Together in health - UnitedHealthcare Pre-Member | shbp

2013 OPEN ENROLLMENT GUIDE

Together in healthState Health Benefit Plan

What’s insideBenefit Plan Options

Integrated Wellness, Clinical and Pharmacy Programs

Online and Telephonic Resources

welcometouhc.com/shbp

Thank you for considering UnitedHealthcare. We are proud to again have the opportunity to administer your State Health Benefit Plan (SHBP) options and currently serve 90% of SHBP members. We know you want the best benefit coverage with the fewest obstacles between you and your health care. Here are some of the ways being a UnitedHealthcare member can help.

Your health plan choicesYou have six great plans to choose from — all offering access to customized clinical and wellness programs, telephonic and online tools, dedicated resources and our robust national network with more than 691,000 doctors and health care professionals and access to more than 60,000 network retail pharmacies.

In addition to our national network, our Georgia network gives you the freedom to use more than 16,800 doctors and health care professionals and 154 acute care hospitals. There are also more than 2,000 network retail pharmacies in our Georgia network. Get the most out of your benefits with

access to a network doctor or hospital that’s close to wherever you are seeking care. Whether you are at home, traveling or have a covered child in school out-of-state, you are able to use the network without referrals, and emergencies are always covered anywhere in the world.

HRA (WELLNESS and Standard Plans)

Choice HMO (WELLNESS and Standard Plans)

High Deductible Health Plan “HDHP” (WELLNESS and Standard Plans)

Medical BenefitsFor details about your 2013 medical benefit options and wellness program overview, please visit welcometouhc.com/shbp or look at your benefits at a glance and wellness documents.

HRA Choice HMO HDHP

What you might consider when choosing a health plan:

WELLNESS Plan

Standard Plan

WELLNESS Plan

Standard Plan

WELLNESS Plan

Standard Plan

Do I need to have completed a 2012 WELLNESS Promise to be eligible for a 2013 WELLNESS Plan?

Yes No Yes No Yes No

Do I need to make a 2013 WELLNESS Promise? Yes No Yes No Yes No

Will I have access to the state and national network? Yes Yes Yes

Can I get out-of-network services? Yes – but your costs may be higher

No* Yes – but your costs may be higher

Do I need a referral for a specialist? No No No

Is this plan eligible for the partially state-funded HRA? Yes No No

Does this plan have a deductible? Yes Yes Yes

Does this plan have copayments? No Yes No

Does this plan have coinsurance? Yes Yes Yes

* Unless it is a qualified emergency.

Your Benefit Plan OptionsUnitedHealthcare is committed to giving you and your family access to a better health care experience.

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PharmacyWorking together in health, we are committed to helping you get the most out of your pharmacy benefit. Your pharmacy benefit offers coverage for a wide selection of prescription medications so that you, and your doctor, have choices when finding the right medication for you.

We are here for you with useful tools and resources to help you learn about your medications, costs, and possible lower-cost medication alternatives, plus much more.

Helpful pharmacy benefit tips Log on to myuhc.com® or call customer

care to look up a medication’s tier placement, cost or possible lower cost alternatives. Ask your doctor if a lower-cost alternative medication may be right for you.

At the pharmacy if you have a question about the cost of your medication please call the dedicated SHBP Member Support phone number on the back of your health plan ID card before you pay for the prescription.

Keep a list of your prescriptions handy. You can print off your Prescription Drug List (PDL) by going to welcometouhc.com/shbp. Review your PDL with your doctor or pharmacist regularly. You and your doctor make decisions about your prescription medications.

Understand how your medication helps you. Talk to your doctor or your pharmacist about your medications.

HRA Choice HMO HDHP

WELLNESS and Standard Plans

I have a Prescription Drug List (PDL) with tiers. (A Prescription Drug List is a list of commonly prescribed brand and generic medications placed into tiers.)

My generic medications are usually the lowest cost option. However, sometimes Brand name drugs and generics may be listed in any tier.

Most of the time1

Some brand name medications are my lowest cost option.

I pay coinsurance (after my deductible is met).

I pay copayments/coinsurance (does not apply to my deductible2).

I may be eligible for the Copayment/Coinsurance Waiver Plan (for WELLNESS Plans only).

The SHBP funds dollar credits to my HRA each year for medical and eligible pharmacy expenses.2

Your eligible pharmacy expenses will be automatically withdrawn from your HRA if remaining funds are available. (No pharmacy spending account card is needed for 2013.)

I have the opportunity to get certain 90-day supply prescriptions through mail order or network retail pharmacies.

My prescriptions for specialty medications are filled through the Specialty Pharmacy Program.

I have both in and out-of-network pharmacy benefits.

1. While generics are typically less expensive than the brand, that may not always be the case, so be sure to check prices on the website to look at all of your options or call Customer Care.

2. Please note that HRA dollar credits used for pharmacy expenses will not apply to the medical deductible or out-of-pocket maximum.

Need more pharmacy benefit information?

Visit welcometouhc.com/shbp or log on to myuhc.com for more information about pharmacy benefits, tools and resources.

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Integrated care for better healthAs a UnitedHealthcare member, you will have seamless health, wellness and clinical support, including:

A dedicated team right here in Georgia working together to meet your health care needs

Medical, pharmacy and behavioral health experts that use leading technology and information to help create a personal care plan to meet your needs

People and programs to help you manage serious conditions, such as cancer, asthma, heart failure and diabetes

All these working together, on your behalf.

Personalized programsThe following wellness and clinical programs are provided to you at no additional cost, yet offer support and resources to help you take control of your health. You can enroll in the programs and take advantage of the personal support from a UnitedHealthcare Wellness Coach, Nurse or Clinician as well as use tools designed to help improve your quality of life.

Visit myuhc.com or call the number on the back of your health plan ID card to learn more about programs that are designed to address your unique health care needs.

A dedicated Wellness Coach may help you achieve better healthMaybe you want to look and feel better. Perhaps you’d like to lower your risk of illness. Or you might just want to finally feel in control of your health. Whatever your reasons are, our online and telephonic Wellness Coaches can give you the personal support you need to achieve better health. Your Wellness Coach can offer you:

A WELLNESS Plan customized to your life and your needs

Knowledge, motivation and expert insight with personalized support

Help with quitting using tobacco products through the Tobacco Cessation Program

Weight management assistance

Helpful resources and interactive health tools

Programs and support available to help you make smart health care decisions.

Integrated Support

Let’s talk wellnessCall 1-800-478-1057 to talk to a Wellness Coach or log on to myuhc.com to get started!

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Get support for a chronic conditionIf you are dealing with a chronic condition, we offer several Disease Management programs to help you take charge and manage your condition. Our Disease Management programs offer personalized support for the following conditions and more:

Asthma

Diabetes

Cancer Support

Chronic Back Conditions

Chronic Obstructive Pulmonary Disease (COPD)

Coronary Artery Disease (CAD)

Heart Failure

Get behavioral health support Sometimes the challenges you face can feel like too much to handle. Your UnitedHealthcare benefits include services provided by United Behavioral Health. We provide confidential support for a wide range of personal issues — from everyday challenges to more serious problems around-the-clock, whenever you need it.

You get access to a wide range of support services for various concerns:

Depression, stress and anxiety

Substance abuse and recovery

Eating disorders

Relationship difficulties

Balancing work and life issues and more

One toll-free call is all it takes to talk to someone about your situation. Call the number on the back of your health plan ID card or visit www.liveandworkwell.com to learn more about your United Behavioral Health services.

Receive personalized guidance throughout your pregnancyThe Healthy Pregnancy program helps you through every stage of your pregnancy and delivery. We provide 24-hour access to experienced nurses, access to our online Healthy Pregnancy Owner’s Manual and other materials, as well as possible money-saving coupons. Visit www.healthy-pregnancy.com or call 1-800-411-7984 to learn more today.

Get trusted information when you need it

The myNurseLineSM program connects you to registered nurses anytime 24/7 — at no extra cost to you. Just call 1-866-696-5846 or chat with a nurse live on myuhc.com.

Enjoy discounts that could add up to big savings

We have discounts with the following companies and more. Access our health discount program* online at www.unitedhealthallies.com.

*The health discount program is not insurance.

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Use your own private website at myuhc.comOnce you become a member, your first stop is your member website, myuhc.com. It’s loaded with details on your benefit plan and much more.

See your plan details and view your current claims and claims history

Find a network doctor or participating retail pharmacy near you

Take a health assessment and chat with a nurse

Online coaching programs on losing weight, heart health, healthy eating and more

Health & Wellness Library

Tools and resources, including the myHealthcare Cost Estimator, price a medication and Personal Health Record

Hospital Comparison Program

Additional pharmacy resources such as a list of medications based on a specific medical condition, medication interactions and side effects, and review your prescription history

Personalized online supportYou have continuous access to your health and benefits information through our online tools. To help you find the right website and tools for you, the chart below describes where to find information.

welcometouhc.com/shbp myuhc.com

Access this site before or after you are a member for up-to-date SHBP information, including information about our integrated wellness, clinical and pharmacy programs

A website designed to help members:• Understand benefits coverage• Access benefits• Track claims• Improve overall health• Organize health information

Find a network doctor in your area - Search by facility or physician Find a network doctor in your area - Search by facility or physician

Find answers to frequently asked questions Learn about your plan details and pharmacy benefit

Learn about your pharmacy benefit, WELLNESS and Standard plan details including information about the WELLNESS Promise

Learn more about a health condition

Use your Plan Cost Estimator Tool Take health quizzes, and learn about common symptoms

Visit the HRA resource center Track doctor visits, immunizations, diagnoses, prescriptions and refill schedules with the Personal Health Record

Learn about possible WELLNESS incentive opportunities Take the online Health Assessment

Online and Telephonic ResourcesOnline tools, information and resources available for members and pre-enrollment.

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Get help making your health plan decisionWe can help you estimate the plan cost with our Plan Cost Estimator tool. The tool takes health information about you and your family and predicts medical costs for the upcoming year. In just a few steps, you can estimate how much each plan option will cost for 2013. Visit welcometouhc.com/shbp to compare plans and estimate costs.

Health Care Lane®

Visit www.healthcarelane.com/shbp today and meet a lot of friendly people who will help you make sense of your health coverage including information about the HRA plan, myuhc.com, wellness program, pharmacy and more.

Smartphone and tablet users — your family’s health, in your handsThe UnitedHealthcare Health4Me™ app provides instant access to your family’s critical health information from your mobile device. The confidential app features include:

Single-registration — you can register with myuhc.com to enable both the mobile and online app functionality

Search for physicians or facilities and map to their location

View claims, account balances, benefit plan details and your health plan ID card

Have an Easy Connect representative contact you to answer any questions and connect you with an experienced registered nurse 24/7

TreatmentFind quality care fast through the UnitedHealth Premium® Designation programWe realize that not all health care is created equal, so we developed the UnitedHealth Premium Designation program. It evaluates and recognizes physicians who meet national industry standards for quality care and local market benchmarks for cost-efficiency.

myHealthcare Cost Estimator

It’s easier to budget for a medical treatment if you have an idea of how much it will cost. The myHealthcare Cost Estimator gives you the information you need to help you plan ahead.

Search and explore cost estimates of different treatments

Compare network and non-network cost estimates

Learn how the cost of a procedure affects your health account balances

Visit welcometouhc.com/shbp

Click on “Find a Doctor/Hospital”

Choose “Find a physician/facility near you”

Quality Care Cost-Efficient Care UnitedHealth Premium Two-Star Physicians

To get started on finding the right doctor for you:

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The information provided in these Programs is for informational purposes only and is not a substitute for your doctor’s care. Please discuss with your doctor how the information provided through these Programs is right for you. Your personal health information is kept private in accordance with your plan’s privacy policy.

For a complete description of the UnitedHealth Premium® Designation program, including details on the methodology used, geographic availability, program limitations and medical specialties participating, please see myuhc.com.®

The myNurseLineSM service cannot diagnose problems or recommend specific treatment. The information provided through the NurseLine service is not a substitute for your doctor’s care. The Healthy Pregnancy Program follows national practice standards from the Institute for Clinical Systems Improvement. The Healthy Pregnancy Program cannot diagnose problems or recommend specific treatment. The information provided is not a substitute for your doctor’s care.

All UnitedHealthcare members can access a cost estimator online tool. Depending on your specific benefit plan and the ZIP Code that is entered, either the new myHealthcare Cost Estimator or the current Treatment Cost Estimator will be available. A mobile version of myHealthcare Cost Estimator will be launched soon, and additional ZIP Codes and procedures will be added soon.

The hospital comparison program uses data from publicly available data sets, UnitedHealthcare claims and hospital data from Leapfrog and CMS, to create a multidimensional view of hospital performance. Not all facilities are eligible for evaluation for the program.

Disclosure: The Health Discount Program is administered by HealthAllies®, Inc., a discount medical plan organization. The Health Discount Program is NOT insurance. The discount program provides discounts at certain health care providers for medical services. The discount program does not make payments directly to the providers of medical services. The discount program member is obligated to pay for all health care services but will receive a discount from those health care providers who have contracted with the discount plan organization. HealthAllies, Inc., is located at P.O. Box 10340, Glendale, CA 91209, 1-800-860-8773, www.unitedhealthallies.com, [email protected]. Georgia Open Enrollment Guide 7/12 © 2012 United HealthCare Services, Inc.

TAKE THE NEXT STEP Now that you’ve learned the basics of your plan options, here’s what to do next.

To learn how to enroll in a plan: Visit your State Health Benefit Plan website at www.myshbp.ga.gov

To learn more about your benefit tools, resources and options: Visit your pre-member website at welcometouhc.com/shbp for tools like your

Plan Cost Estimator

Dedicated SHBP Member Support:

• HRA Plans: 1-800-396-6515

• ChoiceHMOandHighDeductibleHealthPlan:1-877-246-4189

Once enrolled, take advantage of your tools and resources by logging on to myuhc.com

Key contact informationDedicated SHBP Member Support HRA Plans . . . . . . . . . . . . . . . . . . . . . . 1-800-396-6515Dedicated SHBP Member Support Choice HMO and HDHP . . . . . . . . . . . . . . 1-877-246-4189myNurseLine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-866-696-5846Wellness Coach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-800-478-1057Healthy Pregnancy Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-800-411-7984

SHBP Support Website . . . . . . . . . . . . . . . . . . . . . . . . . . www.welcometouhc.com/shbpEnrollment Website . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . www.myshbp.ga.govMember Website . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . www.myuhc.comPreventive Care Tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . www.uhcpreventivecare.comUnited Behavioral Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . www.liveandworkwell.comHealthy Pregnancy Program . . . . . . . . . . . . . . . . . . . . . . . . . . www.healthy-pregnancy.com

Mobile Tool: Health4Me