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Your Health Care CountsOur Health Plan: What Do You Need to Know?
Employee Benefits Orientation - 2014Coverage effective dates: July 1, 2014 - June 30, 2015
You probably have a lot of questions
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Is my doctor in the network? What health care
coverage best fits my needs?
What is my total cost of health care including
premiums?
What extras do I get with my health plan?
Eligibility and Family Status Changes
3Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Active full-time or part time
employees (scheduled to work at
least 17.5 hours per week in a 35
hour work week or at least 20
hours per week in a 40 hour work
week) and their eligible dependents.
Benefits are effective after 30 days
of continuous employment, assuming
all applicable actions and documentation
have been received in good order.
Residents – No waiting period for
Medical coverage (only) and is effective on
first date of employment.
Temporary Employees are not eligible
for benefits
Eligible Dependents – include
spouse, domestic partner (with signed
affidavit), dependent child(ren) up to
age 26.
Legal documentation is required to
enroll your eligible
dependents(marriage license, birth
certificate, court order, etc.)
Making changes to your benefits – if you experience a family status event
such as - marriage, divorce, birth, death,
loss of dependent status, etc., you
have 30 days from the date of the
event to make applicable changes toyour benefits.
All employee benefits terminate on your last
date of employment
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What health care coverage best fits my
needs?
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UnitedHealthcare Choice Plus Plan
You have coverage if you receive care outside our network.
• Freedom to choose any network doctor, including specialists, without referrals
• Coverage for non-network care• No need to choose a primary care physician• 100% preventive care coverage in our network• Care management if you require hospital stay or
surgery • Copayments, coinsurance and/or deductible
Definitions
Copayment - is a fixed amount you pay when you receive the service. The amount can vary by the type of service. You may also have a copay when you get a prescription filled.
Coinsurance - is your share of the costs of a health care service (ie: hospitalization, outpatient procedures) and usually figured as a percentage of the total charge for the service.
Deductible - is the amount you pay for health care services before your health insurance begins to pay.
Choice Plus Basic OptionType of Coverage In Network Out of Network
DeductibleIndividual / Family
$500 / $1,500 $1,000 / $3,000
Out-of-pocket MaximumIndividual / Family
$2,500 / $7,500 $7,500 / $22,500
Lifetime Plan MaximumOrgan Transplant
UnlimitedPlan Maximum
Unlimited$30,000 maximum
Primary Care Physician Office Visit
$30 copayment*Use of MSM physician - $10 reduction in co-pay.
50% after deductible
Specialist Office Visit $50 copayment*Use of MSM physician - $10 reduction in co-pay.
50% after deductible
Emergency Room Visit $100 copayment waived if admitted
$100 copayment waived if admitted
Urgent Care Center Visit $30 copayment 50% after deductible
Inpatient Hospital Stay 90% after deductible 50% after deductible
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Choice Plus High OptionType of Coverage In Network Out of Network
DeductibleIndividual / Family
$0 / $0 $300 / $ 900
Out-Of-Pocket MaximumIndividual / Family
$2,000 / $6,000 $1,500 / $4,500
Lifetime Plan MaximumOrgan Transplant
UnlimitedPlan Maximum
Unlimited$30,000 maximum
Primary Care Physician Office Visit
$25 copayment*Use of MSM physician - $10 reduction in co-pay.
50% after deductible
Specialist Office Visit $50 copayment*Use of MSM physician - $10 reduction in co-pay.
50% after deductible
Emergency Room Visit $100 copayment waived if admitted
$100 copayment waived if admitted
Urgent Care Center Visit $25 copayment 50% after deductible
Inpatient Hospital Stay 90% after deductible 50% after deductible
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Visit and register at : www.myuhc.com
What’s available:
• Print/request membership cards
• Search for a doctor/hospital or urgent care center
• Track claim status
• Claim forms
• Estimate medical cost
• Receive health product discounts
• Keep personal health records
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• Preventive care is covered at 100% for in-network services only.
Out-of-network services subject to
deductible and coinsurance.
• Regular preventive care helps
• Reduce risk of disease
• Detect health problems early
• Protect you from higher costs down the road
• May save your life
Preventive Health Care Coverage
In-Network Services
No deductible.No copayment.
No coinsurance. 100% coverage.
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UnitedHealthcare Pharmacy
Tier 1
Retail Mail Order *
$10 Copay
31-Day Supply
$20 Copay
90-day supply
Tier 2
Tier 3 $50 Copay
31-Day Supply
$30 Copay
31-Day Supply
$60 Copay
90-day supply
$100 Copay
90-day supply
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*Ordering your prescriptions via mail service is fast and convenient. If you are managing long-term or chronic conditions, using our mail service pharmacy makes sense - you can purchase up to a three-month supply of most prescription medications. Learn more about using the OptumRx Mail Service Pharmacy.
Important: Tier 1 FDA approved contraceptives are covered at 100%, in accordance with Health Care Reform.
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Specialty medication is a high-cost, injectable, oral, infused, or inhaled medication if it
has one or more of the following attributes: self-administered or administered by a health care provider and used or obtained in either an
outpatient or home setting. special storage or handling requirements such as needing to be refrigerated. may need close monitoring, on-going clinical management, and complete patient education and
engagement. may not be available at retail pharmacies.
Conditions Include:
Anemia, Cancer, Hemophilia, Hepatitis B and C, HIV/AIDS, Infertility, Multiple Sclerosis , Rheumatoid Arthritis, and more
Services• 24/7 access to pharmacists, providing support focused on you• Adherence and clinical programs to help you better manage your condition • Proactive reminders and timely delivery• Online support and medication information for you
Specialty Pharmacy
We focus on you and the total
condition, not just drug utilization.
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Medical Plan Rates – Effective July 1, 2014
Basic Option High Option
Total Monthly Rates**
Employee Bi-weekly Rates
Total Monthly Rates**
EmployeeBi-weekly Rates
Employee $ 500.84 $ 26.83 $ 533.16 $ 46.68
Employee + Child(ren) $ 976.58 $ 80.50 $ 1,078.62 $ 135.13
Employee + Spouse $ 1,047.75 $ 104.90 $ 1,157.24 $ 167.07
Family $ 1,529.32 $ 168.33 $ 1,689.12 $ 243.24
** Total monthly rates equal cost paid by MSM and employee
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Dental Plan Benefits
• Over 165,000 service providers nationwide
• Savings on Services from Network Dentists – you access negotiated discounts, thereby maximizing your dental benefits
• No claim forms for Network Services
• Preventive Care, including Exams and Cleanings, at little or no
out-of-pocket cost
• Freedom to Visit Out of Network Dentists – you will be reimbursed only for up to reasonable & customary amount for
each service, and you could be responsible for excess charges.
• Benefit Information at www.myuhcdental.comPlease refer to the Summary Plan Description, for full details.
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Dental Services In-Network Out-of-Network
Preventive and Diagnostic 100% 100%
Basic Services
Minor Restorative 80% 80%
Single Extractions 80% 80%
Endodontics and Periodontics 80% 80%
Oral Surgery 80% 80%
Major Services
Crowns/ Bridges 50% 50%
Dentures 50% 50%
Orthodontia 50% 50%
Annual Deductible $ 50 / 150 $ 50 / 150
Annual Benefit Limit $2,000 $2,000
Lifetime Ortho Maximum – Adults and Children
$2,000 $2,000
Dental Plan Benefits
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Dental Plan Rates – Effective July 1, 2014
Coverage LevelTotal Monthly Rates**
Employee Bi-weekly
Rates
Employee $ 36.30 $ 1.81
Employee + Child(ren) $ 70.78 $ 5.42
Employee + Spouse $ 75.94 $ 7.06
Family $ 110.84 $ 11.34
** Total monthly rates equal cost paid by MSM and employee
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Unitedhealthcare Vision …the difference is clear
• Comprehensive eye exams
• Eyeglasses (lenses and frames)
• Contact lenses
• No ID Cards needed
• Basic plan information and provider directory at www.myuhcvision.com
• Discounted laser eye surgery
• Go out of the network with a scheduled reimbursement
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Frequency In-Network Out –of- NetworkReimbursements
Comprehensive Eye Exam Every 12 months $10 copay up to $40
A complete pair of eyeglass lenses or covered-in-full contact lenses after copay
Every 12 months $10 copay N/A
Frame Every 24 months $130 allowance up to $45
Lens Options
• Single vision, lined bi-focal, lined tri-focal or lined lenticular lenses
(Other lens options available at a discounted rate)
• Standard scratch coating
Every 12 months
Covered in full
Covered in full
Covered in full
Single vision up to $40
Bifocals up to $60
Trifocal up to $80
Lenticular up to $80
Elective Contact Lenses
• Contact lenses that fall outside the covered-in-full selection.
(Copay does not apply)
Every 12 months $10 copay up to $210
Additional Materials 20% off 20% off
Vision Benefits at a Glance
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Vision Plan Rates – effective July 1, 2014
Coverage LevelTotal Monthly Rates**
Employee Bi-weekly Rates
Employee $ 4.55 $ 0.23
Employee + Child(ren) $ 8.87 $ 0.68
Employee + Spouse $ 9.52 $ 0.89
Family $ 13.89 $ 1.42
** Total monthly rates equal cost paid by MSM and employee
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Flexible Spending Accounts (FSA)Medical and Dependent Care
Flexible Spending Accounts allow you to set aside before-tax money from your paycheck to pay for certain health care expenses including deductibles, copayments, certain services not covered by your health plan, and dependent day care expenses. After paying your provider you then file a claim for reimbursement (unless using the UHC debit card to pay for expenses).
Important:These accounts have some restrictions on allowable expenses, and any money left in your account at the end of the year ( January – December) will be forfeited; it cannot be rolled over in the next year or paid out.
Two Types of Flexible Spending Accounts
Healthcare (FSA) is used to pay for out-of-pocket medical expenses not covered by insurance (exclusions exist). A list of exclusions can be found on www.myuhc.com.
Dependent Care (FSA) is used to pay for non-medical day care expenses for your eligible dependent child(ren) up to age 13, elder dependents and disabled dependents ( incapable of self support). Non-medical day care expenses include before/after-school care and summer day camp.
Annual Plan Limits: Minimum Contribution $200 Maximum Contribution $2,500 Healthcare; $5,000 Dependent Care
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Flexible Spending Accounts (FSA)Medical and Dependent Care… cont.
Contributions are unique. To determine your contribution amount, you should consider what you typically spend each year on out-of-pocket healthcare and daycare expenses. Include expenditures for yourself and eligible dependents, even if you are not covering your dependents under the medical, dental or vision plans. Additional dollars can be added ONLY if a family status event occurs (birth, day care expenses increase, etc.)
When enrolling in the UHC FSA plan(s), you will receive a Debit card for your convenience. When using your FSA Debit card or submitting claims for eligible expenses, be sure to save all of your itemized receipts as the Internal Revenue Service (IRS) requires proof of payment on some claims.
Any money left in your account at the end of the plan year cannot be rolled over
into the next year or paid out to you, so plan carefully! “Use it or lose it “rule does apply!
FSA Savings calculator: www.welcometouhc.com, click on Tools & Resources.
Claims may be submitted electronically at www.myuhc.com.
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Life and Accident Insurance
Benefit Features
Basic Life MSM automatically provides life insurance coverage in an amount equal to 2x’s your base annual salary (up to a maximum of $500,000). A beneficiary designation is necessary to have on file.
MSM pays cost
Accidental Death & Dismemberment ( AD&D)
Accident insurance provides protection to you and/or your beneficiaries if you die or are seriously injured in an accident. MSM automatically provides accident insurance coverage in an amount equal to 2x’s your base annual salary (up to a maximum of $500,000). It does not cover a death resulting from illness or natural causes.
MSM pays cost
Supplemental Life- Employee
You may purchase coverage up to 1x’s your base annual salary (up to a maximum of $500,000). Proof of good health is required for amounts exceeding $200,000.
Employee must enroll in supplemental life in order to purchase spouse or dependent child(ren) supplemental life coverage.
Employee Paid
Supplemental Life - Spouse
You may purchase life insurance for your spouse in units of $5,000 up to a maximum of $150,000. Any amount greater than $50,000 will require proof of good health (cannot exceed 50% of the employee’s amount of supplemental life coverage).
Employee Paid
Supplemental Life - Dependent Child(ren)
You may purchase insurance for your dependent children in units of $2,500 up to a maximum of $10,000. Each dependent child will be covered at the same amount of insurance.
Employee Paid
Employee Life & AD&D (Basic and Supplemental)– Coverage reduces to 65% at age 65. At age 70 it reduces to 45% of your original benefit. At age 75 it reduces to 30% of your original benefit. Coverage terminates at retirement. Reductions do not apply to your family coverage.
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Income Protection – Short and Long Disability
No one can predict what the future holds, but you can prepare for it.
** These benefits may also be reduced by any other income that you may be receiving (i.e. social security or workers’ compensation benefits, etc.). The Plan will not cover any Disability during the first 12 months after your effective date of coverage
thatis caused by or contributed to, or resulting from, a Pre-Existing Condition or medical or surgical treatment for a Pre-Existing Condition.
Short Term Disability Long Term Disability
Income replacement of up to 60% of pre-disability income**
Employee paid Employer paid
$2,500 maximum weekly benefit $12,500 maximum monthly benefit
Benefits begin on the 15th dayafter a cover illness/injury occurs
Benefits begin 180 days after disability
Benefits end at recovery or at 26 weeks Benefits end at recovery or at Social Security Normal Retirement Age (SSNRA)
AFLACMore information available by calling (800) 433-3036 Policy # 0000012663
Additional income protection such as Accident, Critical Illness, and Hospital Indemnity coverage is available; for details and bi-weekly rates please click the AFLAC Brochure link. Please complete the application, if enrolling.
Employee Paid
Employee Assistance Program (EAP) Care24® services
Care24 services offers you access to a wide range of health and well-being information—seven days a week, 24 hours a day. Life is full of ups and downs, you have access to a great source for support and information who can help with almost any problem ranging from medical and family matters to personal legal, financial and emotional needs.
} Childhood illnesses
} Minor illnesses and injuries
} Medication safety
} Relationship worries
} Choosing appropriate medical care
} Stress and anxiety
} Coping with grief and loss
} Personal legal and
financial issues
} Self-care information
} Help finding a doctor
} Information on medications
} General health information
When you call 1- (888) 887- 4114 you will have access to experienced professionals: • Registered nurses• Master’s-level counselors• Legal and financial professionals• Community resources
You receive three (3) face to face counseling sessions * and unlimited telephonic conversations.* If additional counseling sessions are needed you may be referred through the mental health benefit, part of the medical program, if you are currently enrolled.
Additional information can be found on www.myuhc.com and selecting mental health benefit.
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Retirement Planning – 403(b)
• Eligibility: Employees are eligible to defer from their salary into the 403(b) Plan immediately, provided they meet the benefits eligibility requirements.
• Employer Contribution: Employees in certain employment classes qualify for a 7% employer contribution (Residents, Postdoc Fellows and Research Scholars do not qualify)
• Entry Date: Employees may enroll at any time.
• Salary Deferrals: may equal between 1% and 100% of your compensation on a pre-tax basis. The Internal Revenue Service (IRS) sets maximum deferral limits, which may change each year; please refer to the COLA table on the Internal Revenue Services (IRS) at www.irs.gov for the current year limit.
• Catch-Up Participants: over the age of 50 (or who will attain age 50 by the end of the calendar year), and have or will reach the initial maximum deferral limit, may make additional contributions to the Plan. Please see the COLA table referenced above, for the current year limit.
• Rollovers: Rollovers from a previous 401(a) Plan, 403(a) Plan, 403(b) Plan, or an IRA are accepted into the plan.
Participating in a retirement savings plan is one of the best things you can do to save for your future.
Start immediately: Start savings for retirement with your first paycheck. You decide how much you want to contribute to the plan, and the deduction is automatically taken out of your paycheck.
Maximize your dollar: Your contributions come out of your paycheck before federal and state taxes are taken. This reduces your taxable income, and you pay less in taxes.
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Retirement Planning – 403(b) continued
Loans: Your plan permits loans. The minimum amount that can be requested is $1,000. The maximum number of outstanding loans at any given time is one (1). The interest rate applicable is the prime rate, as found in the Wall Street Journal on the date of the loan, plus 1%. Non-residential loans must be repaid within 5 years; residential loans must be repaid in no more than 15 years.
Distributions: You may take a distribution from the 403(b) plan only for the following qualifying events: termination of employment, attainment of age 59 ½, retirement, permanent disability or death. Your distribution options are determined based on the Individual Agreements that you are invested in. Financial Hardship withdrawals are available if you qualify (based on IRS definition of hardship)
Please complete the Retirement Plan Enrollment Form, in order to start your deferral.Retirement Planning – 403(b)