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H5820_UHC2042REV (11/07) Welcome to Welcome to Universal Universal Hassle Free Healthcare Hassle Free Healthcare
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H5820_UHC2042REV (11/07) Welcome to Universal “Hassle Free Healthcare ” “Hassle Free Healthcare ”

Dec 24, 2015

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Page 1: H5820_UHC2042REV (11/07) Welcome to Universal “Hassle Free Healthcare ” “Hassle Free Healthcare  ”

H5820_UHC2042REV (11/07)

Welcome Welcome to to

UniversalUniversal

““Hassle Free Healthcare Hassle Free Healthcare ””

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“Hassle Free Health Care ”

We want to thank you for considering Universal Health Care for your Medicare coverage. Choosing the Medicare plan that is right for you is very important, not only for your health but your peace of mind.

Our goal today is to provide you with the information youneed so you can make the best informed decision possible.

If you decide to use Universal Health Care for your Medicare coverage, you will have access to quality healthcare, it will be comprehensive, convenient and affordable.

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PFFS Disclaimer

A Medicare Advantage Private Fee-for-Service plan works differently than a Medicare supplement plan. Your doctor or hospital must agree to accept the plan’s terms and conditions prior to providing healthcare services to you, with the exception of emergencies. If your doctor or hospital does not agree to accept our payment terms and conditions, they may not provide healthcare services to you, except in emergencies. Providers can find the plan’s terms and conditions on our website at: www.univhc.com

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What is a PFFS Plan?

A PFFS plan is a type of Medicare Advantage plan offered by a private insurance company like Universal Health Insurance Company.

It is not the same as the Original Medicare plan that is offered by the Federal Government.

It is not a Medicare supplement, Medigap, Medicare Select, or Prescription Drug Plan.

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PFFS Plan Options

PFFS Plan options available to beneficiaries may include:

• PFFS plan offering only medical benefits;

• PFFS plan that combines medical benefits and Part D prescription drug benefits (MA-PD plan); or

• PFFS plan in combination with a stand-alone Part D prescription drug plan (PDP).

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PFFS Plan - EligibilityBeneficiaries must be enrolled in Part Aand Part B.Beneficiary must live in the PFFS plan’sservice area.PFFS plans must enroll any eligiblebeneficiary who applies regardless ofhealth status, except

Beneficiaries with end stage renal disease are not eligible to enroll unless special rules are met.

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PFFS Plans - PremiumsBeneficiaries must continue to pay their Part Bpremiums to remain eligible to join a PFFS plan. Generally, beneficiaries pay a monthly premium

for aPFFS plan in addition to their monthly Part Bpremium.If the PFFS plan includes a Part D benefit, lowincome beneficiaries may be eligible for extra

helpfrom Medicare that covers all or part of the part Dportion of the PFFS plan premium.

Beneficiaries should be encouraged to apply by contacting the Social Security Administration (SSA) at 1-800-772-1213 or applying online at

www.ssa.gov/prescriptionhelp

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PFFS Plan - ProvidersEnrollees may receive covered services from anyprovider who participates in Medicare and agrees toaccept the plan’s terms and conditions of payment.

Enrollees must inform providers before receivingservices that they are PFFS plan members so thatthe providers can decide whether to accept theplan’s terms and conditions.

Providers may, on a patient-by-patient and visit-byvisit basis, decide whether to treat the beneficiary.Some providers that accept Original Medicare maynot accept PFFS plan enrollees.

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PFFS Plan – Providers

(cont’d)PFFS Plans generally pay providers thesame amount Medicare would pay them.

Providers are not permitted to chargethe beneficiary more than the costsharing specified in the PFFS plan’sbenefits.

Cost sharing may include a deductible and copayments or coinsurance.

Cost sharing may include balance billing up to 15% of Medicare rate.

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PFFS Plans and Dual Eligible Beneficiaries

Unique PFFS plan issues exist for Medicare/Medicaid eligible

(dual eligible) beneficiaries.

Categories of dual eligible beneficiaries and out-of-pocket costs that must be paid by Medicaid:

QMB (only) (Qualified Medicare Beneficiary) – Medicare Part B Premium; cost sharing for Part A & B benefits.

QMB Plus – Medicare Part B premium; cost sharing for Part A & B benefits; coordinates Medicaid benefits with Medicare.

SLMB(only) (Specified Low-Income Medicare Beneficiary) – Medicare Part B premium.

SLMB Plus – Medicare Part B premium; coordinates Medicaid benefits with Medicare.

QI (Qualifying Individual) – Medicare Part B premium.Other FBDE (Full Benefit Dual Eligible) – Coordinates

Medicaid benefits with Medicare.QDWI (Qualified Disabled and Working Individual) – Part A

premium.

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PFFS Plans and Dual Eligible Beneficiaries (cont’d)

Key issues that are important to dual eligible beneficiariesconsidering PFFS plan enrollment include:

Whether the beneficiary is eligible for medical benefits under

Medicaid.Medicaid may provide additional benefits, but

Medicaid will coordinate benefits only with Medicaid participating providers.

How cost sharing will be different under the PFFS plancompared to Medicaid benefits.

What is the cost sharing under the PFFS plan benefits?

Medicaid will pay cost sharing assistance only for services provided from Medicaid participating

providers.Whether the beneficiary will need help to find providers

whoaccept both Medicare and Medicaid.

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How Does a PFFS Plan Work?

The PFFS plan pays instead of Medicare.The beneficiary will pay amounts that thePFFS plan does not pay, which are calledcopayments and coinsurance.

A PFFS plan does not pay after Medicare pays

its share.

Original Medicare will not pay for thebeneficiary’s health care while enrolled in aPFFS plan.

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How Do You Obtain Services from a PFFS

Plan?You may receive health care services

from any provider allowed to bill Medicare who agrees to accept the Private Fee-for-service plan’s payment terms and conditions.

You must use network pharmacies toobtain prescription drugs, except inemergencies or urgent situations.

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Before Seeing a Provider, You Should …Verify that your provider will accept the Any, Any,Any Plan. Your health care providers have the right to

choosewhether to accept a Private Fee-for-service plan’s

paymentterms and conditions every time you see your

providers.

If your provider decides not to accept the plan, youwill need to find another provider that will.They should not provide services to you, except in anemergency.

If they choose to provide services, they may not billyou. They must bill the Private Fee-for-service planfor your covered health services. You must pay theappropriate copayments and coinsurance.

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When You Go to the Doctor or Hospital

Show your Any, Any, Any Plan ID cardand tell them that you have chosenAny, Any, Any for your Medicare healthplan.

Do not show your red, white, and blueMedicare card.

Pay the Any, Any, Any copayments orcoinsurance at the time of service.

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What We’ll Talk About What We’ll Talk About TodayToday

■Universal Health Care: Who We Are

■Review Your Current Coverage

■Explain the Benefits of the Any, Any, Any Plan

■Answer Your Questions

■Show You How to Enroll

If you have questions during the presentation, please hold them until the end of the presentation.

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Who is Who is Universal Universal Health Care?Health Care?

Physician Managed & Operated Corporate HQ in St. Petersburg, FL Medicare Advantage in Florida – 2003 Florida Medicaid introduced – 2005 Expanded to South & Central Florida - 2006 Expanded to 8 States with the Any, Any, Any

health plans - 2007

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Our Mission Our Mission StatementStatement

We are an innovative and dynamic organization dedicated to delivering personal, professional and proactive

health care to our members. Our commitment is to partner with our members in their journey toward a

healthy, fulfilling and meaningful life.

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What Is Your What Is Your Current Current Coverage?Coverage?

Do you have any health insurance in addition to Medicare Parts A and B?

Do you pay a premium or does someone else pay it for you?

If you could change anything about your coverage, what would it be?

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Added Benefits of aAdded Benefits of aMedicare Advantage Medicare Advantage PlanPlan

All the benefits that you currently receive from Medicare, plus much more including:

Plans with no Health Plan Premiums No Medicare Deductibles Go to the doctor of your choice who accepts

the plan’s terms and conditions Brand & Generic Rx Coverage* World Wide Coverage (i.e. Emergency and

Urgently Needed Care)*

…and more*Limitations & Co-payments may apply

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Extra Benefits for Dental, Vision and Hearing *

24-hour Medical Consultation Line Opportunity to see any physician without referrals who accepts

the plan’s terms and conditions * No need for a Medicare supplement

*Limitations & Co-payments may apply

Added Benefits of aAdded Benefits of aMedicare Advantage Medicare Advantage PlanPlan

More benefits from the Any, Any, Any Plan, including:

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WHO IS ELIGIBLE TO JOIN UNIVERSAL HEALTH CARE ?

You can join Universal Health Care if you are entitled to Medicare Part A and enrolled in Medicare Part B Live in the service area. Individuals with End Stage Renal Disease are not eligible to enroll in the Universal Health Care.**There are Exceptions to Eligibility Rule for persons who have ESRD

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Compare Your Health Care Options

This table is a brief overview comparing Original Medicare, a popular Medicare supplement and Universal Healthcare Medicare Advantage plans. The Summary of Benefits will go into more detail about benefits.

Original MedicareOffice visits when you aresick

Hospitalization

A common Medicaresupplement - Plan C

Coverage for all Medicaredeductibles and coinsurance

Any, Any, AnyMedicare Advantage Plan You keep all of your Original

Medicare benefits, plus a planthat is Hassle Free, innovativeproactive healthcare, and partnering with our members to create healthy, fulfilling, and meaningful lives.

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US Federal Government Provides Funds for

Original Medicare Medicare Advantage• Limited coverage• Limited preventive care benefits• Deductibles• Coinsurance•Supplemental policy may be necessary•Join a Prescription Drug Plan (PDP) for Part D coverage

• Covers all benefits of original Medicare + no Medicare deductibles Part D included• No supplement needed• Can Include additional benefits

Medicare Beneficiary

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How the Any, Any, Any Plan is Reimbursed

Medicare Part AFinanced in part by payroll taxes paid by workers and employers

Medicare Part BFinanced in part by deductions from your monthly Social Securitycheck.

US Government Medicare Funds

Hospitals AdministrationDoctors

Additional Benefits Other Health Care Providers

UniversalUniversal

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The Benefits of the Any, Any, AnyThe Benefits of the Any, Any, AnyMedicare Advantage PlanMedicare Advantage Plan

For the next few minutes, your Universal Representative will present the specifics of your

Any, Any, Any Medicare Advantage plan benefits, using

the Summary of Benefits booklet.

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Top Reasons to Join Top Reasons to Join thetheAny, Any, Any PlanAny, Any, Any Plan

You have the Ultimate Freedom to see Any Doctor, Any Time, Any Where that accepts the plan’s terms and conditions

No need for Medicare supplement Plans with Part B reimbursement** World Wide Coverage (i.e. Emergency

and Urgently Needed Care)*

*Limitations & Co-payments may apply**In Some Locations

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Top reasons to Join Top reasons to Join thetheAny, Any, Any PlanAny, Any, Any Plan

Hassle free with virtually no paperwork(No referrals, no paper claims to file, etc.)

Brand & Generic Rx Coverage* Extra Coverage for Dental, Vision & Hearing* 24-Hour Medical Consultation Hotline Affordable, Predictable Prescription Drug

Copayments Access to see Specialists Without Referrals that

accept the plan’s term and conditions

* Limitations & Co-payments may apply

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EnrollmenEnrollmentt

Complete an enrollment form. You will receive a new member

packet including your welcome letter, evidence of coverage and identification card.

Your proposed effective date will be…

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OrientatioOrientationn

Go over new member packet How to set up Rx by mail Review membership benefits Customer service contact numbers Answer questions

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PFFS Disclaimer

A Medicare Advantage Private Fee-for-Service plan works differently than a Medicare supplement plan. Your doctor or hospital must agree to accept the plan’s terms and conditions prior to providing healthcare services to you, with the exception of emergencies. If your doctor or hospital does not agree to accept our payment terms and conditions, they may not provide healthcare services to you, except in emergencies. Providers can find the plan’s terms and conditions on our website at: www.univhc.com

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QuestionQuestions?s?

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Thank Thank You!You!

If you have found value in this seminar, please do us the courtesy, and your friends the favor, of telling them about Universal Health Care’s Any, Any, Any Plan.

Call Toll Free: (866) 690-4842 TTY/TDD: 1-800-617-0177

Monday – Friday 8:00AM – 8:00PM EST

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