state f Flrida, a recnciled UC5 Frm is acceptable Cmplete Billing Statement Frm Current Carrier (mst recent) If the grup is replacing current cverage, this must include the names f all individuals currently enrlled with the current carrier
All Savers Alternate Funding Case Submissin Checklist fr Final Qute All Savers Emplyee Applicatins PDF versins f the applicatins shuld be upladed t the grup recrd in myallsavers.cm Waiving Emplyees must prvide their name and must sign the waiving prtin f the applicatin Emplyee s electing cverage must cmplete the fllwing infrmatin: Emplyee Height and Weight (required fr additinal emplyees r thse requesting census changes) Emplyee Scial Security Numbers Emplyee Date f Birth and Gender Emplyee Date f Hire Emplyee Address, Phne Number and Email Address Dependent(s) Height, Weight and Gender Dependent(s) Date f Birth ALL Medical Questins Answered Nte: Medical infrmatin is required fr all applicants unless they are part f a UHC immigratin prject. If they are, we nly need apps fr thse nt already n the census. Details must be prvided fr any Yes answers t medical questins Nte: Medical infrmatin is required fr all applicants unless they are part f a UHC immigratin prject. If they are, we nly need apps fr thse nt already n the census. Signed and Dated by the Emplyee Nte: Fr grups that have already cmpleted medical applicatins fr preliminary quting, new applicatins are nly needed n emplyees that have been added t the census. Hwever, if all details were nt riginally prvided n the applicatins fr preliminary qute, thse details will nw be required fr final quting purpses. Excess Lss Insurance Applicatin Filled ut cmpletely Signed and dated by bth the agent and the emplyer Billing & Cllectins Agreement (nt required in all states) PEPM Value entered Signed and dated by emplyer and brker Nte: Emplyer signs twice (nce n page 3 and nce n page 4) New Yrk Surcharge frms (nt required fr installatin) If the paperwrk is received after the first f the mnth the electin will nt be effective until the fllwing mnth 9/15 2015 United HealthCare Services, Inc. UHCEW729320-001
Cntact List All Savers Area/Tpic Respnsible Party Email Phne Prtals Speciality After Installatin Prir t Installatin Brker cntracting/appintments/cmmissins Licensing and Cmmissins L&CAllSavers@UnitedHealthne.cm 1-866-405-7174 Quting and enrllment Brker Services MyAllSaversinf@UnitedHealthne.cm 1-866-405-7174 Rates and underwriting Medical & Speciality Membership changes, address changes, plan Medical ID Cards Medical & Speciality Billing questins, payment questins Medical Submit prir carrier deductible credit reprt, claims appeals Medical Prvider questins, verify eligibility r benefits, benefits r claims infrmatin Medical Reprting questins Reginal underwriting team Speciality UW Cntact yur Accunt Executive r Renewal Accunt Executive SBGSpecialtyUW@uhc.cm Plicy Admin AdminAllSavers@UnitedHealthne.cm 1-800-291-2634 Member Services AdminAllSavers@UnitedHealthne.cm 1-800-291-2634 Claims ClaimsRequests@UnitedHealthne.cm Member Services NA 1-800-291-2634 Finance NA Michelle Leuck 920-661-2859 r Sandy Mineau 920-661-2764 Dental claims, benefits, eligibility, prvider infrmatin Dental Service Center www.myuhc.cm 1-877-816-3596 Visin claims, benefits, eligibility, prvider infrmatin Visin Service Center www.myuhcvisin.cm 1-800-638-3120 Prf f death frm Life Service Center 1-888-299-2070 Member Prtal - www.myallsaversmember.cm Prvider Prtal - www.myallsaversprvider.cm 5/15 2015 United HealthCare Services, Inc. UHCEW644592-001
All Savers All Savers Alternate Funding Fr the health f yur business Prducer Guide
Table f Cntents Hw des Alternate Funding Wrk? 2 Benefit Verificatin 3 Eligibility Requirements 3 Participatin and Cntributin Requirements 5 Effective Date 5 Prducer Requirements 5 Underwriting 7 Cntract Perid 9 Payment 9 Member and Dependent Changes 9 Stp Lss and Administrative Services Terminatin Prcedures 9 Administrative Prvisins 10 Hw Des Alternate Funding Wrk? This guide cvers All Savers Alternate Funding plans, which are a frm f self-funded plans tailred fr small businesses. With All Savers Alternate Funding plans the emplyer sets up a medical plan, which pays fr emplyees medical benefits directly, and emplyers just have t cver their mnthly bill. Part f the risk fr medical expenses is taken n by the plan rather than by an insurance cmpany. The rest f the risk fr medical expenses is cvered by stp-lss insurance, underwritten by All Savers Insurance Cmpany. Stp-lss insurance puts a cap n the plan s medical claims payment risk. This cap is based n the amunt the plan must pay fr an individual s medical claims (called the specific deductible ), as well as the cmbined amunt f all eligible medical claims the plan must pay in a given perid (called the aggregate attachment pint ). With stp-lss insurance, the plan is prtected frm high individual medical claims and high verall claims expenses. Specific Stp-Lss Cverage prtects the plan frm unexpected large medical claims incurred by cvered individuals in the grup. Specific Stp-Lss Deductible is the amunt f eligible medical claims the plan pays fr any individual member befre the stp-lss insurance begins t reimburse the plan (within the cntract perid). Fr example, if an Alternate Funding plan had a specific deductible f $15,000 per member, and a member has medical claims f $22,000, then the plan cvers $15,000 f thse expenses and the stp-lss insurance cvers the rest. Aggregate Stp-Lss Cverage prvides prtectin by limiting the plan s risk fr the sum f the grup s ttal eligible medical claims. Aggregate Attachment Pint is the ttal amunt f eligible medical claims in the cntract year that the medical plan pays befre stp-lss insurance begins t reimburse the plan. If the eligible medical claims exceed the plan s maximum claims liability fr that cntract year, stp-lss insurance reimburses the plan. Althugh stp-lss insurance is purchased fr the entire year, the plicy prvides immediate reimbursement t emplyers thrughut the year. Fr example, if an Alternate Funding plan has an aggregate attachment pint f $4,000 per mnth and the number f members des nt change, the aggregate accumulates each mnth t an annual aggregate deductible f $48,000 ($4,000 x 12 mnths). 2 The aggregate stp-lss cverage pays fr high aggregate claims expenses thrughut the year. S if claims ttal $40,000 by mnth fur, the plan will have paid up t the aggregate attachment pint f $16,000 ($4,000 x 4 mnths) and the stp-lss insurance will have cvered the remaining $24,000.
If, at the end f the cntract perid, eligible claims under the medical plan exceed the plan s aggregate stp-lss deductible, the stp-lss insurance will reimburse the medical plan fr the amunts ver the aggregate stp-lss deductible. If ttal eligible claims are less than the aggregate stp-lss deductible, a prtin f the surplus claims dllars may be refunded t the plan. Where required by law, the entire surplus will be refunded t the plan. Incurred but nt reprted (IBNR) refers t health care claims that will cme in after the end f the plan year. It s cmmnly called runut r runff. Deficit carry-frward is smething All Savers Alternate Funding plans d nt have, but yu might hear abut it frm thers. If a grup had a really bad year (say $1 millin in actual claims), the stp-lss insurance wuld cver it. But the insurance cmpany might decide t hld back all renewal refunds until that huge sum is paid back. In ther wrds, the insurance cmpany culd carry the deficit frm the ne bad year frward t future years. Again, All Savers plans d nt have a deficit carry-frward. All Savers Alternate Funding plans are designed t be free frm hidden csts r fees. N matter what the previus claims are, yur cmpany s tally starts each year at zer. Benefit Verificatin Befre the case is issued, yu and yur client will receive an utline f benefits fr the chsen plan design. Yur client will be asked t review the utline and sign ff n the ptins selected t cnfirm the final plan parameters. Upn receipt f the signed utline, the plan benefits will be assigned t the grup, rates can be cnfirmed, and the Summary Plan Descriptins (SPDs) can be prepared. We encurage yu t take an active rle in preparing yur client fr the receipt f this benefit utline. T ensure yur clients are cmfrtable with the self-funded cncept and the benefit ptins they have elected, we will make a welcme call t yur client within a few weeks after the date f issue and answer any questins he r she may have. Eligibility Requirements Emplyers Emplyer grups must be lcated in a state where All Savers Insurance Cmpany is licensed t d business. An affiliated grup must have cmmn wnership and cmmn business t be eligible fr cverage. Our target market fr ur Alternate Funding plans are self-insured grups with 10 enrlled t 99 eligible emplyees. Eligibility requirements may vary by state. If a cmpany has been in business three t six mnths, the fllwing supprting dcumentatin is required. Mst recent wage and tax frm. Tax ID#. Prf f rganizatinal wnership type. Nte: Retirees are nt eligible fr cverage under All Savers health plans. 3
New Cmpanies If a cmpany has been in business less than three mnths and has nt filed a state wage and tax frm, the fllwing supprting dcumentatin is required. Payrll recrds frm business inceptin t current date. Prf f rganizatinal wnership. SS-4 Frm/Tax ID#. Schedule K-1 sub-crpratin r partnership arrangement. Evidence f general financial viability frm a banking institutin may be requested. Ineligible Occupatins and Industries Nn-ERISA grups Municipalities Prfessinal emplyer rganizatins (emplyee leasing firms) Emplyee Eligibility An eligible emplyee is a regular full-time emplyee wh is scheduled t wrk at least 30 hurs per week. Retirees are nt eligible fr cverage under All Savers health plans. Dependents Eligible dependents include the emplyee s spuse, emplyee s r emplyee s spuse s child wh is under age 26, including a natural child, stepchild, a legally adpted child, a child placed fr adptin r a child fr whm emplyee r emplyee s spuse are the legal guardian; r an unmarried child age 26 r ver wh is r becmes disabled and dependent upn emplyee. Nte: Dependents may nt enrll in the Plan unless emplyee is als enrlled. If emplyee and emplyee s spuse are bth cvered under the cmpany s medical plan, each may be separately enrlled as an emplyee, r as a dependent f the ther, but a spuse can nt be cvered as bth an emplyee and a dependent. In additin, if emplyee and emplyee s spuse are bth cvered under the cmpany s medical plan, nly ne parent may enrll a child as a dependent. Late Enrllees If an enrllment frm is received later than 31 days frm the date an emplyee r dependent is first eligible t enrll, cverage will be pstpned until the medical plan s next anniversary renewal date. Waiver f Medical Cverage Emplyees and their dependents may waive grup medical cverage during pen enrllment. Emplyees waiving cverage may nt be included as eligible fr the purpses f determining participatin requirements if their existing cverage is a qualifying cverage recgnized by their state. Please cntact a sales supprt ffice fr specific infrmatin. 4
Participatin and Cntributin Requirements Participatin Requirements Emplyers must meet minimum participatin and cntributin requirements in rder t qualify fr the All Savers Alternate Funding plans. Emplyee Participatin is 50% f eligible emplyees. Grups may be asked peridically t submit wage & tax statement(s) r ther apprpriate dcuments t verify nging participatin and eligibility. Cntributin Requirements In additin t the participatin requirements, emplyers must als meet minumum cntributin requirements. The emplyer is required t cntribute a minimum f 50% f the emplyee-nly cst fr the lwest-cst medical plan spnsred by the emplyer. Prir Carrier Deductible When the All Savers Alternate Funding plan immediately replaces prir grup medical cverage, we credit each plan participant s calendar year deductible with the amunt f deductible satisfied under the prir medical plan. Prir Ntificatin Ntificatin must be given t United HealthCare Services, Inc. befre a persn receives certain nn-emergency cvered health services such as a transplant evaluatin r participatin in a clinical trial. The ntificatin must be submitted within five business days, r as sn as pssible befre a scheduled service r treatment ccurs. Ntificatin must als be given f an inpatient stay n the day f admissin and emergency inpatient admissins as sn as reasnably pssible. Emergency health services d nt require ntificatin. If ntificatin is nt given as required, benefits can be reduced by up t 60 percent f eligible expenses, nt t exceed $1,000 per ccurrence. Members are encuraged t cntact United HealthCare Services, Inc. t cnfirm that the services they plan t receive are cvered health services. Effective Date Emplyer grup applicatins may be submitted fr a first-f-the-mnth effective date. All required materials must be cmplete, accurate, and received in ur hme ffice within five wrking days f the requested effective date. The underwriting department will cntact yu with the ffered effective date. Prducer Requirements The writing prducer must be prperly licensed and appinted t represent All Savers Insurance Cmpany in the state where the applicatin was signed. Fllwing are sme suggestins that will help the writing prducer and prpsed enrllees avid misunderstandings abut the type and scpe f cverage that the custmer wants issued. } } Brkers shuld advise emplyers and emplyees t furnish accurate and cmplete infrmatin n medical histry including date, type f treatment, diagnsis, and physician, as apprpriate. 5
D nt prmise an effective date r prmise that the grup applicatin will be apprved. Certain circumstances, such as failure t meet ur participatin requirements, culd result in ur decisin nt t qute the case. The exclusins, limitatins, prvisins, and benefits prvided under the plan shuld be clearly and accurately described t the prpsed grup. The emplyee enrllment frm is a critical piece f infrmatin in the underwriting prcess. It prvides a place fr enrllees t prvide medical infrmatin that is required t underwrite the plan. Therefre, the enrllment frm shuld be cmpleted as meticulusly as pssible, including details such as the type and duratin f treatment given fr a cnditin, medicatins taken, when and if cmpletely recvered, residual symptms, and the names and addresses f the relevant physicians(s). If an enrllee has seen mre than ne physician, it s imprtant t indicate which physician wuld have the relevant recrds. Qutes: Initial qutes, if issued, will be based n the number f emplyees and spuses listed in the census cmpleted n www.myallsavers.cm. Detailed medical infrmatin will be reviewed nly with the applicant s signed underwriting authrizatin as required under federal privacy regulatins. The writing prducer is nt authrized t disregard an enrllee s answer r t impse his r her wn judgment as t what is r is nt imprtant t recrd. Emplyees shuld always be instructed t cmplete their wn enrllment frms, including the medical histry sectin. If the details dn t fit in the blank sectin f the medical histry sectin, attach a separate sheet and have the enrllee sign and date the sheet. Include the addendum with the enrllment frm. New enrllees (eg., new hires) must als cmplete an emplyee applicatin including a medical histry questinnaire. Case Submissin Prcess Grups shuld wait until cverage is cnfirmed in writing befre cancelling their present grup medical cverage t assure n lapse in cverage ccurs. All case submissin is cnducted thrugh the brker prtal n www.myallsavers.cm. The prducer submits new business infrmatin (see Case Submissin Requirements ) t their sales supprt ffice via the website. The sales supprt ffice will frward new grup case submissin t underwriting fr prcessing. The sales supprt ffice will cmmunicate all underwriting ffers t the prducer. If the new grup case submissin is cmplete and n additinal infrmatin is required, expect an underwriting decisin within 15 wrking days. If the new grup case submissin is incmplete, the sales ffice will request the missing infrmatin frm the prducer and hld the case submissin fr a maximum f 3 wrking days. If infrmatin is nt received, the case will be returned t the prducer. (See case submissin requirements.) If additinal medical data is required, the sales ffice will hld the case pen fr a maximum f 60 days frm the enrllment frm signature date. If utstanding infrmatin is nt received in this time frame, the case will be clsed ut. Cmplete and accurate frms will speed the review f the submitted case during underwriting. Frms will be returned t the prducer if required signatures and/r dates are missing r medical questins are left unanswered. Any additinal infrmatin needed t underwrite the case will be requested by the underwriting department. A member f the underwriting staff r sales ffice staff may cntact either the enrllee, emplyer, r prducer depending n the nature f the infrmatin that is utstanding. Outdated r incrrect enrllment frms will be returned t the prducer alng with the crrect versin fr enrllee cmpletin. 6
Case Submissin Requirements T facilitate the prcessing, writing prducer shuld include the fllwing frms: Emplyer Grup Applicatin Packet that includes the Payment Authrizatin fr Alternate Funding (including prducer and emplyer signatures), Stp Lss Applicatin, Administrative Services Agreement. Emplyee Enrllment frms, including signed waivers fr emplyees nt selecting medical cverage. All emplyee enrllment frms must include heights and weights, dates f birth, cverage type selected, and signatures and dates signed by emplyees. Underwriting authrizatin (Authrizatin t use Medical Infrmatin fr Enrllment). The emplyer s mst recent quarterly wage and tax reprt with status f emplyees. Prir carrier s r third party administratr s mst recent billing statement (if replacing cverage). First mnth s payment. If selecting Electrnic Funds Transfer (EFT) billing mde: Emplyer Payment Authrizatin Frm Cpy f quted rates fr plan design(s) selected. The final effective date fr the case is cnfirmed after underwriting review. If underwriting can t make an accurate assessment f the risk, additinal infrmatin may be requested. Effective dates will be determined by underwriting after discussing the ffer with the sales ffice. Effective dates will be the first f the mnth. Prices may change based n any change in census (change in grup size due t additins r terminatin f emplyees during the wrk-up prcess), change in plan, change in effective date, r new medical infrmatin received after initial ffer. Custmer Service Authrizatin Plan participants wh wish their family members, prducer r a cmpany cntact t have access t their persnal health infrmatin must cmplete and submit an Authrizatin t Disclse Medical Infrmatin fr Custmer Service. Underwriting Risk Assessment The underwriting prcess is designed t help assess the relative risk f future lss n the part f any given enrllee fr purpses f Stp-Lss Insurance as part f this plan. Medical histry questinnaires may be submitted at the time f enrllment review and may expedite the underwriting prcess. See the cnditins list/questinnaire required. Medical histry questinnaires need t be cmpleted in detail when an enrllee answers yes t specified cnditins n the Medical Histry sectin f the Emplyee Enrllment Frm. Final actin regarding an enrllment frm is the ultimate decisin f the underwriter based upn the ttal medical facts. 7
Cntract Perid All Savers Alternate Funding plans ffer a base claim reimbursement n a 12/60 basis. This means that eligible medical claims incurred within the cntract perid (12 mnths) and paid within the cntract perid r paid within 48 mnths immediately fllwing the end f the cntract perid will be cvered by the Plan r Stp- Lss Insurance. Payment The Plan Spnsr is respnsible fr bth the ttal fixed csts, which includes administrative csts and stp-lss insurance premiums, and claims funding n a mnthly basis. Plans are ffered with Maximum Funding. Maximum Funding The mnthly maximum medical claims liability will be remitted each mnth with the mnthly remittance fr fixed csts t United HealthCare Services, Inc. This payment will cver the medical claims liability fr the current cntract perid. Mnthly Payments The first mnth s payment must be submitted t: United HealthCare Services, Inc. P.O. Bx 19032 Green Bay, WI 54307-9032 Subsequent payments are due n the first f each mnth and must be sent t the address indicated belw and received by the end f the 31-day grace perid. Regular Mail United HealthCare Services, Inc. P.O. Bx 88106 Chicag, IL 60680-1106 Overnight United HealthCare Services, Inc. Attn: Lckbx #88106 4900 W. 95th Street Oak Lawn, IL 60453 8
Member and Dependent Changes Requests fr benefit changes must be submitted n a cmpleted, signed and dated emplyee enrllment frm. New Emplyee A new emplyee must submit an enrllment frm within 31 days f his r her eligibility date. The emplyee s spuse and dependents can als enrll during this time. Eligibility dates are based n the emplyee s date f hire and the waiting perid selected n the Emplyer Grup Applicatin. If an enrllment frm is nt received within 31 days after the eligibility date, the emplyee is a late enrllee and cverage will be pstpned until the renewal date. Adding a Dependent A cmpleted, signed and dated emplyee enrllment frm must be received fr a spuse and/r child(ren), including newbrns. The emplyee enrllment frm must be submitted within 31 days f the event that qualifies a spuse r child(ren) as a dependent (i.e., marriage, birth, adptin). Terminatin f Emplyee Cverage An emplyee s cverage will terminate at the end f the mnth when any f the fllwing ccur: Emplyment is terminated. The emplyee retires The emplyee requests terminatin f cverage fllwing a life event such as divrce, marriage, r the birth r adptin f a child. The emplyee must sign the request fr terminatin f cverage. The emplyee s hurs are reduced t part time. Terminatin f Dependent Cverage An emplyee can terminate a dependent s cverage at any time. T terminate dependent cverage, the emplyee shuld send the requested date f change and the emplyee s signature. Cverage will be terminated at the end f the requested mnth. Stp Lss and Administrative Services Terminatin Prcedures Certain ERISA regulatins, decisins, and bligatins must be cnsidered when terminating a self-funding agreement. Prducers shuld refer emplyers t their wn legal cunsel fr additinal infrmatin. The emplyer is slely respnsible fr prviding any required ntificatins t the plan participants in the event that the Administrative Services Agreement and/r the Stp-Lss Insurance Plicy is terminated. 9
Early Terminatin If terminatin ccurs befre the end f the cntract perid (due t nnpayment f ttal fixed csts r claims liability, r if the emplyer decides t terminate befre the cntract perid is fulfilled), any maximum liability that is wed prir t the terminatin date must be paid. Claims incurred prir t terminatin will be paid by runut. Claims incurred after terminatin remain the Plan s respnsibility. Cntract Perid End Terminatin If the administrative services and Stp-Lss Insurance plicy fr a self-funded plan terminate at the end f the cntract perid, claims incurred prir t terminatin will be paid by run ut. Administrative Prvisins Plan Changes Plan changes can nly be dne at the grup s renewal. Plan changes must cmply with the fllwing guidelines: Plan changes are available nly n the plan anniversary renewal date. Plan changes must be received within 30 days prir t the plan anniversary renewal date. Prbatinary Waiting Perids A request t change an emplyer s prbatinary perid fr new hires is cnsidered a plan change, and can be made nly n the plan s anniversary renewal date. Direct-Billing Fee There may be a direct-billing fee included n each billing statement. The direct-billing fee is waived fr Electrnic Funds Transfer. Service Fee If payment by check r Electrnic Funds Transfer is declined r returned, a service fee may be applied. Cst Changes Service fees fr the administratin f the medical plan, and premiums fr the stp-lss insurance plicy, are determined by a cmbinatin f factrs including experience f all grups f a similar nature, demgraphic cmpsitin f the grup (e.g., age, dependent cverage, and gegraphic lcatin), and annual increases in the cst f medical services. The third-party administratr has the right t change the service fees n any payment due date after the plan has been in effect fr 12 cnsecutive mnths. Changes t the premium rates under the stp-lss insurance plicy may be made in accrdance with the terms f that plicy. 10
All Savers The smart chice fr yu, fr yur emplyees, fr better health. 100-16560 Administrative services are prvided by United HealthCare Services, Inc. and its affiliates. Stp lss insurance is underwritten by All Savers Insurance Cmpany. 3100 AMS Blvd., Green Bay, WI 54313 (800) 291-2634 2015 United HealthCare Services, Inc. 5/15 UHCEW644583-000
All Savers Alternate Funding Prvider Quick Reference Guide All Savers Alternate Funding, administered by UnitedHealthcare Services, Inc., ffers health plans designed fr small businesses. Members with the All Savers Alternate Funding plan have access t the UnitedHealthcare Chice Plus netwrk with the exceptin f May Clinic facilities. Select UnitedHealthcare dental and visin plans are available with All Savers Alternate Funding plan. This Guide prvides cntact infrmatin, prir authrizatin requirements and ther general infrmatin t assist yu and yur practice when wrking with All Savers members. Online access t infrmatin is available at myallsaversprvider.cm. Frm the myallsaversprvider.cm hme page, click n Register Nw and fllw the five steps f the registratin prcess. Once registered, yu can access the fllwing infrmatin: View and verify member eligibility and benefits View and print claims detail and payment summaries Frequently asked questins Prvider Services Phne: 800-291-2634 Pharmacy Services Fr pharmacy infrmatin, please refer t the back f the member ID card r call 855-816-6618. Mental Health Services Fr mental health referrals, please call the number n the back f the member s ID card r call 800-291-2634. Electrnic Submissin and Payer ID Fr claims submitted electrnically, please use payer ID 81400. PCA16183_20150325
Paper Claims Address All Savers P.O. Bx 31375 Salt Lake City, UT 84131-0375 Fax: 801-478-7582 Claims Recnsideratins Custmer Service Phne: 800-291-2634 Frmal Appeals Address Appeals Review P.O. Bx 31371 Salt Lake City, Utah, 84131-0371 Fax: 317-715-7648 Ntificatin/Prir Authrizatin Requirements Please refer t the All Savers Supplement in the UnitedHealthcare Administrative Guide fr a full list f ntificatin and prir authrizatin requirements, which is available at UnitedHealthcareOnline.cm > Tls & Resurces > Plicies, Prtcls and Guides. Fr ntificatin, call the number n the back f the member s ID card r 800-291-2634. Hspitalizatins require ntificatin n the day f the admissin r as sn as reasnably pssible fr emergency inpatient admissins. A ntificatin f five days is required prir t transplant evaluatins, clinical trials and fr purchase f durable medical equipment csting mre than $1000 and prsthetic devices. Member Identificatin (ID) Cards Fllwing is a sample f the All Savers member ID card: PCA16183_20150325