UnitedHealthcare® Group Medicare Advantage (HMO)

Your Plan Explained
UnitedHealthcare® Group
Medicare Advantage (HMO)
Take advantage of our large provider network.
UHEX12PP3338490_000
Y0066_110531_134847
Your Medicare.
This brochure explains your Medicare Advantage plan, a type of health
plan also known as Medicare Part C. Medicare Advantage plans combine
your Medicare Part A (hospital) and Medicare Part B (doctor and
out-patient) coverage. They also provide additional benefits that can help
improve your health and wellness. Your Medicare Advantage plan also
includes prescription drug coverage.
You have to be enrolled in Medicare Part A and purchase Medicare Part B
to be eligible to enroll in this plan. If you’re not sure if you are enrolled,
check with your local Social Security office. You must continue paying your
Medicare Part B premium to keep your coverage under this group-sponsored
plan. If you stop your payments, you may be disenrolled from this plan.
No physicals or health questions are required to enroll, and pre-existing conditions do not affect your eligibility.
All Medicare Advantage plans are offered by private companies, like UnitedHealthcare® Insurance Company,
who are required to offer coverage that is as good as Original Medicare or better. The government pays us a
fixed fee for your care. UnitedHealthcare then handles the payments to doctors and hospitals.
Your UnitedHealthcare.
Hospital
Doctors
Additional
Benefits
Drugs
Choosing the right health care plan is a big decision. It involves looking at the costs, benefits, access to doctors
and other health care services and so much more. We want to help you get the most out of your health care
dollar so you can feel good about your health plan choice.
Five reasons to choose a UnitedHealthcare® plan.
1
Get coverage from a National Leader – With over 25 years of experience, UnitedHealthcare is one
of the nation’s largest providers of health care coverage for older adults. Nationally, we serve one in five
people eligible for Medicare.1
2
3
Help controlling your care costs – This plan helps limit your out-of-pocket expenses by providing
an annual limit and affordable copays.
Flexibility – We understand that your choice of doctors, hospitals and other health care providers is
important. With this plan, you have a large network of doctors, hospitals and other health care providers
affiliated with the plan. There’s a good chance your doctor is already part of our network. You can also get
your prescriptions filled through a national network of more than 65,000 pharmacies.
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dditional health and wellness programs that make a difference – This plan offers the same benefits as
A
Medicare Parts A and B, plus extras that contribute to your health and wellness.
edicated Customer Service – We have created a helpful customer service team that has been trained
D
on your specific group-sponsored plan. With one simple phone call, you can get answers to all your
health plan benefit questions.
3
Your Plan.
Your plan is a Health Maintenance Organization (HMO) plan. This type of plan provides care through
a network of local doctors and hospitals. Your Primary Care Physician (PCP) may oversee your care and,
in some cases, refer you to specialists as necessary.
When you sign up for a UnitedHealthcare Group Medicare Advantage (HMO) plan, all of your health care
coverage is combined into a single plan. You get coverage for hospital care, doctor care and prescription drugs.
All from one company, with one member ID card. It’s an easier way for you to manage your benefits.
Plan highlights:
• You have the flexibility to choose your own doctor from our large network. In fact, there’s a
good chance your doctor is already a part of our network.
• To receive plan benefits, you must receive services from inside the network.
• If your doctor or hospital is “in-network” (has a contract with UnitedHealthcare for this plan)
they must accept this plan.
• If your doctor or hospital is “out-of-network” (does not have a contract with UnitedHealthcare
for this plan), you must pay the full cost for all services.
• You can enjoy predictable copays (a flat dollar amount) or coinsurance (a percentage) that
represent your share of the cost.
• There is a limit on your out-of-pocket spending for the year.
• Worldwide Emergency and Urgently Needed Services are covered and never require
prior authorization.
Frequently asked questions.
In-Network
Out-of-Network
Yes
No
Standard plan copay or
coinsurance applies
You must pay the full cost
for services
Do I need to choose a
Primary Care Physician (PCP)?
Yes
N/A
Do I need a referral to see
a specialist?
Yes
N/A
Will the doctor or hospital
accept my plan?
What is my copay or coinsurance?
For more information about your plan details including copays, plan benefits and prescription drug
coverage — refer to the Summary of Benefits.
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Your Doctor.
Seeing a doctor is easy. When you enroll in this plan, you have access to a broad network of doctors
and hospitals. Providing members with a large network of health care providers is just another example
of how we help you take control of your health care decisions, by increasing your options and choices
in getting care. With our large network, most likely your doctor is already part of the plan.
To find doctors or hospitals in our network, see the online Provider Directory at
www.UHCRetiree.com/asrs. This directory is updated regularly to provide you with
the current listing of network providers.
If you would like help finding a network doctor or to request a written copy of the
Provider Directory, please call Customer Service.
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Your Additional Benefits
and Programs.
Your plan provides the same coverage as Medicare Parts A and B,
plus many additional benefits and programs that contribute to your
health and wellness. They may include:
NurseLine Services
SM
Speak with a registered nurse, 24 hours a day, 7 days a week.
• Discuss your health and diet.
• Review or discuss your medications.
• Receive information about illnesses and injuries.
• Get tips on working with your doctor.
SilverSneakers® Fitness Program
Stay physically fit and active with the SilverSneakers Fitness Program. This fitness program is available
to you at no additional cost.
With the SilverSneakers Fitness Program you’ll receive:
• A basic fitness center membership at more than 11,000 participating locations.
• Access to all amenities, programs and services that are standard with a basic fitness center membership.
• Nationwide access to any participating fitness location (find locations at www.silversneakers.com).
• Many women-only locations, including Curves,® are available nationwide.
If the nearest participating location is 15 miles or more away from your home, you can register for
the SilverSneakers® Steps program. This is a personalized program that provides tools such as resistance
bands, exercise DVDs and “how-to” material to help you measure, track and increase your daily activity.
The products and services described below are neither offered nor guaranteed under our contract with the
Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding
these products and services may be subject to the UnitedHealthcare grievance process.
Solutions for Caregivers
Providing care for a loved one can be demanding and overwhelming. This plan gives you access to
Solutions for Caregivers – a program that supports you, your family and your loved ones.
Services provided by Solutions for Caregivers include:
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• On-site assessment and development of a personalized care plan for you or your loved one.
• Unlimited phone access to a Care Specialist who can provide counsel on individual, medical, financial,
safety, emotional and social needs.
• Connections with professionals, including home health aides, nurses, lawyers and financial advisors.
Your Prescription Drug Coverage.
Your plan includes Medicare Part D prescription drug coverage, so there’s no need to get a stand-alone
Medicare Part D plan2. Members can fill their prescriptions at more than 65,000 network pharmacies. As
with stand-alone Medicare Part D plans, you pay some of the cost of your drugs (a copay or coinsurance)
and the plan pays the rest. The amount you pay depends on the drugs you take.
Your Plan Sponsor has added the UnitedHealthcare® RxSupplement™ plan to your coverage.
This plan provides supplemental coverage while in the coverage gap stage. With this
plan, your coverage remains the same. You will continue to pay the same copayment or
coinsurance while in the coverage gap as you did before you entered the coverage gap.
Enrollment in the supplement plan is automatically included as part of your coverage when
you enroll in the UnitedHealthcare Group Medicare Advantage plan.
Save on prescription drug costs.
UnitedHealthcare is always looking for ways to save our members money. We have worked with many of
our network pharmacies to provide the Pharmacy Saver program. Hundreds of generic drugs now cost as
low as $2 for a one-month supply. In addition to savings, Pharmacy Saver offers convenience, with many
national and local pharmacies to choose from. To look up qualifying drugs, participating pharmacies and
prices, go to: www.UnitedPharmacySaver.com.
You may also save money on your prescription drugs when you use mail service. See your Summary of Benefits
to learn if your plan offers savings through a mail service pharmacy.
More ways to save.
Your plan’s formulary (drug list) includes 100 percent of the drugs covered by Medicare Part D. Please review
this plan’s drug list to be sure your prescription drugs are covered (not all drug lists are the same).
This drug list is organized into different categories called “tiers.” In general, the lower the tier, the lower your
cost for the drug. Many drugs on the drug list have other generic and brand name drug choices in lower tiers
that treat the same conditions, but cost less. If you’re taking a Tier 2 or Tier 3 drug, you may be able to switch
to a lower-tier (Tier 1 or Tier 2) drug and save money. Talk to your doctor to find out if there is an effective
lower-tier drug for your current medication.
Tier
Your cost
Description
Tier 1
Low
Includes most generic prescription drugs. For the lowest out-of-pocket expense,
you and your doctor should decide if Tier 1 medications are right for your treatment.
Tier 2
Includes many common brand name drugs and some higher-cost generic
prescription drugs.
Tier 3
Includes non-preferred generic and non-preferred brand name drugs. Tier 3 drugs
usually have lower-cost choices in Tier 1 or Tier 2 that can treat the same condition.
Tier 4
(Specialty
Tier)
High
Includes unique or very high-cost drugs. You pay a high copayment or
a percentage of the total cost, called coinsurance.
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List of commonly used drugs.
Shown here are some of the most commonly used drugs covered by this plan. This is not a complete drug list.
To make sure your drugs are covered and to find out tier information, please call Customer Service. Or visit us
online at www.UHCRetiree.com/asrs.
Drug Name
Acetaminophen/Codeine
Actonel
Acyclovir
Advair Diskus
Aggrenox
Alendronate Sodium
Allopurinol
Amiodarone HCl
Amitriptyline HCl
Amlodipine Besylate
Amlodipine Besylate/Benazepril HCl
Amoxicillin
Amoxicillin/Potassium Clavulanate
Anastrozole
Asacol
Atelvia
Atenolol
Avapro
Avodart
Azithromycin
Azor
Baclofen
Benazepril HCl
Benicar
Benicar HCT
Boniva
Budeprion SR
Bupropion HCl
Buspirone HCl
Bystolic
Carbidopa/Levodopa
Carisoprodol
Cartia XT
Carvedilol
Bold = Brand name drug
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Cefuroxime Axetil
Celebrex
Cephalexin
Ciprofloxacin HCl
Citalopram Hydrobromide
Clindamycin HCl
Clobetasol Propionate
Clonidine HCl (Weekly Patch)
Colcrys
Combivent
Crestor
Cyclobenzaprine HCl
Cymbalta
Detrol la
Dexilant
Diclofenac Sodium
Digoxin
Diltiazem CD
Diltiazem HCl
Diltiazem HCl ER
Diovan
Diovan HCT
Divalproex Sodium
Donepezil HCl
Dorzolamide HCl/Timolol Maleate
Doxazosin Mesylate
Doxycycline Hyclate
Enablex
Enalapril Maleate
Endocet
Estradiol
Evista
Exforge
Famotidine
Fexofenadine HCl
Finasteride (5mg Tablet)
Fluconazole
Fluocinonide
Fluticasone Propionate
Furosemide
Gabapentin
Gemfibrozil
Glimepiride
Glipizide
Glyburide
Glyburide/Metformin HCl
Humalog
Hydralazine HCl
Hydrochlorothiazide
Hydrocodone/Acetaminophen
Hydroxychloroquine Sulfate
Hydroxyzine HCl
Ibuprofen
Isosorbide Mononitrate
Isosorbide Mononitrate ER
Klor-Con 10
Klor-Con 8
Klor-Con M20
Lansoprazole
Lantus
Levaquin
Levetiracetam
Levothroid
Levothyroxine Sodium
Levoxyl
Lexapro
Lidoderm
Lipitor
Drug Name – continued
Lisinopril
Lisinopril/Hydrochlorothiazide
Losartan
Lovastatin
Lovaza
Lumigan
Lunesta
Lyrica
Matzim LA
Megestrol Acetate
Meloxicam
Metformin HCl
Metformin HCl ER
Methocarbamol
Methotrexate
Methylprednisolone
Metoclopramide HCl
Metoprolol Succinate ER
Metoprolol Tartrate
Metronidazole
Mirtazapine
Mirtazapine ODT
Morphine Sulfate ER
Namenda
Naproxen
Naproxen DR
Nasonex
Nexium
Niaspan
Nifediac CC
Nifedical XL
Nifedipine
Nifedipine ER
Nitrofurantoin
Nitrostat
Novolog
Omeprazole
Oxybutynin Chloride
Oxycodone HCl
Oxycodone/Acetaminophen
Pacerone (200mg Tablet)
Pantoprazole Sodium
Paroxetine HCl
Plavix
Polyethylene Glycol 3350
Potassium Chloride ER
Pradaxa
Pravastatin Sodium
Prednisone
Premarin
Proair HFA
Promethazine HCl
Propranolol HCl
Propranolol HCl ER
Proventil HFA
Quinapril HCl
Ramipril
Ranitidine HCl
Risperidone
Risperidone ODT
Ropinirole HCl
Seroquel
Seroquel XR
Sertraline HCl
Simvastatin
Singulair
Sotalol HCl
Spiriva Handihaler
Spironolactone
Sulfamethoxazole/Trimethoprim
Synthroid
Tamsulosin HCl
Terazosin HCl
Timolol Maleate
Toprol XL
Torsemide
Tramadol HCl
Travatan Z
Trazodone HCl
Triamcinolone Acetonide
Triamterene/Hydrochlorothiazide
Tricor
Uroxatral
Valacyclovir HCl
Venlafaxine HCl
Venlafaxine HCl ER
Ventolin HFA
Verapamil HCl
Verapamil HCl ER
Vigamox
Voltaren (Gel)
Vytorin
Warfarin Sodium
Welchol
Zetia
Zolpidem Tartrate
Zostavax
Zyprexa
Bold = Brand name drug
Trademarks for the drugs listed above are owned by third parties with whom this plan has no affiliation. This is
not a complete drug list. Please note that the drug list is updated periodically throughout the year, and the list of
covered drugs may change as drugs are added or deleted from the list. To find out if your drugs are covered, call
Customer Service.
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Next Steps.
1. UnitedHealthcare will make sure you are eligible for the plan.
2. In about 4-6 weeks, you will receive your new member ID card.
3. Once you are officially enrolled in the plan, you will receive a Welcome Kit.
4. Begin using your new member ID card on your effective date.
Important Notes.
The Centers for Medicare and Medicaid Services, (CMS) requires that we provide our members with
new or updated plan materials. Providing you with new and updated plan information can help you
understand your plan better, so you can take advantage of all the benefits available to you.
• Evidence of Coverage (EOC) – included in your Welcome Kit, provides complete details about
the benefits and services included with your new plan.
• Annual Notice of Changes (ANOC) – mailed every year before your renewal, describes changes
to your benefits for the next year.
• Updated Pharmacy and Provider Directories – mailed every 1-3 years.
Remember, if you drop your group-sponsored retiree health coverage, you may not be able to re-enroll.
Limitations and restrictions vary by plan sponsor.
Questions?
Call Customer Service toll-free:
1-877-714-0178, TTY 711
8 a.m. – 8 p.m. local time, 7 days a week
When calling Customer Service, let the representative know
that you are calling about a group-sponsored plan. Your group
number can be found on the Summary of Benefits.
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Notes
1
2010 UnitedHealth Group Annual Report
If you enroll in a separate Medicare Part D plan after you enroll in this plan, you may be disenrolled from
your group-sponsored medical and/or prescription drug coverage.
2
OptumHealthSM is a health and well-being company that provides information and support as part of your
health plan. NurseLineSM nurses cannot diagnose problems or recommend specific treatment and are not a
substitute for your doctor’s care. NurseLineSM services are not an insurance program and may be discontinued
at any time.
SilverSneakers® is a registered mark of Healthways, Inc. The SilverSneakers® program is made available as
part of this plan’s benefits to those insured through this plan. UnitedHealthcare does not endorse and is not
responsible for the services or information provided by this program. Always consult your physician before
you begin SilverSneakers or any physical fitness program.
Solutions for Caregivers assists in coordinating community and in-home resources. The final decision about
your care arrangements must be made by you. In addition, the quality of a particular provider must be solely
determined and monitored by you. Information provided to you about a particular provider does not imply and
is in no way an endorsement of that particular provider by Solutions for Caregivers. The information on and
the selection of a particular provider has been supplied by the provider and is subject to change without
written consent of Solutions for Caregivers.
UnitedHealthcare® Medicare Advantage plans are insured through UnitedHealthcare Insurance Company and
its affiliated companies, a Medicare Advantage organization with a Medicare contract.
Members may enroll in the plan only during specific times of the year. Contact UnitedHealthcare for more
information. You must have both Medicare Parts A and B to enroll in the plan.
The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For
more information contact the plan. You must continue to pay your Medicare Part B premium if not otherwise
paid for under Medicaid or by another third party. Limitations, copayments, and restrictions may apply.
You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify
for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours
a day/ 7 days a week; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday
through Friday. TTY users should call, 1-800-325-0778; or your Medicaid Office. You must use contracted
network pharmacies to access your Part D prescription drug benefit except under non-routine circumstances,
in which case quantity limitations and restrictions may apply.
HMO members must use plan providers except in emergency or urgent care situations or for out-of-area renal
dialysis. If you obtain routine care from out-of-network providers neither Medicare nor UnitedHealthcare®
Medicare Advantage plans will be responsible for the costs.
Retiree plan prospects must meet the eligibility requirements to enroll for group coverage.