product catalog - uhc · product catalog plans designed with the needs ... internal revenue service...

CALIFORNIAKey Accounts

100+ EmployeesEffective January 1, 2014

Product CatalogPlans designed with the needs of employers in mind

UnitedHealthcare is a division of UnitedHealth Group, a Fortune 50 company and one of the single largest health coverage carriers in the country. We offer a diverse range of health coverage plans and a national network of more than 739,000 physicians and health care professionals, 5,600 hospitals and 64,000 pharmacies. Serving 25 million members nationwide, we’re committed to enhancing the health care experience through:

Better information – We alert individuals and their doctors to potential health risks or opportunities to take charge of their health. We give employers access to information to plan and implement worksite wellness programs to boost productivity and morale.

Better decisions – When we give employers, individuals and doctors access to relevant information, they can be empowered to make better-informed decisions.

Better health – Our shared goal is helping people live healthier lives,TM which contributes to a healthier and more productive, cost-efficient workplace.

Better information. Better decisions. Better health.

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The Power of the NetworkOur commitment to providing you with health coverage solutions includes off ering an expansive network, both nationally and locally.

Our California HMO network includes more than: 220 hospitals 52,000 physicians and health care

professionals

Our California insurance network used for Choice/Select and Choice Plus/Select Plus includes more than: 340 hospitals 100,000 physicians and health

care professionals

Our national network includes more than: 5,600 hospitals 739,000 physicians and health

care professionals 64,000 pharmacies 1,000 convenience care clinics

Employees have nationwide access to 83 percent of all available U.S. hospital beds and two out of three available doctors and health care professionals.

Network coverage

Seamless and easy to use Fully integrated Stable

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California Key Accounts (100+ employees)UnitedHealthcare off ers a broad range of health plans that are designed to be aff ordable and fl exible for employers of various sizes. To help determine the plans that best suit the employer’s need for aff ordability, we’ve created product continuum charts, like the one below. Th e products are arranged from lowest to highest premium and list key distinguishing features.

UnitedHealthcare Product Continuum Chart

HIGH PREMIUM COSTPREMIUM COST

LOW PREMIUM COST

Alliance*Cost-effective plans with a network of highly effective medical groups focused on

providing patient-centered carel

l

l

PCP Referral

Network only

HSAValues federal income

tax-free savings for future health care costs

l

l

l

l

l

Non-referral No copaymentHigh deductibleHSA qualifiedNetwork and non-network

Signature*Wants a large

network accessand flexible benefits

l

l

l

PCP Referral

Network only

Non-Differential PPO

Seeks ultimate provider flexibility

l

l

Non-referral Network and non-network

HRALikes to empower member

choice in health care spending

Advantage*Strives for low-cost

network access l

l

l

l

l

l

l

Non-referral High deductibleHealth Reimbursement AccountNetwork and non-network

PCP ReferralNetwork only

Choice PlusSeeks a national networkwith non-network flexibility

l

l


Flex*Provides tiered

network plans with access from one of the three distinct networks

l

l

l

PCP Referral

Three networks

Select PlusSeeks a national

networkwith non-network

flexibility

l

l


* Formal HMO product names:Signature = UnitedHealthcare SignatureValueTM

Advantage = UnitedHealthcare SignatureValue AdvantageFlex = UnitedHealthcare SignatureValue FlexAlliance = UnitedHealthcare SignatureValue Alliance

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Consumer-Driven Health 6 Offering HSAs, HRAs, and FSAs to help pay for and manage health care expenses

Choice Plus and Choice 10 The freedom to choose to see any doctor without a referral

Select Plus and Select 11 Lower cost with national network advantages

Non-Differential PPO 16 Flexible, broader-based coverage to address most health care needs

Pharmacy for Consumer-Driven Health, Choice Plus, Choice, Select Plus, Select 17 and Non-Differential PPO UnitedHealthcare Pharmacy supports value and improved medication outcomes

Additional Value-Added Programs for Consumer-Driven Health, Choice Plus, 18 Choice, Select Plus, Select and Non-Differential PPO

Self-Funding Options 19 Self-funded options and administration by UnitedHealthcare or UMR

Signature 22 Offers lower premiums and requires a PCP

Advantage 22 Offers traditional HMO coverage with a select network of physicians

Flex 22 Tiered network plans with choice of a PCP from one of the three networks

Alliance 22 Cost-effective plans with choice of a PCP from a network of highly effective physician groups focused on providing patient-centered care

Pharmacy for Signature, Advantage, Flex and Alliance 24 OptumRx offers pharmacy benefits for cost-conscious members

Additional Value-Added Programs for Signature, Advantage, Flex and Alliance 26

Manage Business Online With eServices 28 Online tools and services help get business done

Value-Added Programs Available With Every Plan 31 Wellness support and resources

Specialty Products 37 Add value to any medical plan with life, disability, dental and vision

Underwriting Guidelines 45

Product Details by Category

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Consumer-Driven Health, Choice Plus, Choice, Select Plus, Select and Non-Differential PPO

l

l

l

l

l

l

Consumer-Driven Health

Choice Plus and Choice

Select Plus and Select


Pharmacy for Consumer-Driven Health, Choice Plus, Choice, Select Plus, Select and Non-Differential PPO

Additional Value-Added Programs for Consumer-Driven Health, Choice Plus, Choice, Select Plus, Select and Non-Differential PPO

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Consumer-Driven Health

UnitedHealthcare HSA, HRA and FSA

HSA and HRA Overview UnitedHealthcare’s HSA and HRA products are designed with the new health care consumer in mind. Our HSA and HRA products offer a medical plan, coverage for preventive care and a health care account that members control and access themselves to cover some of the costs of qualified medical expenses outside network preventive care. Account-based consumer solutions initiate the transformation from passive health plan members into value-conscious consumers.

HSA features

• Members can manage their medical claims and HSA together online or with a customer care professional.

• Three account types offer balance of interest, account fees and spending. Non-proprietary mutual fund investing is available.

• For greater member convenience, HSAs include a debit card and online bill payment.

• Accounts are administered by Optum Bank,SM member FDIC. OptumHealth Financial ServicesSM provides educational tools that help both employers and individuals successfully engage in their financial health.

UnitedHealthcare HSA plans help members become more-informed and active health care consumers. By taking ownership of their health and health care spending, employees can also help their employers have more control of their health care costs. Recent studies support the value of HSA-eligible plans in reducing costs and promoting a healthier workplace.• HSA-eligible plans have shown 20 percent to 30

percent lower-cost-than-average premiums, helping U.S. businesses save money.1

• Premium savings for employees with an HSA-eligible plan amount to an average $852.2

• HSA plan members are two to three times more likely to participate in wellness programs than those in non-consumer-driven health plans.3 Our wellness offerings include worksite wellness programs, a confidential,* personalized health assessment, online and telephonic coaching and personal support.

HRA features

• Employers and employees get tax savings with an HRA. The distributions from the employer-funded HRA are tax-deductible to the employer; employee reimbursements from the HRA are tax-exempt.

• UnitedHealthcare offers three types of HRAs: - Traditional HRA: The HRA will reimburse the

member immediately on the first day of the plan year. Once the account is exhausted, the member pays the remaining deductible out of pocket, and then medical benefits apply.

- Split-deductible HRA: The HRA does not reimburse the member until the member has paid a certain amount, known as the access point. The access point can be set at any level by the employer.

- Shared-deductible HRA: A percentage of each eligible expense is paid out of the HRA and the rest is the member’s responsibility. A shared-deductible HRA can be paired with a traditional or split-deductible HRA.

• Employers set the contribution amount, covered expenses, debit card access and carryover rules.

• Employees are automatically enrolled in the medical plan.

• Accounts are not funded until a request for reimbursement is filed.

• UnitedHealthcare claims are paid to the provider and member automatically.

• Employers get monthly reports to help track account use.

• HRAs can work with all plans, including Flexible Spending Accounts (FSAs).

Employers can set up a UnitedHealthcare HRA to help their employees pay for eligible medical expenses that are not covered by their health benefit plan. The HRA offers the employer flexibility, since the employer can determine the deductible and out-of-pocket levels and even customize the type of expenses that can be covered by HRA funds. HRAs give employers cost-containing measures plus streamlined administration. For employees, preventive care is covered at 100 percent (network) and HRA funds can be used for other eligible expenses. This helps them pay for out-of-pocket costs.

1 HSA Insider, HSA Road Rules for Employers, Seventh Edition, May 2008.2 14th Annual National Business Group on Health/Watson Wyatt Survey Report – 2009, “The Effect of the Economic Crisis on Health Care Programs”.3 2006 survey of 212,000 UnitedHealthcare members enrolled in UnitedHealthcare Health Savings Accounts for the full year of 2006.* Confidential to the fullest extent permitted by law.

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FSA OverviewUnitedHealthcare’s FSAs can accompany both traditional and consumer-driven health plans to give employers and employees more savings. FSAs are governed by the Internal Revenue Service and can be offered by employers to cover benefits that are not covered in their core medical plan. Employees fund the FSA with pre-tax dollars to help pay for qualified medical, dependent care and commuter expenses.

UnitedHealthcare offers four types of FSAs:

• Health care FSA – Can be paired with other health plans or be stand-alone.

• Limited purpose FSA – Can be offered to members who also have an HSA with an eligible high-deductible plan. It can be set aside for dental and vision expenses.

• Dependent care FSA – Covers qualified day care expenses for children under 13, an adult dependent, babysitters while members are working, housekeepers who care for eligible children, day camp and transportation to and from a childcare provider.

• Commuter Expense Reimbursement Account (CERA) – Funds in this FSA can be used for qualified transportation expenses.

FSA features

• Members can access their FSA online and use online calculators to keep track of their expenses and balances.

• Members can sign up for direct deposit of FSA reimbursements into their bank accounts.

• Administration is fast and streamlined with auto-submission of medical claims.

• Employers have the option to customize the type of qualified expenses that can be covered by funds from the FSA.

UnitedHealthcare is a one-stop shop for medical coverage and HSA, HRA or FSA administration. With integrated benefits, UnitedHealthcare plans can help members save money and become more informed and involved health care consumers.

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Plan Code Coinsurance DeductibleDeductible Type2 Combined

Med/Rx Ded3

Out-of-Pocket Maximum4 Network5

Select Plus/Select1 Choice Plus/Choice1 Network Out of Network Network Out of Network Network Out of Network PCP Spec ER InpatientHospital

IP Per Occurrence Ded6

Consumer

PT-9 537 80% 60% $1,000 $2,000 Embedded Yes $2,000 $4,000 80% 80% N/A 80% N/A


PU-B 539 90% 70% $1,500 $3,000 Embedded No $2,500 $5,000 90% 90% N/A 90% N/A

PU-D 541 80% 60% $1,500 $3,000 Embedded No $2,500 $5,000 80% 80% N/A 80% N/A

PU-C 540 100% 80% $2,000 $5,000 Embedded No $2,000 $10,000 100% 100% N/A 100% N/A

PU-S 545 90% 70% $2,000 $4,000 Embedded No $4,000 $8,000 90% 90% N/A 90% N/A

PU-P 544 80% 60% $2,000 $4,000 Embedded Yes $4,000 $9,000 80% 80% N/A 80% N/A

PU-W 547 80% 60% $2,500 $6,000 Embedded Yes $5,000 $10,000 80% 80% N/A 80% N/A

PU-A 538 100% 80% $3,000 $5,000 Embedded Yes $4,000 $6,000 100% 100% N/A 100% N/A

PU-J 543 90% 70% $3,000 $5,000 Embedded Yes $4,000 $6,000 90% 90% N/A 90% N/A

PU-X 548 90% 70% $3,000 $5,000 Embedded Yes $5,000 $10,000 90% 90% N/A 90% N/A

PU-T 546 80% 60% $3,000 $5,000 Embedded Yes $4,000 $6,000 80% 80% N/A 80% N/A

PU-F 542 100% 70% $5,000 $10,000 Embedded Yes $5,000 $20,000 100% 100% N/A 100% N/A

PW-H 096 90% N/A $1,500 N/A Embedded No $2,500 N/A 90% 90% N/A 90% N/A

PW-M 449 80% N/A $2,000 N/A Embedded Yes $4,000 N/A 80% 80% N/A 80% N/A

PW-P 452 80% N/A $2,500 N/A Embedded Yes $5,000 N/A 80% 80% N/A 80% N/A

UK-A 453 90% N/A $3,000 N/A Embedded Yes $5,000 N/A 90% 90% N/A 90% N/A

PW-K 099 100% N/A $5,000 N/A Embedded Yes $5,000 N/A 100% 100% N/A 100% N/A

HSA

UL-G 549 100% 80% $1,500 $3,500 Non-Embedded Yes $2,500 $4,500 100% 100% N/A 100% N/A

UL-K 553 90% 70% $1,500 $3,500 Non-Embedded Yes $2,500 $4,500 90% 90% N/A 90% N/A

UL-L 554 80% 60% $1,500 $3,500 Non-Embedded Yes $3,500 $6,000 80% 80% N/A 80% N/A

UL-H 550 100% 80% $2,000 $4,000 Non-Embedded Yes $3,000 $8,000 100% 100% N/A 100% N/A

UL-N 556 90% 70% $2,000 $4,000 Non-Embedded Yes $4,000 $8,000 90% 90% N/A 90% N/A

UL-P 558 80% 60% $2,000 $4,000 Non-Embedded Yes $4,000 $9,000 80% 80% N/A 80% N/A

UL-M 555 70% 50% $2,000 $4,000 Non-Embedded Yes $3,000 $6,000 70% 70% N/A 70% N/A

UL-I 551 100% 80% $2,500 $4,500 Embedded Yes $3,500 $5,500 100% 100% N/A 100% N/A

UL-Q 559 90% 70% $2,500 $5,000 Non-Embedded Yes $5,000 $10,000 90% 90% N/A 90% N/A

UL-T 562 80% 60% $2,500 $6,000 Non-Embedded Yes $5,000 $10,000 80% 80% N/A 80% N/A

UL-J 552 100% 80% $3,000 $5,000 Embedded Yes $4,000 $6,000 100% 100% N/A 100% N/A

UL-O 557 90% 70% $3,000 $5,000 Embedded Yes $4,000 $6,000 90% 90% N/A 90% N/A

UL-R 560 90% 70% $3,000 $5,000 Embedded Yes $5,000 $10,000 90% 90% N/A 90% N/A

UL-S 561 80% 60% $3,000 $5,000 Non-Embedded Yes $4,000 $6,000 80% 80% N/A 80% N/A

UL-U 563 80% 60% $3,000 $6,000 Embedded Yes $5,000 $10,000 80% 80% N/A 80% N/A

IS-7 564 70% 50% $5,000 $10,000 Embedded Yes $6,350 $12,700 70% 70% N/A 70% N/A



IS-Z 567 60% 50% $6,250 $12,500 Embedded Yes $6,350 $12,700 60% 60% N/A 60% N/A

UL-2 459 80% N/A $1,500 N/A Non-Embedded Yes $3,500 N/A 80% 80% N/A 80% N/A

UK-4 463 80% N/A $2,000 N/A Non-Embedded Yes $4,000 N/A 80% 80% N/A 80% N/A



UL-C 469 70% N/A $5,000 N/A Embedded Yes $6,350 N/A 70% 70% N/A 70% N/A

UL-D 470 70% N/A $5,500 N/A Embedded Yes $6,350 N/A 70% 70% N/A 70% N/A

UL-E 471 65% N/A $6,000 N/A Embedded Yes $6,350 N/A 65% 65% N/A 65% N/A

UL-F 472 60% N/A $6,250 N/A Embedded Yes $6,350 N/A 60% 60% N/A 60% N/A

Options PPO Consumer

PU-9 80% 60% $2,000 $3,000 Embedded No $4,000 $6,000 80% 80% N/A 80% N/A

Options PPO HSA

UL-V 100% 80% $2,000 $4,000 Non-Embedded Yes $3,000 $8,000 100% 100% N/A 100% N/A

1 Select and Choice plans offer the same network and benefits as our Select Plus and Choice Plus plans, with covered services limited to network providers only.2 Family Deductible is 2x Individual, except for plans PS4/523 and PT1/529. For plans with a Non-Embedded deductible, one or more eligible members of a family unit may satisfy the entire Family Deductible. No one in the family will be eligible for benefits until the Family Deductible has been met.3 Plans with a combined medical and drug annual deductible may only be offered with pharmacy plans S5, 2V and H9.4 Family Out-of-Pocket Maximum is 2x Individual, except for plans PS4/523 and PT1/529. Member cost share, including Office Visits, deductible, coinsurance and pharmacy, apply to the Out-of-Pocket Maximum.

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Med/Rx Ded3


Select Plus/Select1 Choice Plus/Choice1 Network Out of Network Network Out of Network Network Out of Network PCP Spec ER InpatientHospital

IP Per Occurrence Ded6

Consumer



PU-B 539 90% 70% $1,500 $3,000 Embedded No $2,500 $5,000 90% 90% N/A 90% N/A

PU-D 541 80% 60% $1,500 $3,000 Embedded No $2,500 $5,000 80% 80% N/A 80% N/A

PU-C 540 100% 80% $2,000 $5,000 Embedded No $2,000 $10,000 100% 100% N/A 100% N/A

PU-S 545 90% 70% $2,000 $4,000 Embedded No $4,000 $8,000 90% 90% N/A 90% N/A

PU-P 544 80% 60% $2,000 $4,000 Embedded Yes $4,000 $9,000 80% 80% N/A 80% N/A

PU-W 547 80% 60% $2,500 $6,000 Embedded Yes $5,000 $10,000 80% 80% N/A 80% N/A

PU-A 538 100% 80% $3,000 $5,000 Embedded Yes $4,000 $6,000 100% 100% N/A 100% N/A

PU-J 543 90% 70% $3,000 $5,000 Embedded Yes $4,000 $6,000 90% 90% N/A 90% N/A

PU-X 548 90% 70% $3,000 $5,000 Embedded Yes $5,000 $10,000 90% 90% N/A 90% N/A

PU-T 546 80% 60% $3,000 $5,000 Embedded Yes $4,000 $6,000 80% 80% N/A 80% N/A

PU-F 542 100% 70% $5,000 $10,000 Embedded Yes $5,000 $20,000 100% 100% N/A 100% N/A

PW-H 096 90% N/A $1,500 N/A Embedded No $2,500 N/A 90% 90% N/A 90% N/A

PW-M 449 80% N/A $2,000 N/A Embedded Yes $4,000 N/A 80% 80% N/A 80% N/A

PW-P 452 80% N/A $2,500 N/A Embedded Yes $5,000 N/A 80% 80% N/A 80% N/A

UK-A 453 90% N/A $3,000 N/A Embedded Yes $5,000 N/A 90% 90% N/A 90% N/A

PW-K 099 100% N/A $5,000 N/A Embedded Yes $5,000 N/A 100% 100% N/A 100% N/A

HSA

UL-G 549 100% 80% $1,500 $3,500 Non-Embedded Yes $2,500 $4,500 100% 100% N/A 100% N/A

UL-K 553 90% 70% $1,500 $3,500 Non-Embedded Yes $2,500 $4,500 90% 90% N/A 90% N/A

UL-L 554 80% 60% $1,500 $3,500 Non-Embedded Yes $3,500 $6,000 80% 80% N/A 80% N/A

UL-H 550 100% 80% $2,000 $4,000 Non-Embedded Yes $3,000 $8,000 100% 100% N/A 100% N/A

UL-N 556 90% 70% $2,000 $4,000 Non-Embedded Yes $4,000 $8,000 90% 90% N/A 90% N/A

UL-P 558 80% 60% $2,000 $4,000 Non-Embedded Yes $4,000 $9,000 80% 80% N/A 80% N/A

UL-M 555 70% 50% $2,000 $4,000 Non-Embedded Yes $3,000 $6,000 70% 70% N/A 70% N/A

UL-I 551 100% 80% $2,500 $4,500 Embedded Yes $3,500 $5,500 100% 100% N/A 100% N/A

UL-Q 559 90% 70% $2,500 $5,000 Non-Embedded Yes $5,000 $10,000 90% 90% N/A 90% N/A

UL-T 562 80% 60% $2,500 $6,000 Non-Embedded Yes $5,000 $10,000 80% 80% N/A 80% N/A

UL-J 552 100% 80% $3,000 $5,000 Embedded Yes $4,000 $6,000 100% 100% N/A 100% N/A

UL-O 557 90% 70% $3,000 $5,000 Embedded Yes $4,000 $6,000 90% 90% N/A 90% N/A

UL-R 560 90% 70% $3,000 $5,000 Embedded Yes $5,000 $10,000 90% 90% N/A 90% N/A

UL-S 561 80% 60% $3,000 $5,000 Non-Embedded Yes $4,000 $6,000 80% 80% N/A 80% N/A

UL-U 563 80% 60% $3,000 $6,000 Embedded Yes $5,000 $10,000 80% 80% N/A 80% N/A




IS-Z 567 60% 50% $6,250 $12,500 Embedded Yes $6,350 $12,700 60% 60% N/A 60% N/A

UL-2 459 80% N/A $1,500 N/A Non-Embedded Yes $3,500 N/A 80% 80% N/A 80% N/A




UL-C 469 70% N/A $5,000 N/A Embedded Yes $6,350 N/A 70% 70% N/A 70% N/A

UL-D 470 70% N/A $5,500 N/A Embedded Yes $6,350 N/A 70% 70% N/A 70% N/A

UL-E 471 65% N/A $6,000 N/A Embedded Yes $6,350 N/A 65% 65% N/A 65% N/A

UL-F 472 60% N/A $6,250 N/A Embedded Yes $6,350 N/A 60% 60% N/A 60% N/A

Options PPO Consumer

PU-9 80% 60% $2,000 $3,000 Embedded No $4,000 $6,000 80% 80% N/A 80% N/A

Options PPO HSA

UL-V 100% 80% $2,000 $4,000 Non-Embedded Yes $3,000 $8,000 100% 100% N/A 100% N/A

5 Benefits with coinsurance (%) responsibility are subject to the Deductible.6 The Per Occurrence Deductible is separate from the Annual Deductible and accrues toward the Out-of-Pocket Maximum.This benefit grid is intended only to highlight plan benefits and should not be relied upon to fully determine coverage. These plans may not cover all health care expenses. This policy has exclusions, limitations and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, contact your sales representative.

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Choice Plus and Choice

Flexible Products With Network Advantages

UnitedHealthcare provides network and non-network benefits, plans for single-site, multi-site and multi-state businesses and variable options for deductibles, coinsurance and pharmacy plans that help meet employers’ needs. The new Minimum Value plans offer low premium options and comply with the new Health Care Reform standards for employers to provide minimum coverage.

These benefit plan designs offer employers:

Affordability – Low-cost alternatives for premiums Choice – Popular combinations of benefits and pricing Network – Access to more than 739,000 physicians, 5,600 hospitals, and 64,000 pharmacies across the country

Choice Plus

UnitedHealthcare Choice Plus gives members the freedom to see any doctor in the Choice Plus network without a referral. Benefits of the Choice Plus plan include:• Members visit any participating physician or facility

(including specialist) without a referral• Members can visit any non-participating physician

and still enjoy benefits with somewhat higher deductibles and coinsurance

• When members visit participating physicians and hospitals, there aren’t any claim forms or bills to worry about

• Lower out-of-pocket costs for network care• Range of plan designs with different deductible levels,

copayments, coinsurance and out-of-pocket amounts

Choice

The Choice product works like the Choice Plus product except it offers access to physicians within the network only:• Members can visit any participating physician or facility

(including specialist) without a referral

Other cost-saving measuresPhysicians and facilities that aren’t in our network set their own prices. The result can be higher billed charges for employers and higher out-of-pocket costs for members. If members choose to go to a non-network doctor or facility, we offer two non-network programs to help control costs. Shared Savings Program – Our Shared Savings program contracts with third-party vendors to access and negotiate discounts on services received from non-network health care professionals. The average savings is 15 to 35 percent off the physician’s or facility’s billed charges. Maximum Non-Network Reimbursement Program – This program caps certain eligible expenses from non-network physicians and facilities at a maximum amount based on the payment methodology used by Medicare. This fixed maximum helps control medical trend and reinforces to members the value of seeking services from network health care professionals. Whether members choose network or non-network care, we’re always looking for ways to save employers’ and employees’ money.

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Select Plus and Select

Lower Cost With National Network Advantages

UnitedHealthcare’s Select products offer the same key benefits as our Choice products – network and non-network benefits, plans for single-site, multi-site and multi-state businesses and variable options for deductibles, coinsurance and pharmacy plans that help meet employers’ needs. The new Minimum Value plans offer low premium options and comply with the new Health Care Reform standards for employers to provide minimum coverage.

These benefit plan designs offer employers:

Affordability – Low-cost alternatives for premiums Choice – Popular combinations of benefits and pricing Network – Access to more than 739,000 physicians, 5,600 hospitals, and 64,000 pharmacies across the country

Our new Select Plus and Select products, available to our California sitused customers, provide the same great flexibility and national network access as our Choice Plus and Choice options. Select products promote the value of coordinated care without the restrictions for primary care referrals. Select does not require members to designate a PCP to coordinate their care, nor are specialist referrals required for eligible services. However, every Select Plus and Select member is automatically assigned a PCP once enrolled. Members are encouraged to engage their PCP as a guide that can ensure most appropriate care for their specific health needs.

Select Plus

Select Plus gives members the freedom to see any doctor in the Select Plus network without a referral. Benefits of the Select Plus plan include:• Members visit any participating physician or facility

(including specialist) without a referral• Members can visit any non-participating physician and

still enjoy benefits with somewhat higher deductibles and coinsurance

• When members visit participating physicians and hospitals, there aren’t any claim forms or bills to worry about

• Lower out-of-pocket costs for in-network care• Range of plan designs with different deductible levels,

copayments, coinsurance and out-of-pocket amounts

Select

The Select plan works like the Select Plus plan except it offers access to physicians within the network only:• Members can visit any participating physician or facility

(including specialist) without a referral

Other cost-saving measuresPhysicians and facilities that aren’t in our network set their own prices. The result can be higher billed charges for employers and higher out-of-pocket costs for members. If members choose to go to a non-network doctor or facility, we offer two non-network programs to help control costs. Shared Savings Program – Our Shared Savings program contracts with third-party vendors to access and negotiate discounts on services received from non-network health care professionals. The average savings is 15 to 35 percent off the physician’s or facility’s billed charges. Maximum Non-Network Reimbursement Program – This program caps certain eligible expenses from non-network physicians and facilities at a maximum amount based on the payment methodology used by Medicare. This fixed maximum helps control medical trend and reinforces to members the value of seeking services from network health care professionals. Whether members choose network or non- network care, we’re always looking for ways to save employers’ and employees’ money.

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Med/Rx Ded3


Select Plus/Select1 Choice Plus/Choice1 Network Out ofNetwork Network Out of Network Network Out of Network PCP Spec ER Inpatient

HospitalIP Per

Occurrence Ded6

Traditional

PQ-U 473 100% 80% N/A $300 Embedded No $2,000 $2,000 $10 $10 $75 100% N/A

PQ-W 475 100% 80% N/A $1,000 Embedded No $2,500 $5,000 $15 $25 $150 100% N/A

PQ-Y 477 100% 80% N/A $1,500 Embedded No $2,500 $5,000 $20 $30 $150 100% N/A

PQ-Z 478 90% 50% N/A $1,500 Embedded No $2,000 $6,500 $15 $15 $100 90% N/A

PQ-V 474 100% 70% N/A $2,000 Embedded No $2,500 $6,000 $15 $15 $75 $250 N/A

PQ-X 476 100% 80% N/A $2,500 Embedded No $2,500 $7,500 $20 $20 $100 $250 N/A

PV-I 069 100% N/A N/A N/A Embedded No $2,500 N/A $15 $15 $75 $250 N/A

PV-J 070 100% N/A N/A N/A Embedded No $2,500 N/A $15 $25 $150 100% N/A

PV-K 071 100% N/A N/A N/A Embedded No $2,500 N/A $20 $20 $100 $250 N/A

PV-L 072 100% N/A N/A N/A Embedded No $2,500 N/A $20 $30 $150 100% N/A

Traditional with Deductible

PQ-1 479 100% 80% $250 $500 Embedded No $250 $3,000 $15 $15 $100 100% N/A

PQ-7 485 90% 60% $250 $1,000 Embedded No $2,000 $4,000 $20 $20 $75 90% N/A

PQ-2 480 90% 70% $250 $500 Embedded No $1,250 $2,500 $10 $10 $100 90% N/A

PQ-3 481 90% 70% $250 $500 Embedded No $1,250 $2,500 $15 $15 $100 90% N/A

PQ-4 482 90% 70% $250 $500 Embedded No $2,250 $4,500 $10 $10 $100 90% N/A

PQ-5 483 90% 70% $250 $500 Embedded No $2,250 $4,500 $15 $15 $100 90% N/A

PR-Y 490 90% 70% $250 $250 Embedded No $2,500 $10,000 $20 $20 $250 90% $250

PR-4 495 90% 70% $250 $500 Embedded No $3,500 $7,000 $30 $30 $250 90% $500

PR-F 488 80% 60% $250 $500 Embedded No $2,250 $4,500 $15 $15 $100 80% N/A

PR-Z 491 80% 60% $250 $500 Embedded No $2,250 $4,500 $20 $20 $100 80% N/A

PR-2 493 80% 60% $250 $500 Embedded No $2,250 $4,500 $25 $25 $100 80% N/A

PS-Y 499 70% 50% $250 $500 Embedded No $3,500 $7,000 $20 $30 $250 70% $500

PR-K 489 90% 60% $500 $1,000 Embedded No $2,000 $4,000 $20 $20 $100 90% N/A

PQ-6 484 90% 70% $500 $1,000 Embedded No $1,500 $4,000 $10 $10 $100 90% N/A

PQ-9 487 90% 70% $500 $1,000 Embedded No $2,500 $5,000 $15 $15 $100 90% N/A

PR-1 492 90% 70% $500 $1,000 Embedded No $3,000 $6,000 $20 $20 $100 90% N/A

PQ-8 486 80% 60% $500 $1,000 Embedded No $1,500 $5,000 $15 $15 $100 80% N/A

PR-3 494 80% 60% $500 $1,000 Embedded No $2,500 $5,000 $20 $20 $100 80% N/A

PR-5 496 80% 60% $500 $1,000 Embedded No $3,500 $7,000 $20 $20 $100 80% N/A

PR-6 497 80% 60% $500 $1,000 Embedded No $4,500 $9,000 $20 $40 $100 80% N/A

PR-7 498 80% 60% $500 $1,000 Embedded No $4,500 $9,000 $20 $20 $250 80% $500

PS-Z 500 80% 60% $500 $500 Embedded No $5,000 $10,000 $30 $30 $250 80% $500

PS-1 520 70% 50% $500 $1,000 Embedded No $4,500 $9,000 $20 $20 $250 70% $250

PV-M 073 100% N/A $250 N/A Embedded No $250 N/A $15 $15 $100 100% N/A

PV-N 074 90% N/A $250 N/A Embedded No $1,250 N/A $10 $10 $100 90% N/A

PV-O 075 90% N/A $250 N/A Embedded No $2,250 N/A $15 $15 $100 90% N/A

PV-P 076 90% N/A $250 N/A Embedded No $2,500 N/A $20 $20 $250 90% $250

PV-R 078 90% N/A $250 N/A Embedded No $3,500 N/A $30 $30 $250 90% $500

PV-Q 077 80% N/A $500 N/A Embedded No $2,500 N/A $20 $20 $100 80% N/A

PV-S 079 80% N/A $500 N/A Embedded No $5,000 N/A $30 $30 $250 80% $500

PV-T 080 70% N/A $500 N/A Embedded No $4,500 N/A $20 $20 $250 70% $250

Balanced

PS-7 526 80% 60% $750 $1,500 Embedded No $2,500 $5,000 $35 $35 $250 80% N/A

PS-2 521 90% 70% $1,000 $2,000 Embedded No $3,000 $6,000 $15 $15 $100 90% N/A

PS-5 524 90% 70% $1,000 $2,000 Embedded No $3,000 $6,000 $20 $40 $250 90% N/A

PS-3 522 90% 60% $1,000 $2,000 Embedded No $2,000 $4,000 $25 $25 $250 90% N/A

PS-6 525 80% 60% $1,000 $2,000 Embedded No $3,000 $10,000 $25 $25 $100 80% N/A

13


Med/Rx Ded3



HospitalIP Per

Occurrence Ded6

Traditional

PQ-U 473 100% 80% N/A $300 Embedded No $2,000 $2,000 $10 $10 $75 100% N/A

PQ-W 475 100% 80% N/A $1,000 Embedded No $2,500 $5,000 $15 $25 $150 100% N/A

PQ-Y 477 100% 80% N/A $1,500 Embedded No $2,500 $5,000 $20 $30 $150 100% N/A

PQ-Z 478 90% 50% N/A $1,500 Embedded No $2,000 $6,500 $15 $15 $100 90% N/A

PQ-V 474 100% 70% N/A $2,000 Embedded No $2,500 $6,000 $15 $15 $75 $250 N/A

PQ-X 476 100% 80% N/A $2,500 Embedded No $2,500 $7,500 $20 $20 $100 $250 N/A

PV-I 069 100% N/A N/A N/A Embedded No $2,500 N/A $15 $15 $75 $250 N/A

PV-J 070 100% N/A N/A N/A Embedded No $2,500 N/A $15 $25 $150 100% N/A

PV-K 071 100% N/A N/A N/A Embedded No $2,500 N/A $20 $20 $100 $250 N/A

PV-L 072 100% N/A N/A N/A Embedded No $2,500 N/A $20 $30 $150 100% N/A

Traditional with Deductible

PQ-1 479 100% 80% $250 $500 Embedded No $250 $3,000 $15 $15 $100 100% N/A

PQ-7 485 90% 60% $250 $1,000 Embedded No $2,000 $4,000 $20 $20 $75 90% N/A

PQ-2 480 90% 70% $250 $500 Embedded No $1,250 $2,500 $10 $10 $100 90% N/A

PQ-3 481 90% 70% $250 $500 Embedded No $1,250 $2,500 $15 $15 $100 90% N/A

PQ-4 482 90% 70% $250 $500 Embedded No $2,250 $4,500 $10 $10 $100 90% N/A

PQ-5 483 90% 70% $250 $500 Embedded No $2,250 $4,500 $15 $15 $100 90% N/A

PR-Y 490 90% 70% $250 $250 Embedded No $2,500 $10,000 $20 $20 $250 90% $250

PR-4 495 90% 70% $250 $500 Embedded No $3,500 $7,000 $30 $30 $250 90% $500

PR-F 488 80% 60% $250 $500 Embedded No $2,250 $4,500 $15 $15 $100 80% N/A

PR-Z 491 80% 60% $250 $500 Embedded No $2,250 $4,500 $20 $20 $100 80% N/A

PR-2 493 80% 60% $250 $500 Embedded No $2,250 $4,500 $25 $25 $100 80% N/A

PS-Y 499 70% 50% $250 $500 Embedded No $3,500 $7,000 $20 $30 $250 70% $500

PR-K 489 90% 60% $500 $1,000 Embedded No $2,000 $4,000 $20 $20 $100 90% N/A

PQ-6 484 90% 70% $500 $1,000 Embedded No $1,500 $4,000 $10 $10 $100 90% N/A

PQ-9 487 90% 70% $500 $1,000 Embedded No $2,500 $5,000 $15 $15 $100 90% N/A

PR-1 492 90% 70% $500 $1,000 Embedded No $3,000 $6,000 $20 $20 $100 90% N/A

PQ-8 486 80% 60% $500 $1,000 Embedded No $1,500 $5,000 $15 $15 $100 80% N/A

PR-3 494 80% 60% $500 $1,000 Embedded No $2,500 $5,000 $20 $20 $100 80% N/A

PR-5 496 80% 60% $500 $1,000 Embedded No $3,500 $7,000 $20 $20 $100 80% N/A

PR-6 497 80% 60% $500 $1,000 Embedded No $4,500 $9,000 $20 $40 $100 80% N/A

PR-7 498 80% 60% $500 $1,000 Embedded No $4,500 $9,000 $20 $20 $250 80% $500

PS-Z 500 80% 60% $500 $500 Embedded No $5,000 $10,000 $30 $30 $250 80% $500

PS-1 520 70% 50% $500 $1,000 Embedded No $4,500 $9,000 $20 $20 $250 70% $250

PV-M 073 100% N/A $250 N/A Embedded No $250 N/A $15 $15 $100 100% N/A

PV-N 074 90% N/A $250 N/A Embedded No $1,250 N/A $10 $10 $100 90% N/A

PV-O 075 90% N/A $250 N/A Embedded No $2,250 N/A $15 $15 $100 90% N/A

PV-P 076 90% N/A $250 N/A Embedded No $2,500 N/A $20 $20 $250 90% $250

PV-R 078 90% N/A $250 N/A Embedded No $3,500 N/A $30 $30 $250 90% $500

PV-Q 077 80% N/A $500 N/A Embedded No $2,500 N/A $20 $20 $100 80% N/A

PV-S 079 80% N/A $500 N/A Embedded No $5,000 N/A $30 $30 $250 80% $500

PV-T 080 70% N/A $500 N/A Embedded No $4,500 N/A $20 $20 $250 70% $250

Balanced

PS-7 526 80% 60% $750 $1,500 Embedded No $2,500 $5,000 $35 $35 $250 80% N/A

PS-2 521 90% 70% $1,000 $2,000 Embedded No $3,000 $6,000 $15 $15 $100 90% N/A

PS-5 524 90% 70% $1,000 $2,000 Embedded No $3,000 $6,000 $20 $40 $250 90% N/A

PS-3 522 90% 60% $1,000 $2,000 Embedded No $2,000 $4,000 $25 $25 $250 90% N/A

PS-6 525 80% 60% $1,000 $2,000 Embedded No $3,000 $10,000 $25 $25 $100 80% N/A

Continued on next page.

14


Med/Rx Ded3



HospitalIP Per

Occurrence Ded6

PS-8 527 80% 60% $1,000 $2,000 Embedded No $3,000 $3,000 $25 $35 $250 80% N/A

PS-9 528 80% 60% $1,000 $2,000 Embedded No $4,000 $10,000 $30 $30 $150 80% N/A

PT-2 530 80% 60% $1,000 $2,000 Embedded No $3,000 $6,000 $30 $50 $250 80% N/A

PT-3 531 70% 50% $1,000 $2,000 Embedded No $4,000 $10,000 $25 $25 $250 70% N/A

PS-4 523 90% 70% $1,500 $3,000 Embedded No $3,500 $7,000 $15 $15 $100 90% N/A

PT-1 529 80% 60% $1,500 $3,000 Embedded No $4,500 $9,000 $20 $20 $100 80% N/A

PT-4 532 80% 50% $1,500 $3,000 Embedded No $4,000 $8,000 $30 $30 $250 80% N/A

PT-5 533 80% 50% $2,000 $4,000 Embedded No $5,000 $10,000 $25 $40 $250 80% N/A

PT-6 534 80% 50% $2,500 $4,500 Embedded No $5,000 $10,000 $20 $40 $250 80% N/A

PT-7 535 70% 50% $3,000 $6,000 Embedded No $5,000 $10,000 $25 $50 $250 70% N/A

PV-X 084 80% N/A $750 N/A Embedded No $2,500 N/A $35 $35 $250 80% N/A

PV-U 081 90% N/A $1,000 N/A Embedded No $2,000 N/A $25 $25 $250 90% N/A

PV-V 082 90% N/A $1,000 N/A Embedded No $3,000 N/A $20 $40 $250 90% N/A

PV-W 083 80% N/A $1,000 N/A Embedded No $3,000 N/A $25 $25 $100 80% N/A

PV-Y 085 80% N/A $1,000 N/A Embedded No $3,000 N/A $25 $35 $250 80% N/A

PV-Z 086 80% N/A $1,000 N/A Embedded No $4,000 N/A $30 $30 $150 80% N/A

PV-1 087 80% N/A $1,000 N/A Embedded No $3,000 N/A $30 $50 $250 80% N/A












Options PPO

PU-5 100% 80% N/A $2,500 Embedded No $2,500 $7,500 $20 $20 $100 $250 N/A

PU-6 80% 60% $500 $1,000 Embedded No $1,500 $5,000 $15 $15 $100 80% N/A

PU-8 80% 60% $1,000 $2,000 Embedded No $4,000 $10,000 $30 $30 $150 80% N/A

PU-7 100% 80% $2,000 $4,000 Embedded No $2,000 $8,000 $25 $25 $125 100% N/A

1 Select and Choice plans offer the same network and benefits as our Select Plus and Choice Plus plans, with covered services limited to network providers only.2 Family Deductible is 2x Individual, except for plans PS4/523 and PT1/529. For plans with a Non-Embedded deductible, one or more eligible members of a family unit may satisfy the entire Family Deductible. No one in the family will be eligible for benefits until the Family Deductible has been met.3 Plans with a combined medical and drug annual deductible may only be offered with pharmacy plans S5, 2V and H9.4 Family Out-of-Pocket Maximum is 2x Individual, except for plans PS4/523 and PT1/529. Member cost share, including Office Visits, deductible, coinsurance and pharmacy, apply to the Out-of-Pocket Maximum.

15


Med/Rx Ded3



HospitalIP Per

Occurrence Ded6

PS-8 527 80% 60% $1,000 $2,000 Embedded No $3,000 $3,000 $25 $35 $250 80% N/A

PS-9 528 80% 60% $1,000 $2,000 Embedded No $4,000 $10,000 $30 $30 $150 80% N/A

PT-2 530 80% 60% $1,000 $2,000 Embedded No $3,000 $6,000 $30 $50 $250 80% N/A

PT-3 531 70% 50% $1,000 $2,000 Embedded No $4,000 $10,000 $25 $25 $250 70% N/A

PS-4 523 90% 70% $1,500 $3,000 Embedded No $3,500 $7,000 $15 $15 $100 90% N/A

PT-1 529 80% 60% $1,500 $3,000 Embedded No $4,500 $9,000 $20 $20 $100 80% N/A

PT-4 532 80% 50% $1,500 $3,000 Embedded No $4,000 $8,000 $30 $30 $250 80% N/A

PT-5 533 80% 50% $2,000 $4,000 Embedded No $5,000 $10,000 $25 $40 $250 80% N/A

PT-6 534 80% 50% $2,500 $4,500 Embedded No $5,000 $10,000 $20 $40 $250 80% N/A

PT-7 535 70% 50% $3,000 $6,000 Embedded No $5,000 $10,000 $25 $50 $250 70% N/A

PV-X 084 80% N/A $750 N/A Embedded No $2,500 N/A $35 $35 $250 80% N/A

PV-U 081 90% N/A $1,000 N/A Embedded No $2,000 N/A $25 $25 $250 90% N/A

PV-V 082 90% N/A $1,000 N/A Embedded No $3,000 N/A $20 $40 $250 90% N/A

PV-W 083 80% N/A $1,000 N/A Embedded No $3,000 N/A $25 $25 $100 80% N/A

PV-Y 085 80% N/A $1,000 N/A Embedded No $3,000 N/A $25 $35 $250 80% N/A

PV-Z 086 80% N/A $1,000 N/A Embedded No $4,000 N/A $30 $30 $150 80% N/A













Options PPO

PU-5 100% 80% N/A $2,500 Embedded No $2,500 $7,500 $20 $20 $100 $250 N/A

PU-6 80% 60% $500 $1,000 Embedded No $1,500 $5,000 $15 $15 $100 80% N/A

PU-8 80% 60% $1,000 $2,000 Embedded No $4,000 $10,000 $30 $30 $150 80% N/A

PU-7 100% 80% $2,000 $4,000 Embedded No $2,000 $8,000 $25 $25 $125 100% N/A

5 Benefits with coinsurance (%) responsibility are subject to the Deductible.6 The Per Occurrence Deductible is separate from the Annual Deductible and accrues toward the Out-of-Pocket Maximum.This benefit grid is intended only to highlight plan benefits and should not be relied upon to fully determine coverage. These plans may not cover all health care expenses. This policy has exclusions, limitations and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, contact your sales representative.

16

UnitedHealthcare’s Non-Differential PPO product provides maximum freedom for dealing with any health care situation. This flexible product provides a broader-based coverage to include more doctors and specialists

to visit without referrals. With this version of health insurance, benefits are provided for covered health services received from any physician or other licensed health care professional.


Plan Code

Coinsurance Deductible

Deductible Type1

Combined Med/Rx

Ded2


Network Out ofNetwork Network Out of

Network Network Out ofNetwork PCP Spec ER Inpatient

Hospital

IP Per Occurrence

Ded5

PU-Z 80% N/A $250 N/A Embedded No $2,000 N/A 80% 80% N/A 80% N/A

PU-1 80% N/A $500 N/A Embedded No $3,000 N/A 80% 80% N/A 80% N/A

PU-2 80% N/A $1,500 N/A Embedded No $4,000 N/A 80% 80% N/A 80% N/A



1 Family Deductible is 2x Individual, except for plans PS4/523 and PT1/529. For plans with a Non-Embedded deductible, one or more eligible members of a family unit may satisfy the entire Family Deductible. No one in the family will be eligible for benefits until the Family Deductible has been met.2 Plans with a combined medical and drug annual deductible may only be offered with pharmacy plans S5, 2V and H9.3 Family Out-of-Pocket Maximum is 2x Individual, except for plans PS4/523 and PT1/529. Member cost share, including Office Visits, deductible, coinsurance and pharmacy, apply to the Out-of-Pocket Maximum.4 Benefits with coinsurance (%) responsibility are subject to the Deductible.5 The Per Occurrence Deductible is separate from the Annual Deductible and accrues toward the Out-of-Pocket Maximum.This benefit grid is intended only to highlight plan benefits and should not be relied upon to fully determine coverage. These plans may not cover all health care expenses. This policy has exclusions, limitations and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, contact your sales representative.

17

Pharmacy for Consumer-Driven Health, Choice Plus, Choice, Select Plus, Select and Non-Differential PPO

UnitedHealthcare Pharmacy

Designed to meet employers’ financial goals, as well as the health and wellness needs of their employees and their families, our pharmacy management program is included in all fully insured plans. Here are the reasons to offer UnitedHealthcare Pharmacy:

1. We are aligned with your goals:

Focusing on total health care costs Building and executing a consistent

overall medical and pharmacy strategyThis approach is based on the fact that we manage risk for total health care spending for approximately 8 million fully insured members.

2. Our pharmacy management program focuses on all the components to help ensure optimal performance through:

Benefit design that engages and motivates consumers to choose higher-value drugs

A Prescription Drug List (PDL) based on evidence of total health care value and managed with flexibility to quickly respond to new information and changing market conditions

Demonstrated ability to drive market share, motivating pharmaceutical companies to provide greater rebates, resulting in lower net costs for entire therapeutic categories

Support tools and programs to help consumers fully understand their options and costs

Clinical programs to help improve quality of care and to support high health care value options

1 Deductible does not apply to Tier 1 for plans TB, TC, TD and TE.2 This pharmacy plan may only be paired with medical plans with a $1,000 or greater deductible. It is not eligible to be paired with HSA plans or any other plans with a combined medical/ pharmacy deductible. Only generic drugs are covered with this plan under Tier 1. State-mandated brand-name drugs, if any, are covered under Tier 2 and Tier 3.This benefit grid is intended only to highlight plan benefits and should not be relied upon to f`ully determine coverage. These plans may not cover all health care expenses. This policy has exclusions, limitations and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, contact your sales representative.

Plan Code

Deductible1 Member Copay Mail Order (90-Day Supply)Individual Family Tier 1 Tier 2 Tier 3 Tier 4

P8 $100 $300 $7 $35 $50 N/A 2.5x

W1 $100 $300 $7 $25 $50 N/A 2.5x

W2 $100 $300 $7 $30 $50 N/A 2.5x

N7 N/A N/A $7 $25 $50 N/A 2.5x

S5 N/A N/A $7 $25 $45 N/A 2.5x

U8 N/A N/A $7 $30 $50 N/A 2.5x

V5 N/A N/A $7 $35 $50 N/A 2.5x

Q2 $100 $300 $8 $25 $45 N/A 2.5x

S6 $100 $300 $8 $25 $50 N/A 2.5x

G5 N/A N/A $8 $25 $45 N/A 2.5x

K3 N/A N/A $8 $25 $50 N/A 2.5x

5V $100 $300 $10 $35 $60 100 2.5x

5S $100 $300 $10 $30 $50 100 2.5x

6M $100 $300 $10 $35 $60 N/A 2.5x

AQ $100 $300 $10 $30 $70 N/A 2.5x

AT $100 $300 $10 $35 $70 N/A 2.5x

F7 $100 $300 $10 $25 $45 N/A 2.5x

G4 $100 $300 $10 $30 $50 N/A 2.5x

P9 $100 $300 $10 $25 $50 N/A 2.5x

Y7 $100 $300 $10 $30 $60 N/A 2.5x

TB $150 $450 $10 $25 $45 N/A 2.5x

TD $150 $450 $10 $30 $50 N/A 2.5x

TC $250 $750 $10 $25 $45 N/A 2.5x

TE $250 $750 $10 $30 $50 N/A 2.5x

2V N/A N/A $10 $35 $60 N/A 2.5x

5U N/A N/A $10 $35 $60 $100 2.5x

0H N/A N/A $10 $30 $70 N/A 2.5x

0I N/A N/A $10 $35 $70 N/A 2.5x

4F N/A N/A $10 $30 $50 $100 2.5x

F5 N/A N/A $10 $25 $45 N/A 2.5x

H9 N/A N/A $10 $30 $50 N/A 2.5x

K5 N/A N/A $10 $25 $50 N/A 2.5x

Y6 N/A N/A $10 $30 $60 N/A 2.5x

5E N/A N/A $15 $35 $50 N/A 2.5x

TA N/A N/A 10% 20% 30% N/A 2.5x

DZ2 N/A N/A $10 $45 $85 N/A 3x

RU2 N/A N/A $15 $45 $85 N/A 3x

Combined Medical/Rx Deductible Plans

S5Medical Deductible

Applies

$7 $25 $45 N/A 2.5x

2V $10 $35 $60 N/A 2.5x

H9 $10 $30 $50 N/A 2.5x

18

Our goal is to help employers and employees manage costs by helping people improve their total health and productivity. That’s why we offer these additional health and wellness programs at no additional charge.

Care CoordinationSM

Coordinates and customizes services where gaps in care may exist. Education and prevention programs include pre-admission counseling, inpatient care advocacy and readmission prevention.

eSync PlatformSM Technology UnitedHealthcare’s sophisticated eSync platform takes a big-picture look at a member’s health, and, using proprietary technology, alerts the member and his or her physician to a potentially serious condition so that intervention can occur at the diagnostic stage.

Disease Management Identifies high-risk individuals with chronic conditions, such as asthma, diabetes and coronary artery disease, who may benefit from a focused intervention program. Individuals are placed on one of three levels of intervention to improve quality of life and keep cost trends in check.

Complex Medical ConditionsThe Complex Medical Conditions program provides access to Centers of Excellence networks comprising medical centers that are identified as specialists in the treatment of specific conditions and that meet strict evaluation requirements. The Complex Medical Conditions program also provides clinical consulting services to manage treatment programs and costs to maximize employee benefits.

Evidence-Based Medicine Improves consistent clinical outcomes and reduces inefficient delivery of care. We offer Clinical Evidence (a compilation of thousands of recent research studies); facilitate peer-to-peer data-sharing consultations; and provide physicians and hospitals with relevant data regarding their performance compared to nationally accepted, evidence-based practices.

United Behavioral HealthBehavioral health and substance disorder services, ranging from counseling to acute inpatient care are delivered by our affiliate, United Behavioral Health (UBH).Features:

Support and treatment for mental health and substance disorder issues

Integration with medical benefits for streamlined administration

Indirect and direct cost savings

Care24®

Care24 assists employees with health, personal or family-related concerns via a toll-free phone number 24 hours a day, seven days a week. One toll-free number puts them in touch with nurses, counselors, financial consultants and attorneys.For situations where in-person resources are needed, Care24 contracts with more than 9,000 professionals nationwide who provide local, in-person support. In addition, our database of more than 60,000 unique community resources, representing 400,000 points of expertise, adds to Care24’s depth of service.Care24 also offers employers access to audio messages on more than 1,100 health and well-being topics. Most audio tapes are available in Spanish, and we provide translation services for more than 140 languages.

myuhc.com® Gives members online, self-service access to benefit and network information. myuhc.com also provides customized information and articles on hundreds of health-related topics.

Additional Value-Added Programs for Consumer-Driven Health, Choice Plus, Choice, Select Plus, Select and Non-Differential PPO

19

Self-Funding OptionsUnitedHealthcare offers two solutions when it comes to “self-funding” to meet employers’ needs: (1) a bundled, fully integrated approach with UnitedHealthcare; and (2) an unbundled third-party administrator (TPA) model with UMR, offering flexibility and the opportunity for greater customization on every level, such as account structure, networks, pharmacy and stop-loss.

UnitedHealthcareWe’ve designed an efficient, streamlined approach to self-funding that allows employers to take advantage of our powerful networks and renowned clinical quality initiatives, with the simplicity of truly integrated systems. The following services, with clinical and wellness components, are included:• Health Adviser Member Service• Care Management and Decision Support• Disease Management• Complex Condition Management• UnitedHealth Wellness®There are also several buy-up programs that can help enhance a medical plan to meet employers’ needs.

Stop-LossUnitedHealthcare stop-loss coverage protects against large losses that occur for one individual (sometimes called “specific”) or the membership in total (also called “aggregate”).

Care24®

Care24 is a complete service that gives employees access to a wide range of resources. One toll-free phone number puts them in touch with nurses, counselors, financial consultants and attorneys – 24 hours a day, seven days a week.

UMR UMR is the largest third-party administrator (TPA) in the United States, offering flexible medical, dental and disability administration and other benefit solutions. Through UMR, we can provide a flexible, customized total benefit plan solution.

Flexible, customized solutions

UMR can provide flexibility in plan designs, banking arrangements, customized reporting, multiple care management and wellness programs and access to value-added ancillary services. In addition, we work well with multiple partners, including local, regional and national PPO networks, stop-loss carriers and pharmacy benefit managers to provide our customers with a flexible yet integrated solution.

Personalized and accountable service

Using technology as a tool, UMR provides personal service 24/7 and easy-to-navigate online resources with relevant and understandable information.

Strategic cost and risk management resources

With our local, regional and national network relationships (including UnitedHealthcare’s Options network), we can offer employers significant discounts and accessibility. Efficient, advanced claim controls and management also maximize non-network savings.

Intelligent technology

With customized, on-demand reporting and in-depth plan analysis, employers can monitor plan performance and better understand where their money is spent.

Market-specific solutions

UMR can deep-dive into specific industries, to offer employers tailored approaches that work for their business.

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Signature

Advantage

Flex

Allliance

Pharmacy for Signature, Advantage, Flex, and Alliance

Additional Value-Added Programs for Signature, Advantage, Flex and Alliance

HMO Products

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Signature, Advantage, Flex and Alliance

The Signature plan includes our full network of contracted providers. With this HMO plan, members simply choose a Primary Care physician (PCP) from our full network of contracted providers to coordinate all their medical care. They can then visit their PCP for routine checkups, and when they need to see a specialist, their PCP can provide a referral. Members are charged only a copayment for each doctor’s visit. Preventive care, including checkups, is covered. The basic deductible HMO plans are now available on all networks.

The Advantage plan offers the same level of benefit coverage as a traditional HMO plan at a lower premium. The difference is in the network. The Advantage plan offers a narrower network of contracted providers. Members must choose a PCP from the Advantage network to coordinate all their medical care.

Flex is an HMO that promotes consumer engagement by giving members more information and flexibility in how they spend their health care dollars. The plan provides the same level of coverage as the traditional UnitedHealthcare HMO plans. The difference is in the distinct network choices. The Flex plan arranges providers into distinct networks, based on objective measurements of their ability to deliver quality care at lower costs. Members pay reduced premiums when they select doctors from a specific network, or tier (custom plan quoting only).

The Alliance plan requires members to choose a PCP from network medical groups that were selected based on their outstanding reputations and clinically proven abilities to deliver the kind of care that keeps health care costs down. The focus of these plans is on “patient-centered care” – the PCP coordinates the member’s care with other physicians and specialists in their chosen medical group’s network to ensure that the member will receive outstanding care. As with our other plans, members get the tools they need to do their own evaluations, so they can select the right physician to meet their unique needs and preferences.

To make these plans flexible enough to meet the needs of employers and their employees, they can be paired with either a HSA or a HRA. These options each provide a unique set of features, benefits and requirements. For example, the employee is the “owner” of the HSA, while HRAs give the employer much more control over which expenses to cover. With both types of account, funds can “roll over” from year to year to allow members to save for bigger expenses, and significant tax benefits can be realized, with proper use.

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HMO Plan CodesDeductible1

Out-Of-Pocket

Maximum2PCP Spec ER Inpatient Hospital IP Copay Max

IP Copay Type

Outpatient Surgery

DeductibleType

Combined Med/Rx

DeductibleSignature Advantage Alliance

KA0 KIW KS1 N/A $1,500 $10 $10 $150 Paid in full N/A N/A Paid in full N/A N/A

KA3 KJ0 KS4 N/A $1,500 $10 $10 $150 $250 $250 Admit $200 N/A N/A

KA6 KJ3 KS7 N/A $1,500 $15 $15 $150 $250 $250 Admit $200 N/A N/A

KB0 KJ6 KSI N/A $1,500 $15 $15 $150 $500 $500 Admit $400 N/A N/A

KB3 KKI KSS N/A $1,500 $20 $20 $150 Paid in full N/A N/A Paid in full N/A N/A

KB6 KL1 KSV N/A $1,500 $20 $20 $150 $250 $250 Admit $200 N/A N/A

KD0 KL4 KT1 N/A $1,500 $20 $20 $150 $500 $500 Admit $400 N/A N/A

KD3 KL7 KT4 N/A $1,500 $25 $25 $150 $250 $250 Admit $200 N/A N/A

KD6 KC0 KT7 N/A $1,500 $25 $25 $150 $500 $500 Admit $400 N/A N/A

KAO KM1 KTG N/A $1,500 $10 $20 $150 $150 $450 Day $100 N/A N/A

KAI KM4 KTJ N/A $1,500 $10 $20 $150 $250 $750 Day $200 N/A N/A

KE0 KM7 KTM N/A $1,500 $20 $30 $150 $150 $450 Day $100 N/A N/A

KE3 KNI KTP N/A $1,500 $25 $35 $150 Paid in full N/A N/A Paid in full N/A N/A

KE6 KO1 KTS N/A $1,500 $25 $35 $150 $150 $450 Day $100 N/A N/A

KF0 KO4 KTV N/A $2,500 $15 $30 $150 $250 $750 Day $200 N/A N/A

KF3 KO7 KIZ N/A $2,500 $25 $40 $150 $250 $750 Day $200 N/A N/A

KF6 KM0 KU1 N/A $2,500 $35 $50 $150 $250 $750 Day $200 N/A N/A

KD9 KOA KU4 N/A $4,500 $20 $40 $200 $500 $2,500 Day $400 N/A N/A

KG0 KOD KU7 N/A $4,500 $25 $45 $200 $250 $1,250 Day $200 N/A N/A

KG3 KOG KT0 N/A $4,500 $30 $50 $200 $250 $1,250 Day $200 N/A N/A

KG6 KOJ KUG N/A $4,500 $30 $50 $200 $500 $2,500 Day $400 N/A N/A

KDI KOM KUK N/A $2,500 $25 $45 $200 10% 10% N/A 10% N/A N/A

KH0 KOP KUN N/A $3,500 $25 $45 $200 20% 20% N/A 20% N/A N/A

KFO KOS KUS N/A $4,500 $25 $45 $200 30% 30% N/A 30% N/A N/A

KI0 KOV KUV N/A $2,500 $30 $50 $200 10% 10% N/A 10% N/A N/A

KI3 KLO KV1 N/A $2,500 $35 $55 $200 10% 10% N/A 10% N/A N/A

KI6 KLI KV4 N/A $3,500 $35 $55 $200 20% 20% N/A 20% N/A N/A

KC9 KP7 KV7 N/A $4,500 $35 $55 $200 30% 30% N/A 30% N/A N/A

KIB KJ9 KVG N/A $2,500 $45 $65 $200 10% 10% N/A 10% N/A N/A

KIE KQ0 KVK $250 $3,000 $20 $35 $150 30% after Ded 30% after Ded N/A 30% after Ded Embedded No

KIH KQ7 KVN $500 $3,000 $20 $35 $150 30% after Ded 30% after Ded N/A 30% after Ded Embedded No

KIK KR1 KVR $1,000 $4,500 $25 $40 $150 30% after Ded 30% after Ded N/A 30% after Ded Embedded No

KIN KR4 KVU $1,500 $5,000 $25 $40 $150 30% after Ded 30% after Ded N/A 30% after Ded Embedded No

KIQ KR7 KVX $2,000 $5,000 $45 $60 $150 30% after Ded 30% after Ded N/A 30% after Ded Embedded No

KIT KP0 KW1 $3,000 $6,000 $45 $60 $150 30% after Ded 30% after Ded N/A 30% after Ded Embedded No

HSA-Eligible3

N/A N/A KW4 $1,500 $3,00010% after Ded

10% after Ded

10% after Ded

10% after Ded

10% after Ded N/A 10%

after DedNon-

Embedded Yes

N/A N/A KW7 $2,000 $4,00020% after Ded

20% after Ded

20% after Ded

20% after Ded


after DedNon-

Embedded Yes

N/A N/A KWG $3,000 $6,00020% after Ded

20% after Ded

20% after Ded

20% after Ded


after Ded Embedded Yes

HRA-Eligible

N/A N/A KWK $1,500 $4,000$30 after Ded

$45 after Ded

10% after Ded

10% after Ded


after Ded Embedded No

N/A N/A KWN $2,000 $5,000$35 after Ded

$50 after Ded

20% after Ded

20% after Ded



N/A N/A KWQ $3,000 $6,000$40 after Ded

$55 after Ded

30% after Ded

30% after Ded



1 Family Deductible is 2x Individual. For plans with a Non-Embedded deductible, one or more eligible members of a family unit may satisfy the entire Family Deductible. No one in the family will be eligible for benefits until the Family Deductible has been met.2 Family Out-of-Pocket Maximum is 2x Individual. Member cost share, including Office Visits, deductible, coinsurance and pharmacy, apply to the Out-of-Pocket Maximum.3 Only pharmacy plans 3Y8, 3Y9 and 3Z4 are available with HSA-eligible plans.This benefit grid is intended only to highlight plan benefits and should not be relied upon to f`ully determine coverage. These plans may not cover all health care expenses. This policy has exclusions, limitations and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, contact your sales representative.

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OptumRx

As a leading pharmacy benefit manager serving more than 11 million members, OptumRx is committed to offering quality pharmacy benefits at a reasonable price. We realize that people are more than their prescriptions. That’s why our integrated medical and pharmacy model considers the whole person. Combined data is used to make decisions and deliver the best possible health outcomes. Through a partnership approach, we work to: • Deliver a simple, high-touch service model.

Our pharmacy experts help employers get the most from their benefits. Administration is easier with one contact, one bill and integrated reporting. Members get a single health plan ID card, customer care number and website.

• Drive prescriber collaboration. Through on-site visits and educational materials, we work to increase generic utilization, mail service use and formulary compliance. Plus, manage specialty drug trend.

• Improve quality and safety through formulary and clinical program management. We also monitor fraud, waste and abuse through real-time audit and regulatory collaboration.

• Maximize savings through better trend and cost management. We achieve this through formulary management, product design and utilization strategies.

Empowering individuals to take charge of their health can help control costs. Members using medications as prescribed may have fewer doctor visits and hospitalizations, which can lead to lower medical expenses. And that helps employers, too. Members can fill prescriptions through mail service and enjoy convenient door-to-door delivery. Or, they can choose one of our 64,000 network retail pharmacies.

New pharmacy formulary

UnitedHealthcare has added a four-tier formulary to the portfolio. This new formulary isolates high cost and specialty medications into the fourth tier and provides clear and predictable cost to members. Commonly used Generic and Brand medications remain available as lower-cost options.

Pharmacy for Signature, Advantage, Flex and Alliance

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Plan Code1 Deductible2 Member CopayMail Order

(90-Day Supply)

30% up to $150 Self Injectable

30% up to $250 Self Injectable

Individual Family Generic Formulary

Brand-Name

Formulary

Non-Formulary

Specialty Medications

2HI 2DJ N/A N/A $5 $10 N/A N/A 2x

2II 2EJ N/A N/A $5 $15 N/A N/A 2x

2JI 2GJ N/A N/A $10 $10 N/A N/A 2x

2KI 2GI N/A N/A $10 $15 N/A N/A 2x

2LI 2IJ N/A N/A $10 $20 N/A N/A 2x

2MI 2JJ N/A N/A $10 $25 N/A N/A 2x

2NI 2KJ N/A N/A $10 $35 N/A N/A 2x

2OI 2LJ N/A N/A $15 $25 N/A N/A 2x

2PI 2MJ N/A N/A $15 $35 N/A N/A 2x

2QI 2OJ N/A N/A $20 $30 N/A N/A 2x

2EI 2PJ $100 $300 $20 $35 N/A N/A 2x

3QA 3AK N/A N/A $5 $10 $25 N/A 2x

3OG 3OD N/A N/A $5 $15 $30 N/A 2x

3KD 3KE N/A N/A $10 $20 $25 N/A 2x

3QG 3YG N/A N/A $10 $20 $30 N/A 2x

3NG 3NH N/A N/A $10 $20 $40 N/A 2x

3JF 3YJ N/A N/A $10 $25 $35 N/A 2x

359 3IJ N/A N/A $10 $25 $40 N/A 2x

3IF 3IK N/A N/A $10 $25 $50 N/A 2x

3OH 3QH N/A N/A $15 $25 $40 N/A 2x

3XE 3XD N/A N/A $15 $30 $45 N/A 2x

3KF 3XF N/A N/A $20 $30 $50 N/A 2x

3NE 3ID $100 $300 $20 $35 $50 N/A 2x

331 332 N/A N/A $10 $20 $45 N/A 2x

333 334 N/A N/A $10 $30 $50 N/A 2x

335 336 N/A N/A $15 $25 $50 N/A 2x

337 338 $100 $300 $15 $30 $50 N/A 2x

470 471 N/A N/A $10 $20 $40 $100 2x

472 473 N/A N/A $10 $25 $40 $100 2x

480 481 N/A N/A $10 $25 $50 $100 2x

482 483 N/A N/A $10 $30 $50 $100 2x

490 491 N/A N/A $10 $35 $60 $100 2x

492 493 N/A N/A $15 $30 $45 $100 2x

Plan Code3 Offered with Medical Plan

Deductible2 Member CopayMail Order

(90-Day Supply)Individual Family Generic Formulary

Brand-Name

Formulary

Non-Formulary

Specialty Medications

Combined Medical/Rx Deductible Plans

3Y8 KW4Medical Deductible

Applies $10 $30 $50 N/A 2x3Y9 KW7

3Z4 KWG

1 Pharmacy plan code varies based on copayment level of the self-injectable drug benefit in the paired medical plan.2 Applies to all drugs.3 Only pharmacy plans 3Y8, 3Y9 and 3Z4 are available with HSA-eligible plans.This benefit grid is intended only to highlight plan benefits and should not be relied upon to f`ully determine coverage. These plans may not cover all health care expenses. This policy has exclusions, limitations and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, contact your sales representative.

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Additional Value-Added Programs for Signature, Advantage, Flex and Alliance

Disease Management and Health Management ProgramsManaging a disease is never easy. But with the right support and information, it can be made more tolerable.

We offer case-based disease management programs for: • Asthma• Cancer• Chronic Obstructive Pulmonary Disease• Congestive Heart Failure• Coronary Artery Disease/Stroke• Depression• Diabetes• End-Stage Renal Disease• Neonatal Care Management• Healthy Pregnancy ProgramWe also offer Health Management programs that provide education and self-care information that can help members live healthier lives. Our Health Management programs include: • Taking Charge of Asthma®• Taking Charge of Diabetes• Taking Charge of Your Heart Health• Stop Smoking

Health Discount ProgramThe Health Discount Program* offers members savings of between 10-25 percent on health and wellness purchases not included in their standard health benefit plan. Even if they already have medical, dental and vision coverage, as an enrolled health plan member, they can save even more money by using their Health Discount Program for fitness centers, weight management, alternative care, dental, vision and more.• Dental, Vision, alternative care and infertility

treatment savings• Fitness equipment and apparel discounts

• Reduced rates on fitness clubs, including 24 Hour Fitness,® LA Fitness,® Anytime Fitness, Bally Total Fitness,® Curves,® Gold’s Gym® and Snap Fitness®

HMO members can log on to www.uhcwest.com and search through the Health and Wellness tab to find providers and discounts, and start taking advantage of this program.

Healthy Pregnancy ProgramThis program is like a “fairy godmother” for any mom-to-be. In addition to an information resource center that provides valuable tips, advice, screening and immunization schedules, and what mothers need to know for pre- and post-baby health, the Healthy Pregnancy program also includes:• Pregnancy consultation to identify a new mother’s risks

and special care needs • 24-hour toll-free access to experienced maternity nurses• No-additional-cost book: Your Journey Through PregnancyThe Healthy Pregnancy program is a completely new program for HMO members.

24-Hour InformationIf members need answers to general health questions, they no longer need to wait until Monday morning. The 24-Hour Health Information program provides members with access to experienced registered nurses by calling 1-866-747-4325 or TTY 711. They also have the option of listening to prerecorded information on a variety of health topics.

Online Self-ServiceAt www.uhcwest.com, HMO members may order health plan ID cards and change their provider, plus get access to interactive health information, health benefits, doctor directories, information on the Mail Service Pharmacy, health tips, resource links and more.

NurseLineSM

Efficient use of health care resources can help contain employers’ medical costs. NurseLine nurses provide health information, discuss treatment options and assist individuals in finding an appropriate level of care.Maintaining good health starts with asking questions and understanding the answers. NurseLine services empower people with information, support and guidance. From helping prepare questions for an upcoming doctor visit to determining the appropriate use of medical resources, NurseLine helps individuals make educated decisions about their personal health.NurseLine provides immediate access to experienced registered nurses for nearly any health or medical concern – 24 hours a day, seven days a week.

Catastrophic Care ManagementComplex case management

Special Population CareFrail members, ER frequent

users, pre-catastrophic care, terminally ill members

Chronic Disease ManagementCHF, CAD/stroke, COPD, ESRD

Diabetes, Depression, AMI

Acute Episode ManagementIn-/Out-pt. Medical Management

Transitional, Continuity of Care

Preventive Health Managementpreventive care/risk reduction,

health improvement, member education

* These discounts apply only to services that are not covered by the member's plan or are above plan limits.

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Notes

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eServices

Customer satisfaction is the goal of everything we do at UnitedHealthcare. Service is a significant part of our commitment to improve the health care experience for consumers, employers and physicians.We’re continually investing in technology and our staff to offer service solutions when and how our customers and their employees need them – whether it’s online, on the phone or in person. Our eService solutions, Employer eServices,® OnlinEnroll® and United eServices® deliver true extra value that our customers notice every day.

Solutions for EmployersEmployer eServices provides streamlined administration for employers

Employer eServices is UnitedHealthcare’s secure website that provides immediate and secure self-service access to health benefits information. Self-service efficiency leads to:• Increased employee satisfaction – employees

have access to their benefits immediately and experience less hassle at the time of service with updated eligibility information

• Increased accuracy – customers benefit from accuracy through real-time processing and more accurate billing statements

From eligibility maintenance to customer reporting and billing solutions, Employer eServices is a gateway to tools that make health benefits administration more efficient.

Online eligibility maintenance

• Add new employees• Verify and change eligibility• Request medical health plan ID cards• Verify or change status of employees

and dependents

Electronic eligibility management

• Submit data electronically from an HR system – no manual entry

• Spend less time reconciling full population files• Download error reports into an easy spreadsheet• Receive email notifications with updated

eligibility statistics

Online billing

• Check claims status (self-funded customers only)• View invoices online• Authorize payment online• Download invoices into spreadsheets• View, sort and search current and prior

month’s invoices• Request adjusted invoices after changing/

adding eligibility information

Real-time reporting*

• View benefit plan cost and use information• Access free standard reports and optional

customized reports

Communication Resource Center (CRC)

The Communication Resource Center at www.EmployereServices.com or www.uhc.com/crc makes it easy for employers to communicate with their employees and help them get the most from their benefit plan. • Access fliers, posters, brochures and articles

that employers can email, print, use in company newsletters or any other form of employee communication

• Build a customized newsletter with articles provided• Use communication tools that help employers

plan a workplace wellness campaign

* Availability based on group size and funding arrangements

Manage Business Online With eServices

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Solutions for Employers and EmployeesOnline enrollment with OnlinEnroll

Enrolling online makes benefit administration easier for employees and more efficient for employers with easy data collection and management of all carriers in one spot. Online enrollment with UnitedHealthcare eliminates the hassles of paperwork, saving valuable time. With OnlinEnroll, employees can enter their own personal, dependent and enrollment information in one central website – and across multiple carrier systems – allowing employers to access, update and report on the centralized data.Please contact your UnitedHealthcare representative for a quote or for more information.

Solutions for BrokersUnited eServices

United eServices makes administration simpler for brokers who are appointed to sell UnitedHealthcare products. We developed the United eServices website to help appointed brokers and consultants streamline their administrative tasks and provide better service to employers. Brokers can access an array of online tools and information:• Network information• Online commission statements and

bonus schedules• Sales support materials• Reward program information• Forms

United eServices also provides a gateway to the Employer eServices site for those brokers who manage benefits administration on behalf of their clients.Register with United eServices online. Visit www. unitedeservices.com and click on the registration button.

Broker website at uhc.com

The broker section of our website, www.uhc.com, provides brokers and consultants everything they need to help them serve their customers and build their business. Information can be filtered by group size and/or by health plan location. Additionally, dedicated market news pages can be bookmarked on their Internet browser, making it even easier for them to quickly obtain news for a specific geographic area. Features of the site include:• Access to the latest news in a specific geographical area• Information about the UnitedHealthcare product

portfolio and how to market the company’s services• The latest news archives for articles about offerings

affecting customers• Links to health care modernization and legislative

updates• Access to materials to help support new and renewal

business• Calendars of different training opportunities• Links to online tools that they use every day can be

accessed 24 hours a day, seven days a week, including access to United eServices (appointed brokers only), Employer eServices and others

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SimplyEngaged®

Wellness Programs

Market-Specific Solutions and Resources

Value-Added Programs Available With Every Plan

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SimplyEngaged

Helps employers engage their employees, which may help them take control of health care costs.

UnitedHealthcare is pleased to introduce SimplyEngaged,® a turnkey wellness and consumer engagement incentive program offered to customers at an additional cost. SimplyEngaged is designed to help improve the health of members.SimplyEngaged may help employers better control their health care costs while sustaining competitive employee benefits by rewarding employees with financial incentives when they complete the following:We also recommend that employers introduce a consumer-driven health product designed to engage employees more in the financial impact of their health care decisions.

The more engaged employees are in their health care, the healthier they may be and that may result in health care savings for employers.

Implementing SimplyEngagedSimplyEngaged involves three distinct components.

1 We’ll help employers establish a simple but formal “workplace wellness program” with these four easy steps:

• Send out an announcement letter to all employees from the company owner or a senior executive.

• Designate a “Wellness Champion” to serve as an ambassador to promote wellness events and activities.

• Sponsor at least one health fair/wellness event (including a biometric screening) within the first 120 days of the policy year. UnitedHealthcare will cover the cost of biometric screenings for covered employees at locations with 20 or more participating employees.

• Distribute a quarterly communication (newsletter, article or flier) on a health and wellness topic to employees.

2 Active promotion of the SimplyEngaged reward program may help improve employee health and decrease long-term health benefit costs.

We’ll provide employers with tools to motivate employees and their covered spouses/domestic partners to complete the wellness and health improvement activities.

3 Brokers and employers meet formally twice a year with a UnitedHealthcare representative. These meetings would be with the company owner or a senior executive. The first meeting should be early in the policy year to cover the details of implementing the SimplyEngaged components in the workplace. The second meeting should occur about 60 days prior to renewal.

Educate, motivate and encourage with SimplyEngaged Employers can find a range of tools and materials to help make the program a success by asking the UnitedHealthcare account manager for materials or visiting the Communication Resource Center at EmployereServices.com.• Kickoff letter template (for your CEO)• Employee presentation

• Calendar showing when to promote various activities• Fliers and posters

• Ongoing wellness communications

• Tool to create wellness newsletters

Please speak with your UnitedHealthcare representative to receive a customized quote for SimplyEngaged.

Online Health Assessment $75

Online health coaching program $25

Telephone-based health coaching program

$75

Maximum per employee $175

Maximum per family $350

Employees and their covered spouses/domestic partners receive their choice of gift cards to over 350 national retailers when they complete these wellness activities.

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UnitedHealthcare offers health and wellness programs at no additional cost, including an enhanced 24-hour online health and wellness site with tools and resources that may help make it easier for members to develop a healthier lifestyle. Select Health & Wellness on our websites to find:

Health assessment and personalized health action programThis online questionnaire provides secure and confidential* information to help members assess their overall health, plus information to help them identify their health risks based on family or personal history, with immediate health improvement suggestions.

Personal health recordMembers can keep track of their personal health history – conditions, medications, procedures and test results.

Online health trackers and toolsOur online health tools, such as exercise and weight loss trackers, Body Mass Index (BMI) and calorie calculators, and easy-to-use online health quizzes, can provide members with access to helpful information and feedback on their progress toward healthier living.

Preventive care guidelinesGet a detailed list of guidelines to help members consider how often to see a doctor, when they should have a particular type of screening, when to get vaccinations and more.

Online health coachingTake advantage of our online programs designed to help members achieve their health and wellness goals. With programs that provide information and health activities to help members lower their blood pressure, reduce cholesterol or lose weight, we’ve got something to help members live a healthier life.

Comprehensive library of health and wellness informationOur vast library of health and wellness articles includes information on topics, including family, fitness and nutrition, healthy aging, healthy pregnancy, preventive medicine, relationships and more. Get the latest information on a variety of health and wellness topics, including:• Personalized content based on a member’s condition,

life stage or lifestyle• Clinical information on a wide range of diseases,

conditions, tests, procedures, treatments, therapies and drugs

• Exclusive articles to help members make sense of the latest health news and trends

• Daily articles on consumer health news

Log on today at www.uhc.com or www.uhcwest.com.

Wellness Programs

* Confidential to the fullest extent permitted by law.

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Market-Specific Solutions and Resources

Multicultural SolutionsLatino Health SolutionsSM

Latinos have specific health care and cultural preferences – and many prefer Spanish, especially when dealing with such complicated or personal subjects as health care coverage. We understand these cultural preferences and have designed a broad range of services to assist employers’ needs within the Latino community, including:• A Spanish-language website, www.uhclatino.com,

offers interactive, easy-to-use, Web-based health and educational resources.

• Schedules of benefits and enrollment materials in Spanish.

• Online provider directory of Spanish-speaking physicians.• Customer service in Spanish, with bilingual customer

care professionals.

Asian American Markets

UnitedHealthcare has worked to develop alternative products, health education and in-language communications to better serve our Asian American customers and members.

Asian American Markets features:• www.uhcasian.com – an educational website that

offers general health care topics and terms in English, Chinese, Korean, Vietnamese and Japanese.

• Asian-language provider directories that won the 2007 Recognizing Innovation in Multicultural Health Care Award from the National Committee of Quality Assurance.

• Sponsored community events for traditional Asian holidays, including Lunar New Year.

Generations of Wellness®

When it comes to good health, people need to have options that take into account their individual needs – not only their background and history, but their cultural preferences and even where they live and work.That’s why UnitedHealthcare created Generations of Wellness®, an initiative designed to address health issues specific to African Americans. By providing more relevant options and choices, we’re working to create a better health care experience.

Generations of Wellness helps members:• Create their own personalized road maps to good

health by using innovative, interactive health tools, such as our Family Health History Tree and health tip fliers, found on www.uhcgenerations.com.

• Become more engaged in their own health, and their community, by participating in UnitedHealthcare-sponsored health and wellness events.

• Prevent or manage diabetes, stroke and other conditions that affect a disproportionately high number of African Americans by referencing our health tip fliers utilizing our Online Health Coach.

Resources for WomenSource4WomenTM

Source4Women, our women’s website at www.uhc.com/source4women.htm, offers an online space for women to share their insights about health and improve their ability to manage their health care. Our female members and their friends and family members can register to participate in the Source4Women communities by going to www.uhc.com/source4women/community. They will find four core communities, discussions and advice, email notifications and blogs about managing their, and their families’, health and more.

The site also offers online seminars in which they can hear from leading women’s health experts on key topics.

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Notes

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Life

Disability

Dental

Dental Indemnity

Dental Direct Compensation

Vision

Specialty Products

38

Most of us don’t want to think about “worst case” scenarios, but life insurance is an affordable way to prepare for life’s challenges and provide peace of mind for employers and their employees. UnitedHealthcare offers a distinctive life and disability insurance portfolio that offers flexible solutions. These plans can be packaged with health care coverage plans for even greater savings.

Features• Basic Life schedules may be based on flat amounts of

coverage, job level, or a multiple of the employee’s salary.• Accidental Death and Dismemberment (AD&D)

provides insurance coverage for loss of life or injuries sustained within 90 days from the date of the accident.*

• Dependent Life may provide a sense of security for an employee’s family.

• Accelerated Benefit for employees who are terminally ill and not expected to live for more than one year.

• Waiver of Premium for eligible employees totally disabled before age 60, until age 65.

• Eligible beneficiaries may have the option of utilizing an FDIC-insured bank account offered by Optum Bank, member FDIC.

• AD&D Seat Belt Benefit pays an additional 10 percent of the AD&D benefit (up to $10,000) if a covered person dies while wearing a properly fastened seat belt.

• Life Conversion allows employees to convert to an individual life insurance policy when losing coverage under the group plan in certain circumstances.

Basic Life/AD&D Benefits

100–5,000** Lives

Flat amount coverage(increments of $5,000)

Variable

Multiple of salary(rounded to the next $1,000 if not a multiple of $1,000)

Variable

Guaranteed issue Variable

Life insurance and AD&D benefits both reduce 35 percent at age 65 and to 50 percent of the original amount at age 70. Coverage limitations and exclusions may apply.

Dependent Life**

Dependent Benefit (51-99 Lives) Spouse Child

Plan A $2,000 $1,000

Plan B $4,000 $2,000

Plan C $7,500 $3,750

Coverage is guaranteed issue. Coverage is not available for spouse only or child(ren) only. Not available for retirees. Benefit will be paid as follows: Dependent age, 0-13 days = No benefit; 14 days and older = Full benefit.

* Limitations for AD&D include, but are not limited to: disease, bodily or mental infirmity, suicide, participation in a riot or insurrection assault, felony, war, use of any drug unless prescribed by a physician, driving while intoxicated, engaging in certain hazardous activities, private aircraft.

**Tailored plan designs for employers with 100+ Lives

This benefit grid is intended only to highlight plan benefits and should not be relied upon to fully determine coverage. This policy has exclusions, limitations and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, contact your sales representative.

In California, UnitedHealthcare Life and AD&D product is provided by Unimerica Life Insurance Company, Milwaukee, WI.

Life

39

Disability

Exclusions for Short Term and Long Term Disability include: war, self-inflicted injury, participation in a riot or commission of a felony, cosmetic or elective surgery, and disabilities due to pre-existing conditions during the first two years of coverage. Benefits for Mental Illness and Substance Abuse may be limited to two years. Some plans have a shorter pre-existing exclusion period. Coverage may also be reduced by payments received from other sources of income received for the disability.Disability plans, benefit details, options available, and plan enhancements will vary by employer group and plan design selected. Employers/employees must meet eligibility requirements to receive benefits. Other restrictions may apply.Short-term disability is only available for 100+ employees.This benefit grid is intended only to highlight plan benefits and should not be relied upon to fully determine coverage. This policy has exclusions, limitations and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, contact your sales representative.In California, UnitedHealthcare Disability products are provided by Unimerica Life Insurance Company, Milwaukee, WI.

UnitedHealthcare offers disability insurance products.

Benefits to Employers Flexible, customized plan designs

Benefits to Employees Wide array of benefit features Dedicated and knowledgeable claim specialists

Disability Products• Short-term disability (STD): The STD portfolio

provides flexible options for duration, weekly benefit amounts, and non-occupational or 24-hour coverage. Our integrated case management services provide support to the disabled employee help them understand their care, recovery, and possible return to work.

• Long-term disability (LTD): The LTD portfolio offers a spectrum of benefit options, durations, monthly benefit amounts, and employee buy-up plans. Our services provide the employee with support and access to vocational and physical rehabilitation, career planning, and transitional work return.

• Voluntary LTD: For groups of 10 or more, employers can provide LTD insurance as an employee-pay-all benefit with portable coverage. This option gives employees the power to purchase long-term disability coverage at group rates on their own through the convenience of payroll deduction.

Features Include:• Flexible plan design: With UnitedHealthcare

Disability, products can be customized to meet benefit and financial objectives. Funding options include fully insured, employer-paid, or employee-pay-all. Our seamless coverage eliminates gaps or overlaps in income by unifying salary continuation programs with elimination periods.

Benefit Details STD LTD

Benefit Percentage 50%, 60%, or 66 2/3% 50%, 60% or 66 2/3%

Benefit Duration 13 or 26 weeks2-year, 5-year, or to age 65/Social Security Normal Retirement Age

Definition of Disability Own occupation or any occupation Either 2-year own occupation, or own occupation to age 65 for management and 2-year own occupation for all others

Maximum Benefit Up to $1,000 per week Up to $10,000 per month

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Abbreviated sample Dental HMO fee scheduleDHMO Plans for California

Code Procedure

Contributory/Voluntary Laguna 110C D350x/D306x

Newport 120C D250x/D251x

Malibu 130C D250h/D251h

Pismo 140C D175h/D176h

Santa Cruz 150C D125h/D126h

D0999 Office visit fee - per visit $0 $0 $0 $0 $0

Preventive

D0120 Periodic oral examination $0 $0 $0 $0 $0

D0210 Radiographs - complete series (bitewings included) $0 $0 $0 $0 $0

D1351 Sealant - per tooth (under 18 only) $10 $8 $8 $5 $5

Restorative

D2140 Amalgam - 1 surface, permanent $15 $8 $0 $0 $0

D2751 Resin - anterior, one surface $20 $10 $0 $0 $0

Crowns

D2710 Crown, Resin-based composite indirect $180 $150 $150 $125 $90

D2751 Crown, porcelain with metal, molar $305 $250 $250 $175 $125

D2791 Crown, full cast metal $305 $250 $250 $175 $125

Endodontics

D3310 Root Canal anterior $125 $125 $95 $75 $45

D3330 Root Canal molar $365 $325 $305 $275 $115

Periodontics

D4210 Gingivectomy/gingivoplasty - per quadrant $150 $130 $115 $115 $50

D4341 Periodontal scaling and root planing $55 $55 $45 $40 $25

Dentures (Prosthodontics)

D5110 Complete denture - maxillary $425 $350 $275 $225 $150

D5211 Partial denture, resin base $400 $325 $250 $275 $115

Oral Surgery

D7140 Extraction, erupted tooth or exposed root $15 $10 $8 $0 $0

D7230 Removal of impacted tooth - partially bony $95 $85 $85 $75 $50

Orthodontic

Adult and Child 24 months treatment $1,895 $1,895 $1,895 $1,895 $1,895

Specific copayment levels have also been set for start-up and retention services.

Dental HMO OverviewWe offer a number of flexible – and affordable – plan designs that are supported by a large national and regional network and value-added services.Our responsive team of experts provides the guidance and expertise employers need to go from enrollment to installation and ongoing administration.

Dental HMO PlansDental HMOs offer comprehensive coverage, including preventive and major services, at a modest price.

Each covered procedure has a fixed copayment, allowing members to know their out-of-pocket costs in advance. Coverage for emergency and out-of-area services are included.Unlike other plan types, Dental HMOs have no waiting periods, no deductibles or annual maximums and no claim forms.Specialty referrals by the member’s primary dentist are required under this plan design.Orthodontic services can be made available on all plans.

- HMO/PPO Dual Option available at five eligible employees, three enrolled - Prior carrier billing statement can be submitted in lieu of wage and tax documents - Spreadsheet enrollment available with standalone offerings - All options include Orthodontia benefits - PackagedSavings may be available when written with UnitedHealthcare medical - Options available down to two eligible employees - Voluntary options do not require a binder check to initiate coverage - 1st or 15th of the month effective dates available

- True “Open Enrollment” included on all options - 12-month guarantee included on all options

Please see Benefit Summaries for complete benefit descriptions. UnitedHealthcare Dental® HMO plans are offered and provided by Dental Benefit Providers of California, Inc.

Dental

Dental PPO and In-Network-Only (INO)PPO

PPO plans allow members the flexibility to choose either network or non-network services. Members experience the greatest savings when they choose a dentist from a national network of more than 241,000 dental professionals.With a wide selection of dental plans finding a solution that meets the needs of an employer is easy.

In-Network-Only (INO)

INO plans are structured similarly to PPO but members may only select a dentist that participates in the national network of more than 241,000 providers. Coverage for emergency and out-of-area services are included.

Indemnity

Indemnity plans offer the most flexibility because members may choose to visit any dentist.

PPO, INO and Indemnity plans all include these features with no increase to premium:• Prenatal dental care: Expectant mothers throughout

their pregnancy and during the first three months after delivery qualify for additional preventive care services with no copayment and no impact on the plan deductible.

• Oral cancer screening: Adults receive a screening once per year at the discretion of their dentist.

UnitedHealthcare dental metrics• Competitive network discounts• High first-call resolution rate: 92 percent first call

resolution• Fast claims service: 99 percent of claims paid within 10

business days; 100 percent within 30 calendar days• 99 percent accurate: 99 percent financial and

clerical accuracy• 70 percent auto-adjudication rate: 73 percent of claims

are automatically adjudicated

UnitedHealthcare IndemnityContributory Voluntary

I1310 I1323 I1206 I1210

Percentage Payable 100/80/50 100/80/50 100/80/50 100/80/50

Endo/Pero/Oral Covered in basic Covered in basic Covered in basic Covered in major

Annual Max $1,000 $1,500 $1,000 $1,000

Individual Deductible $50 $50 $50 $50

Waiting Period No wait No wait No wait No wait

Payment Basis 85% UCR 85% UCR 85% UCR 85% UCR

Ortho Child-only Child-only Child-only Child-only

Lifetime Ortho Max $1,000 $1,000 $1,000 $1,000

Minimum Group Size 10 10 10 10

UnitedHealthcare PPOContributory

P4212 P3498 P4213 P4216 P3439 P3416

Percentage Payable100/90/60 in

100/80/50 out100/80/50 in80/60/50 out

100/90/60 in 100/80/50 out

100/90/60 in100/80/50 out

100/80/50 in80/60/50 out

100/80/50 in100/80/50 out

Endo/Pero/Oral Covered in basic Covered in basic Covered in basic Covered in basic Covered in basic Covered in basic

Annual Max $1,000 $1,000 $1,500 $2,000 $1,000 $1,000

Individual Deductible $50 $50 $50 $50 $50 $50

Waiting Period No wait 12 month No wait No wait No wait No wait

Payment Basis 85% UCR 85% UCR 85% UCR 85% UCR 85% UCR 85% UCR

Ortho Child-only No ortho No ortho No ortho No ortho Child-only

Lifetime Ortho Max $1,000 N/A N/A N/A N/A $1,000

Minimum Group Size 10 2 2 2 2 10

UnitedHealthcare PPOContributory Voluntary

P0042 P3418 P3315 P3341 P3352 P3358

Percentage Payable100/80/50 in80/60/50 out

100/80/50 in80/50/50 out

100/80/50 in80/60/50 out

100/80/50 in80/60/50 out

100/90/60 in100/80/50 out

100/90/60 in100/80/50 out

Endo/Pero/Oral Covered in basic Covered in basic Covered in major Covered in major Covered in major Covered in major

Annual Max $1,500 $1,000 $1,000 $1,500 $1,000 $1,000

Individual Deductible $50 $50 $50 $50 $50 $50

Waiting Period 12 month No wait 12 month 12 month 12 month No wait

Payment Basis 85% UCR 85% UCR 85% UCR 85% UCR 85% UCR 85% UCR

Ortho No ortho Child-only Child-only No ortho No ortho No ortho

Lifetime Ortho Max N/A $1,000 $1,000 N/A N/A N/A

Minimum Group Size 2 10 10 2 2 2

Additional dental plans available. Please contact your sales representative.UnitedHealthcare Dental® coverage provided by or through UnitedHealthcare Insurance Company, located in Hartford, Connecticut, or its affiliates. Administrative services provided byDental Benefit Providers, Inc., Dental Benefit Administrative Services (CA only), United HealthCare Services, Inc. or their affiliates.

41

42

1 Sample designs are not available in all states due to statutory limitations.2 The listed network percentages represent the portion of UnitedHealthcare Specialty Benefits’ maximum allowable charges (MAC) for which the plan will be responsible. Network providers

agree to accept the MAC as payment if in full and also agree to file claims for the member. A member will be responsible for full payment if services are obtained from a non-network provider.

3 Minimum of 10 enrolled to offer orthodontic coverage.UnitedHealthcare dental coverage provided by or through UnitedHealthcare Insurance Company, located in Hartford, Connecticut, or its affiliates. Administrative services provided by Dental Benefit Providers, Inc., Dental Benefit Administrative Services (CA only), United HealthCare Services, Inc. or their affiliates.

UnitedHealthcare dental INOStandard Plan Options1

PIN522 PIN572 PIN582

Class I Services

Exams 100% 100% 100%

All X-rays 50% 100% 100%

Cleanings 100% 100% 100%

Sealants 100% 100% 100%

Palliative Treatment 100% 100% 100%

Class II Services

Basic Restorative 50% 80% 80%

Simple Extractions 50% 80% 80%

Space Maintainers 100% 100% 100%

Repairs of Crowns, Inlays, Onlays, Bridges & Dentures 50% 50% 50%

Nonsurgical Periodontics 50% 50% 50%

Surgical Periodontics 50% 50% 50%

Complex Oral Surgery 50% 50% 50%

General Anesthesia 50% 80% 80%

Class III Services

Inlays, Onlays, Crowns 50% 50% 50%

Prosthetics 50% 50% 50%

Endodontics 50% 50% 50%

Orthodontics for dependent children to age 193

Diagnostic, Retention, Active Treatment N/A $1,500 Adult/Child N/A

Program Maximums and Deductibles

Annual Maximum Options (per person) $1,500 $3,500 $3,500

Annual Program Deductible Options $50/$150 $25/$75 $25/$75

Dental Indemnity

43

Dental Direct Compensation

Abbreviated sample Direct Compensation fee scheduleADA Description Copayments

Avalon 200

Trinity 300

Carmel 600

Bodega 500

Regency 700

Napa 800

Imperial 1000

Minimum # of enrollees

2 2 10 10 50 100 200

Diagnostic

D0120 Oral examination $0 $0 $0 $0 $0 $0 $0

D0210 X-ray, complete with bitewings $0 $0 $0 $0 $0 $0 $0

D0274 X-ray, bitewings, 4 films $0 $0 $0 $0 $0 $0 $0

D0330 X-ray, panoramic film $0 $0 $0 $0 $0 $0 $0

Preventive

D1110 Cleaning, adult $0 $0 $0 $0 $0 $0 $0

D1120 Cleaning, child $0 $0 $0 $0 $0 $0 $0

D1201 Topical fluoride with cleaning, child $0 $0 $0 $0 $0 $0 $0

D1351 Sealant, per tooth $15 $12 $8 $10 $0 $0 $0

Restorative

D2330 Resin composite, 1 surface, anterior $24 $0 $0 $6 $0 $0 $0

D2530 Inlay, metallic, 3 surfaces $275 $250 $90 $160 $156 $78 $0

D2740 Crown, porcelain/ceramic substrate (non-molar) $275 $250 $90 $160 $105 $66 $0

D2750 Crown, porcelain fused to metal (non-molar) $275 $250 $90 $160 $114 $73 $0

Endodontics

D3310 Root canal, anterior (without final restoration) $150 $170 $50 $70 $74 $0 $0

D3320 Root canal, bicuspid (without final restoration) $190 $220 $75 $120 $89 $0 $0

D3330 Root canal, molar (without final restoration) $275 $350 $100 $170 $110 $60 $0

Periodontics

D4341 Scaling and root planing, 4 or more teeth per quad $70 $65 $40 $50 $28 $0 $0

D4342 Scaling and root planing, 1 to 3 teeth, per quad $42 $40 $24 $30 $22 $0 $0

Prosthodontics

D5110 Complete denture, upper $350 $325 $190 $240 $153 $93 $0

D5211 Partial denture with resin base, upper $320 $300 $165 $220 $146 $63 $0

D5213 Partial denture with metal frame & resin base, upper $385 $355 $200 $265 $153 $80 $0

Oral Surgery

D7111 Extraction Coronal Remnants - Prim Tooth $9 $7 $3 $5 $0 $0 $0

Orthodontics

D8999 Startup $350 $350 $350 $350 $350 $350 $350

D8090 24-month program - Both upper and lower arch $2,250 $2,250 $2,250 $2,250 $2,250 $2,250 $2,250

Direct Compensation is a unique product offering from UnitedHealthcare. The plans have no waiting periods, no deductibles or annual maximum and no claims forms. Copayments are fixed for each covered procedure, all very similar to traditional DHMOs. The difference is that Direct Compensation is a non-capitated product, or, a performance-based compensation model that creates greater access and timely service for members.

Members must choose a primary dentist from a large, stable network of providers. Coverage for emergency and out-of-area services is included. Primary dentists are responsible for specialty referrals should a member seek care from a specialty dentist.

Orthodontic services can be made available on all plans.

Limitations and additional fees for material upgrade may apply. For ortho, additional fees may apply for retainer and final records.Benefits for the UnitedHealthcare Dental® DHMO plans are provided by or through Dental Benefit Providers of California, Inc. (CA).UnitedHealthcare dental coverage provided by or through UnitedHealthcare Insurance Company, located in Hartford, Connecticut, or its affiliates. Administrative services provided by Dental Benefit Providers, Inc., Dental Benefit Administrative Services (CA only), United HealthCare Services, Inc. or their affiliates.

44

UnitedHealthcare vision plans

Contributory Plan 1

(Voluntary Plan 5)

Contributory Plan 2

(Voluntary Plan 6)

Contributory Plan 3

(Voluntary Plan 7)

Contributory Plan 4

(Voluntary Plan 8)

Network/Non-Network Network/Non-Network Network/Non-Network Network/Non-Network

Exam/Lens/Frame Frequency 12/12/12 12/12/12 12/12/24 12/12/24

Exam Allowance 100%/$40 100%/$40 100%/$40 100%/$40

Frame Allowance $130/$45

Lens Allowance

Single Vision 100%/$40 100%/$40 100%/$40 100%/$40

Bifocal 100%/$60 100%/$60 100%/$60 100%/$60

Trifocal 100%/$80 100%/$80 100%/$80 100%/$80

Lenticular 100%/$80 100%/$80 100%/$80 100%/$80

Contact Lens Allowance

Elective 100%/$105 100%/$105 100%/$105 100%/$105

Medically Necessary 100%/$210 100%/$210 100%/$210 100%/$210

Copayment

Material $10 $25 $10 $25

Exam $10 $10 $10 $10

This is a sample of the plans available. Please contact your UnitedHealthcare representative for complete plan details.

• Backed by UnitedHealthcare, with a rapidly growing presence in California.

• Highly competitive benefits, with material allowances for frames and lenses.

• Plans available to groups of two eligible/enrolled members.• All plans available as Voluntary and as Contributory.

• Over 33,000 providers nationwide, including private practices.

• Serves over 29,000 clients and administers vision benefits to more than 19.2 million members nationwide.

Stand-Alone Vision Plans

UnitedHealthcare vision offers a generous frame allowance that covers in full, after applicable copayment, many of the most popular frames on the market today. For any materials costs above the plan allowance, an additional discount would apply. Additional frame allowances are available based on plan design and group size. If a member chooses a non-network provider, they will be reimbursed up to $45 for frames.• Eyeglass lenses include standard scratch-resistant

coating at no extra charge

• Discounts on mail-order contacts, via convenient online shopping or toll-free calls

• Access to discounted laser vision correction procedures• Reduced out-of-pocket expenses for non-covered options• 20 percent discount on additional materials at

participating providers• 30 percent discount on frame overage at participating

providers

Vision Plans With Value

UnitedHealthcare vision coverage provided by or through UnitedHealthcare Insurance Company, located in Hartford, Connecticut, or its affiliates. Administrative services provided by Spectera, Inc., United HealthCare Services, Inc. or their affiliates.

Vision

45

Underwriting Guidelines

1. Eligible Businesses – businesses must meet the following to be considered:

• An employer/employee relationship must be present.

• All employees, excluding owners and officers, should be covered for workers’ compensation.

• The business must be financially sound. • Eligible Businesses for California Key

Accounts – businesses must have at least 100 full-time active employees working 30 hours per week.

2. High Risk Industries • Membership Organizations (including

business associations, political organizations, religious organizations, member organizations not elsewhere classified (NEC), professional organizations, and civic organizations)

• Professional Employer Organizations (must be referred to Small Business)

• Help supply services (including employee leasing service, fashion show model supply service, labor pools, manpower pools, modeling service, office help supply service, temporary help service, and usher service). A wage and tax report may be required for verification to provide a proposal.

3. Employer Contributions – The employer should contribute a minimum of 50 percent of the employee-only premium.

4. Renewal Participation • UnitedHealthcare sole carrier – At least 75

percent of all eligible employees must enroll in the employer-sponsored UnitedHealthcare plan. Those employees who are waiving due to other group coverage being in force will not be counted toward this requirement (i.e., spousal coverage). UnitedHealthcare will not accept less than 50 percent of all benefit-eligible employees (including those waiving for spousal coverage) enrolling in an employer-sponsored plan.

• UnitedHealthcare alongside a staff model HMO or other carrier(s) – At least 75 percent of all eligible employees must enroll in an employer-sponsored plan. Those employees who are waiving due to other group coverage being in force will not be counted toward this requirement (i.e., spousal coverage). UnitedHealthcare will not accept less than 50 percent of all employees

(including those waiving for spousal coverage) enrolled with UnitedHealthcare.

• It is recommended that new business meet the same participation guidelines.

5. Effective Date of Coverage – All new group enrollment paperwork must be submitted to us by the effective date of coverage to be considered for that date. Employer groups submitting their paperwork after that date will be considered for the next effective month.

Required information to quote a case1. Company Information • Name • Address • Industry • SIC2. Census Information by Employee That Includes: • Age/DOB • Dependent Status/# Dependents • Male/Female • Enrollment by Product (including other

carriers which will be offered alongside UnitedHealthcare)

• ZIP Codes of Employees • Waivers • COBRAs3. Employer Contribution4. Risk Questionnaire/Specific Claim Information • Any known medical conditions5. Carrier History • Carrier history for last five years including

reason for leaving each carrier6. Number of Years in Business7. Waiting Period8. Current/In-force Rates & Benefits9. Renewal Rates10. Requested Commission11. Broker of Record: Yes or No 12. Twenty-four months of detailed medical and

prescription claims experience broken out for each plan/product to be replaced

13. List of large claims (claims exceeding $25,000); large claims data must match the claims experience period

General Guidelines Overview — California Key Accounts

46

Notes

47

Notes

48

Health plan coverage provided by or through UnitedHealthcare Insurance Company and UnitedHealthCare of California. Administrative services provided by United Healthcare Services, Inc., OptumRx or OptumHealth Care Solutions, Inc. Behavioral health products are provided by U.S. Behavioral Health Plan, California (USBHPC) or United Behavioral Health (UBH).

HRA and HSA: The UnitedHealthcare plan with Health Reimbursement Account (HRA) combines the flexibility of a medical benefit plan with an employer-funded reimbursement account. The UnitedHealthcare plan with Health Savings Account (HSA) is a high deductible health plan (HDHP) that is designed to comply with IRS requirements so eligible enrollees may open a Health Savings Account (HSA) with a bank of their choice or through Optum Bank, Member FDIC. The HSA refers only and specifically to the Health Savings Account that is provided in conjunction with a particular bank, such as Optum Bank, and not to the associated HDHP.

The Care24® Program integrates elements of traditional employee assistance and work-life programs with health information lines for a comprehensive set of resources. It is not a substitute for a doctor’s or professional’s care. Due to the potential for a conflict of interest, legal consultation will not be provided on issues that may involve legal action against UnitedHealthcare or its affiliates, or any entity through which the caller is receiving these services directly or indirectly (e.g., employer or health plan). This program and its components may not be available in all states or for all group sizes and are subject to change. Coverage exclusions and limitations may apply.

NurseLineSM is for informational purposes only. Nurses cannot diagnose problems or recommend specific treatment and are not a substitute for your doctor’s care. NurseLine services are not an insurance program and may be discontinued at any time.

United Behavioral Health: Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates.

UnitedHealth Wellness® is a collection of programs and services offered to UnitedHealthcare enrollees to help them stay healthy. It is not intended to be medical advice or a substitute for your doctor’s care. It is not an insurance product but is offered to existing enrollees of certain products underwritten or provided by UnitedHealthcare Insurance Company or its affiliates to encourage their participation in wellness programs. Health care professional availability for certain services may be dependent on licensure, scope of practice restrictions or other requirements in the state. Some UnitedHealth Wellness programs and services may not be available in all states or for all group sizes. Components subject to change.

The 24-Hour Health Information Program is provided by PacifiCare Health Plan Administrators, Inc. The 24-Hour Health Information Program’s intent is to provide general information regarding common health questions or conditions. If you have a specific question relating to a condition or medical course of treatment for yourself or others, please consult your physician. If you believe you need emergency services, call 911, or its local equivalent, or go to the nearest medical facility for treatment.

Online Health and Wellness: Your personal information will be used only by UnitedHealthcare and its wellness program affiliates to provide individualized health information to you to improve your health practices. The Health Assessment is protected by one of the most advanced technologies for Internet information processing and complies with the federal and state security and privacy statutes mandated by HIPAA legislation. Participation in the Health Assessment is strictly confidential. Any health information collected as part of the assessment will be kept confidential in accordance with the Notice of Privacy Practices; information will be used only for health and wellness recommendations, or for payments, treatment, or health care operations; and will be shared with your health plan, but not with your employer.

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

Health Assessment: Participation in the Health Assessment is strictly voluntary. Any health information collected as part of the assessment will be kept confidential in accordance with the Notice of Privacy Practices; be used only for health and wellness recommendations or for payment, treatment or health care operations; and be shared with your health plan, but not with your employer.

Disease Management: Disease Management programs and services may vary on a location-by-location basis and are subject to change with written notice. UnitedHealthcare does not guarantee availability of programs in all service areas and provider participation may vary. Certain items may be excluded from coverage and other requirements or restrictions may apply. If you select a new provider or are assigned to a provider who does not participate in the Disease Management program, your participation in the program will be terminated. Self-Funded or Self-Insured Plans (ASO) covered persons may have an additional premium cost. Please check with your employer.

Source4Women: Source4Women content and materials are for information purposes only, are not intended to be used for diagnosing problems and/or recommending treatment options, and are not a substitute for your doctor’s care. Lists of potential treatment options and/or symptoms may not be all inclusive.

Health discount program (formerly UnitedHealth Alliessm): Disclosure: The UnitedHealth Allies health discount program is administered by HealthAllies®, Inc., a discount medical plan organization located at 505 N. Brand Blvd., Suite 850, Glendale, CA, 91203, 1-800-860-8773. The health discount program is NOT insurance. The health discount program provides discounts for certain health products and services. The health discount program does not make payments directly to the providers of health products and services. The program member is obligated to pay for all health products and services but will receive a discount from those providers who have contracted with the discount plan organization. The health discount program is offered to existing members of certain products underwritten or provided by UnitedHealthcare Insurance Company or its affiliates to provide specific discounts and to encourage participation in wellness programs. Health care professional availability for certain services may be dependent on licensure, scope of practice restrictions or other requirements in the state. UnitedHealthcare does not endorse or guarantee health products/services available through the discount program. This program may not be available in all states or for all groups. Components subject to change.

This Product Catalog is intended only to highlight your benefits and should not be relied upon to fully determine your coverage. If this Product Catalog conflicts in any way with the plan documents, i.e., the Combined Evidence of Coverage and Disclosure Form (EOC/DF) or Certificate of Coverage (COC) including the Schedule of Benefits and any amendment(s), the plan document shall prevail. Your plan document provides the terms and conditions of your coverage with UnitedHealthcare of California and UnitedHealthcare and all applicants have a right to review this document prior to enrollment. Upon request, a copy of the plan document will be provided to all potential enrollees prior to enrollment.

Components subject to change.

These programs provide information and support as part of your health plan. It is not a substitute for a doctor’s or professional’s care. Please discuss with your doctor how the information provided by these programs is right for you.

Sales Support

©2013 United HealthCare Services, Inc.400-3967 BRK/EMP 12/13 UHCCA472863-009

Concord

2300 Clayton Rd, Suite 1000 Concord, CA 94520925-246-1300

Fresno

7067 N. Mariposa AvenueFresno, CA 93720925-246-1300

Glendale

505 N. Brand Blvd., Suite 1200Glendale, CA 91203866-663-9226

Inland Empire

3400 Central Avenue, Suite 225 Riverside, CA 92506951-274-3045

Orange County

5701 Katella Avenue, CA120-0517Cypress, CA 90630 877-511-3039

Sacramento

8880 Cal Center Drive, Suite 300Sacramento, CA 95826925-246-1300

San Diego

4365 Executive Drive, Suite 500 San Diego, CA 92121 858-658-8900

San Francisco

425 Market Street, 13th Floor San Francisco, CA 94105 925-246-1300

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