affordable, quality healthcare with a
TRANSCRIPT
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Affordable, Quality Healthcare with a
Choice of Providers
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Overview
Pacificare will not be available after December 31, 2009. The United Healthcare (UHC) Point-of-Service (POS) Plans will replace the Pacificare Plans.
If you are currently enrolled in the PacifiCare HMO, you and your dependents will be automatically enrolled in the $0 Deductible POS Plan for 1/1/2010. However, you can choose another option during open enrollment.
If you are currently enrolled in the PacifiCare PPO, you and your dependents will be automatically enrolled in the $1,000 Deductible POS Plan for 1/1/2010. However, you can choose another option during open enrollment.
NEW!
Before making a decision, please review the detailed plan summaries available on the new benefits webpage.
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United Healthcare Features
Key Plan Features: United Healthcare is parent company of Pacificare UHC has a nation-wide network of providers; You no longer have to be concerned
about a Colorado-only service area 99% network match to current providers used by Pacificare members; This
means those of you who have PacifiCare should not need to change your doctors No need to pick primary care physician in advance Direct access to specialists; You do not need a referral to see a specialist Ability to obtain out-of-network care (separate deductibles, out-of-pocket maximums apply and benefit
coverage is lower)
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Coverage Highlights
UHC $1,000 Deductible POS Plan
In-Network Out-of-Network
Deductible (ind/family) $1,000/$2,000 $2,000/$8,000
Deductible applies before services are paid by plan?
Yes, except services that are subject to a co-payment
Yes, for all services
Do deductibles cross-accumulate between in and out-of network?
No
Co-insurance 80% after deductible is met
60% after deductible is met
Out-of-Pocket Maximums (includes deductible)
$3,000/$6,000 $10,000 /$20,000
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Coverage Highlights
UHC Point-of-Service Plan
In-Network Out-of-Network
Co-payment $ Primary Care OV - $25Specialty Care OV - $25Urgent Care – $50Emergency Room – $100
N/AN/AN/AEmergency Room - $100
Co-payment $ Well Visits - $0 Not covered
Prescription drugs 30-day retail supply at network pharmacy; $100 deductible for prescriptions then,$10 co-payment – generic, formulary$30 copayment - brand, formulary$60 co-payment non-formulary prescriptionsMail order (90 days) - 2.5x the co-payments above
Services subject to co-insurance
All services not subject to co-payments
All services
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2009 to 2010 Claims ComparisonFamily Full-Time BMEA Maternity Claims
Pacificare HMO UHC $1,000 Deductible
Physician Office Visits – primary care – 10 total
$150 copayment (10 @ $15) $250 copayment (10 @ $25)
Complete Annual Physical all 3 family members
$45 copayment (3 @ $15) $0 Copay
Physician office visits Maternity $30 copayment (Copayment for first visit only)
$25 copayment (Copayment for first visit only)
Ultrasound Included with initial copayment Included with initial copayment as long as charged under global fee
Lab Work Included with initial copayment Included with initial copayment as long as charged under global fee
C-Section Birth and hospitalization (baby leaves hospital at same time as mother)
$300 Copayment Total Charge from Hospital: $6,339 $1,000 Deductible; $1,068 Coinsurance
(20% of remaining amount)
3 prescriptions – monthly – 2 tier 1, 1 tier 2 7 prescriptions – one time – 3 tier 1, 3 tier 2, 1 tier 3
$600 copayment (24 @ $10, 12 @ $30)
$170 copayment (3 @ $10, 3 @ $30, 1 @ $50)
$200 deductible for 2 family members $540 copayment (24 @
$10, 11 @ $30)
$180 copayment (3 @ $10, 3 @ $30, 1 @ $60)
Emergency Room Visit – 1 visit $100 copayment $100 copayment
Total Member Out-of-Pocket Cost $1,395 $3,363
Total Member Annual Premium $4,850 $2,083
Total Member Annual Expenditure
$6,245 $5,446
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2009 to 2010 Claims ComparisonFamily Full-Time BMEAOne Adult has Diabetes
Pacificare HMO UHC $1,000 Deductible
Physician Office Visits – primary care – 15 total $225 copayment (15 @ $15) $375 copayment (15 @ $25)
Complete Annual Physical all 4 family members $60 copayment (4@ $15) $0 copayment
Diabetes office visits $45 copayment (3 @ $15) $75 copayment (3 @ 25)
Cholesterol Test Included in Office Visit Included in Office Visit
Blood Sample Included in Office Visit Included in Office Visit
Complete Metabolism Test Included in Office Visit Included in Office Visit
Diabetes Eye Exam $30 copayment $25 copayment
Blood Sugar Test Included in Office Visit Included in Office Visit
3 prescriptions – monthly – 2 tier 1, 1 tier 2
7 prescriptions – one time – 3 tier 1, 3 tier 2, 1 tier 3
$600 copayment (24 @ $10, 12 @ $30)
$170 copayment (3 @ $10, 3 @ $30, 1 @ $50)
$200 deductible for 2 family members
$540 copayment (24 @ $10, 10 @ $30)
$180 copayment (3 @ $10, 3 @ $30, 1 @ $60)
Emergency Room Visit – 1 visit $100 copayment $100 copayment
Total Member Out-of-Pocket Cost $1,230 $1,495
Total Member Annual Premium $4,850 $2,083
Total Member Annual Expenditure $6,080 $3,578
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2009 to 2010 Claims ComparisonEmployee Only - Full-Time BMEAJoe Healthy Employee
Pacificare HMO UHC $1,000 Deductible
Complete Annual Physical $15 copayment $0 copayment
Flu Shot $0 copayment if done at physical, otherwise $15 copayment
$0 copayment
Suspected broken arm (done at Emergency Room xrays only)
$100 copayment $100 copayment
Total Member Out-of-Pocket Cost $115 $100
Total Member Annual Premium $1,606 $0
Total Member Annual Expenditure
$1,721 $100
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Pacificare HMO UHC $1,000 Deductible
Complete Annual Physical $15 copayment $0 copayment
Specialist Office Visits (2) $60 copayment (2 @ $30) $50 copayment (2 @ $25)
Knee Replacement Surgery (Inpatient)
$300 copayment Estimated Charge $40,057
Deductible $1,000
Out of Pocket $2,000
Physical Therapy (8) $120 copayment (8 @ $15) $200 copayment (8 @ $25)
3 prescriptions – monthly – 2 tier 1, 1 tier 2
7 prescriptions – one time – 3 tier 1, 3 tier 2, 1 tier 3
$600 copayment (24 @ $10, 12 @ $30)
$170 copayment (3 @ $10, 3 @ $30, 1 @ $50)
$100 deductible
$570 copayment (24 @ $10, 11 @ $30)
$180 copayment (3 @ $10, 3 @ $30, 1 @ $60)
Total Member Out-of-Pocket Cost $1,265 $4,100
Monthly Premium $1,606 $0
Total Member Annual Expenditure
$2,871 $4,100
2009 to 2010 Claims ComparisonEmployee Only - Full-Time BMEAJoe Employee – Full Knee Replacement
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Find Your Doctor
Visit www.uhc.com/groups/**** to find your doctor – Name– Specialty– Condition or Procedure– Office hours– Gender– Education– Address and driving directions– Languages spoken
Most likely your physician is in our network
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UnitedHealthcare Pharmacy
Mail-Order Pharmacy– Prescription Solutions will continue to be the mail order provider for City of
Boulder mail-order prescriptions– You current authorizations and refills should transfer to our new account
number at the beginning of the year.– If you have any problems, call UHC customer service.
What is the Prescription Drug List (PDL)?– List of brand and generic medications, approved by the U.S. Food and Drug
Administration – Medications are categorized within tiers, with Tier 1 being the lowest cost tier
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myuhc.com
On myuhc.com, you can– Find network doctors / hospitals– Estimate procedure costs– Track claims status– Health improvement program– Personal Health Record– Health product discounts– Review plan details
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UnitedHealth Premium® Program
When searching for a physician on myuhc.com
– Look for the star when you search for a physician
The stars:– indicate doctors and cardiac facilities
that follow medical guidelines – Compare quality and costs of health
care facilities
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Hospital Comparison Program
– On myuhc.com– Find national quality ratings and cost
information on 54 procedures and conditions
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Wellness Resources
– Latest health news, including a healthy recipes
– Online quizzes to test your health knowledge
– Online Health Coach helps guide you to better health
www.myuhc.com
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NurseLineSM
– Connect with a registered nurse any time– Get health advice from a registered nurse by phone– Prepare yourself before seeking a doctor’s care– Recorded messages on thousands of health topics– Live, one-to-one Nurse Chats
at myuhc.com
www.myuhc.com
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Health Discounts
Save 20% - 50% on products and services not in plan – Laser eye surgery– Cosmetic dentistry– Health club memberships– Weight loss programs and more
www.myuhc.comunder “Health & Wellness