Transcript Presentation Title

Health Care with a Difference
Benefits Orientation
2012
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Highlights for Oxford Freedom Access Plans
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More affordable rates and plans to give greater flexibility when
it comes to choosing doctors and health care coverage
options.
 Non-referrals
 Split copayments
 In- and out-of-network access
 National network access
 Routine preventive care covered at 100%
 Reminders to keep up with preventive care
 GYM Reimbursement Program
 Healthy Bonus Program
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Oxford Service Area
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Our local Oxford Freedom Network in Connecticut, Metro New York
and New Jersey has more than 83,000 physicians and other
healthcare professionals, who practice at more than 125,000 office
locations, and more than 220 hospitals.
Tri-State Service Area
State
Counties
Connecticut
Fairfield
Hartford
Litchfield
Middlesex
New Haven
New London
Tolland
Windham
New Jersey
Atlantic
Bergen
Burlington
Camden
Cape May
Cumberland
Essex
Gloucester
Hudson
Hunterdon
Mercer
Middlesex
Monmouth
Morris
Ocean
Passaic
Salem
Somerset
Sussex
Union
Warren
New York
Orange
Putnam
Queens
Richmond
Rockland
Suffolk
Sullivan
Ulster
Westchester
New York
Bronx
Dutchess
Kings
Nassau
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Oxford Medical Plans
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LOW-AMERICANA
Plan Provisions
HIGH-GATEWAY
In Network
Out of Network
In Network
Out of Network
Choice Plus/
Freedom
N/A
Choice Plus/Freedom
N/A
N/A / N/A
$1,000 / $3,000
N/A / N/A
$200 / $400
100%
70%
100%
80%
N/A / N/A
$8,500 / $25,500
N/A / N/A
$1,200 / $2,400
N/A
N/A
N/A
N/A
$10/$15
Deductible & 30% UCR
$15/$30
Deductrible and 20% UCR
Lab
100%
Deductible & 30% UCR
100%
Deductrible and 20% UCR
Radiology
100%
Deductible & 30% UCR
100%
Deductrible and 20% UCR
Annual Physical Exam Copay
100%
Deductible & 30% UCR
100%
Deductrible and 20% UCR
Hospitalization - Inpatient
100%
Deductible & 30% UCR
100%
Deductrible and 20% UCR
Hospitalization - Outpatient
100%
Deductible & 30% UCR
100%
Deductrible and 20% UCR
Mental Health - Inpatient
#N/A
Deductible & 30% UCR
#N/A
Deductrible and 20% UCR
Mental Health - Outpatient
#N/A
Deductible & 30% UCR
#N/A
Deductrible and 20% UCR
Substance Abuse - Inpatient
100%
Deductible & 30% UCR
100%
Deductrible and 20% UCR
Substance Abuse - Outpatient
$15
Deductible & 30% UCR
$30
Deductrible and 20% UCR
Emergency Room Copay
$25
$25
$25
$25
$5 / $15 / $25
Not Covered
$5 / $15 / $25
Not Covered
Network
Deductible (Individual / Family)
Co-Insurance
Out-of-Pocket Max (excludes deductible)
(Ind./Fam)
Lifetime Plan Maximum
Office Visit Copay/Specialist Copay
Rx Drug Copay (Tier 1, 2, 3)
Mail Order Copay (Up to 90 day)
OON Reimbursement Level
Dependent Limiting Age
2x Retail
2x Retail
UCR 80th Percentile
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UCR 80th Percentile
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Vision Reimbursement
• General Vision Services
• Eye exam-$50 every 12 months
• Hardware- $200 every 24 months
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Oxford medical/vision claim form
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Prescription Drug List
 What is the Oxford Prescription Drug List (PDL)?

Drugs on the list will be based on clinical, economic and
pharmacoeconomic evidence

Drugs are placed in tiers according to their total health care value
regardless of brand or generic status
 What is the purpose of the Oxford PDL?

Make prescriptions more affordable and accessible

Help you make informed decisions that will lower your out-of-pocket
costs
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Pharmacy Copays/Mail Order
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Retail
Tier 1
Tier 2
Tier 3
Mail order
$ 5 Copay
$10 Copay
31-Day Supply
90-Day Supply
$15 Copay
$ 30 Copay
31-Day Supply
90-Day Supply
$ 25 Copay
$ 50 Copay
31-Day Supply
90-Day Supply
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Complementary & Alternative Medicine
Oxford members have access to our network of over 4,500
complementary and alternative medicine (CAM) providers in
Connecticut, New York and New Jersey, including:
 Acupuncturists
 Naturopaths (CT only)
 Nutritionists
 Yoga Instructors
 Chiropractors
Oxford has negotiated contracted rates with all of our network
CAM providers in Connecticut, New Jersey and New York. These
rates vary by specialty and region, and in most instances reflect a
discount from the provider's normal fee.
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National Network Access
UnitedHealthcare’s Choice Plus National Network has you
covered.
 If you’re on vacation and you or your child needs a doctor, you may
visit one of over 626,000* physicians and health care professionals
nationwide, and your visit will be covered in-network.
 If your son or daughter attends an out-of-state college, our plans
provide him or her with seamless in-network care, just as if they were
home.
 If you need to visit a hospital outside of your service area, you have
access to 5,503* hospitals throughout the country.
* Data as of 3/2010
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What you should think about
 Review this simple, four-step checklist as you decide:
1
Find your doctor in our network
2
Understand your total cost of health care
3
Understand what each plan covers
4
Review and compare the “extras”
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Find your doctor – Step 1
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Visit www.oxfordhealth.com to find your doctor or facility
 Search by name, specialty, condition or procedure
Most likely,
your doctor is
in our network
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UnitedHealth Premium® Designation Program
Making information transparent to give you more control
over your health care decisions.
 Identifies doctors in 22 specialties and cardiac facilities that follow
nationally recognized medical guidelines
 Compare quality and cost of health care facilities in treating specific
conditions
 Look for the
when you search for a physician
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Personal health record
 Find all of your health
information in one place:
 Conditions
 Medications
 Treatments and procedures
 Lab results
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Questions?
 Prospective members:
 1-800-760-4566
 HR department
 Current members:
 www.oxfordhealth.com
 Member Services telephone number on your member ID
cards
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CONTRIBUTION RATES
• SEE MEDICAL CONTRIBUTION RATES
@MY.PRATT.COM
• COST OF ADDING FAMILY AND
DOMESTIC PARTNERS
• PROOF OF OTHER COVERAGE TO
WAIVE
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Oxford Enrollment
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Payroll Authorization
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Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
United Healthcare Dental
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
UnitedHealthcare Dental®
Large national preferred provider organization (PPO) network
of over 144,000 dentists and specialists including over 10,000
dentists in New York.
 Visit any of the dentists in our national network
 See any specialist you want, without a referral
 Preventive care, including exams and cleanings, at little or no out-of-pocket
cost
 You don’t have to submit a claim form when you visit a network dentist
 Access Customer Care toll-free, day or night
 Easy access to benefit information at www.myuhcdental.com
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Dental
Two Dental Options to Choose From
 Option 1 – PPO Plan
 Option 2 – Base In Network Only (INO) Plan
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United Healthcare Dental Plans
2012 In-Network Only Dental
Plan
Plan Provisions
In Network
Out of Network
Network
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2012 Incentive PPO Dental
Plan
In Network
Out of Network
PPO
Annual Deductible/Individual
N/A
N/A
$50
$50
Annual Deductible/Family
N/A
N/A
$150
$150
Waived for Preventive
N/A
N/A
Yes
Yes
Annual Plan Maximum
$2,000
$2,000
$1,000
$1,000
Diagnostic and Preventive
100%
N/A
100%
100%
Basic Services
80%
Emerg-80%
90%
80%
Major Services
50%
Emerg-80%
60%
50%
Orthodontia - Deductible
N/A
N/A
N/A
N/A
Orthodontia Coinsurance
50%
50%
50%
50%
Orthodontia - Adult Lifetime Maximum
N/A
N/A
N/A
N/A
Orthodontia - Child Lifetime Maximum
$2,000
$2,000
$1,000
$1,000
Office Visit Copay
Coinsurance
Child Limiting Age
19/26
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19/26
Plan 1 – PPO
PPO Benefit
 Incentive PPO Plan where In Network Benefits
are slightly richer at In Network Providers
• In Network: 100% - Preventive Service, 90% - Basic Services, 60%
for Major Services, $1000 Annual Max; 50% for Ortho, $1000 Max
• Out of Network: 100% - Preventive Service, 80% - Basic Services,
50% for Major Services, $1000 Annual Max; 50% for Ortho, $1000 Max
 Best Option If You Plan on Using Dentists In and
Out of Network
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Plan 2 – In Network Only
In Network Only (INO) Benefit
 This plan provides services at In Network
Providers Only
 Utilizes our National PPO Network
 Benefits not as Rich as in PPO Plan
• In Network: 100% - Preventive Service, 80% - Basic Services, 50% for
Major Services, $2000 Annual Max; Ortho – 50%, $2,000 Max
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New Feature
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Max Rollover Benefit
 Allows you to rollover a portion of your unused annual
max from one year to another
 Examples:
• In PPO Plan with Max of $1,000 – you can rollover up to $350 to the
following year
• In the INO plan with a Max of $2,000 – you can roll over up to $600
each year
Original
Annual
Maximum
Annual
Claim
Threshold
Annual
Account
Award
Annual
Network
Bonus
Annual
Award+
Bonus
MaxMultiplier
Account
Limit
$1,000
$500
$250
$100
$350
$1,000
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New Feature
Prenatal Dental Care Benefit
 A link between Periodontal Disease and
Premature Birth has been established
 All fees and expenses for cleanings, deep scaling
and periodontal maintenance will be waived for
women in 2nd or 3rd trimester
 Deductibles are waived and services do not count
towards annual max
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Online Access
Website: www.myuhcdental.com
 Look up In-Network Dental Providers
 Answers to Frequently Asked Dental
Questions
 Check Dental Claims
 Compare Costs with Treatment Calculator
 Customer Service
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Enrollment Form
• To Enroll in Dental, Must Fill Out Enrollment
Form
• On the Enrollment Form Be Sure to Indicate
Which Dental Plan you are Selecting
 Option 1 – PPO
 Option 2 – Base INO
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Questions??
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CONTRIBUTION RATES
• SEE DENTAL CONTRIBUTION RATES
@MY.PRATT.COM
• COST OF ADDING FAMILY AND
DOMESTIC PARTNERS
• YOU DO NOT NEED PROOF OF OTHER
COVERAGE
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United Healthcare Enrollment
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Policies and
Procedures
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Policies and Procedures
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Affirmation of Policy
Brooklyn Campus Posting Policy
Campus Map
Campus Visitors Policy
CHIP Notice
COBRA Initial Notice
Domestic Partnership Coverage Guide
Early Dismissal Policy
Family and Medical Leave Act (FMLA)
H-1B Visa Policy
Health and Counseling Services for Employees Policy
Healthcare Reminders and Notices
HIPAA Special Enrollment-Initial Notice
HIPAA Notice of Privacy Practices for Protected Health Information
Holiday Schedule Memorandum
Inclement Weather Closing Memorandum
Political Activities & Campaign Guidelines
Military Leave Policy
• Smoking Policy
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Orientation Summary Checklist
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Life Insurance Enrollment
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Retirement Participation
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Supplemental Retirement Annuity
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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Ameriflex Enrollment Guide
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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