Health Care with a Difference
Oxford Open Enrollment for:
November 2010
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Contents
 What’s New for 2011
 Benefit Plan Options and Highlights
 Oxford Local and National Network Capabilities
 What you should consider before making a choice
 Wellness tools and resources
 Practical tools and resources
New UHC Dental Plan Overview
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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What’s New for 2011
• Effective 1/1/2011: UHC/Oxford Health Plans will
replace your current carrier for Medical Benefits
• Effective 1/1/2011: UnitedHealthcare will be your
carrier for Dental Benefits
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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Your 2011 benefit plans
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Medical Plan Options

Oxford Freedom Plan Access (Oxford Freedom Network)
 “Americana” Base Option A
 “Gateway” High Option B
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Highlights for Oxford Freedom Access Plans
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More affordable rates and plans to give greater flexibility when
it comes to choosing doctors and health care coverage
options.
 Non-referrals
 Split copayments
 In- and out-of-network access
 National network access
 Routine preventive care covered at 100%
 Reminders to keep up with preventive care
 GYM Reimbursement Program
 Healthy Bonus Program
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Medical benefits at a glance
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“Americana” Base Option A
Type of Coverage
Network Benefit
Non-Network Benefit
Physician’s Office Services
$10 Copayment
30% after deductible
Specialist Office Visit
$15 Copayment
30% after deductible
Referrals Required
No
No
Emergency Room Services
$25 Copayment (Waived if
Admitted)
$25 Copayment (Waived if
Admitted)
Inpatient Hospital Stay
100%
30% after deductible
Urgent Care Center Services
$15 Copayment
30% after deductible
Deductible
None
$1,000 Single
$3,000 Family
Maximum Out-of- Pocket
(Including Deductible)
Not Applicable
$8,500 Single
$25,500 Family
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Medical benefits at a glance
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“Gateway” High Option B
Type of Coverage
Network Benefit
Non-Network Benefit
Physician’s Office Services
$15 Copayment
20% after deductible
Specialist Office Visit
$30 Copayment
20% after deductible
Referrals Required
No
No
Emergency Room Services
$25 Copayment (Waived if
Admitted)
$25 Copayment (Waived if
Admitted)
Inpatient Hospital Stay
100%
20% after deductible
Urgent Care Center Services
$30 Copayment
20% after deductible
Deductible
None
$200 Single
$400 Family
Maximum Out-of- Pocket
(Including Deductible)
Not Applicable
$1,200 Single
$2,400 Family
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Pharmacy
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 24/7 information at www.oxfordhealth.com



Compare costs of medications
Locate pharmacy
Order and refill prescriptions
 More than 61,000 pharmacies nationwide
 Large selection of prescription drugs

Designed to help you save money
 Home delivery of prescriptions for
maintenance medications
$20.00
$80.00
$40.00
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Pharmacy
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Retail
Tier 1
Tier 2
Tier 3
Mail order
$ 5 Copay
$10 Copay
31-Day Supply
90-Day Supply
$15 Copay
$ 30 Copay
31-Day Supply
90-Day Supply
$ 25 Copay
$ 50 Copay
31-Day Supply
90-Day Supply
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Prescription Drug List
 What is the Oxford Prescription Drug List (PDL)?

Drugs on the list will be based on clinical, economic and
pharmacoeconomic evidence

Drugs are placed in tiers according to their total health care value
regardless of brand or generic status
 What is the purpose of the Oxford PDL?

Make prescriptions more affordable and accessible

Help you make informed decisions that will lower your out-of-pocket
costs
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Pharmacy payment process
2
1
Present
ID card to
pharmacy.
Pharmacy verifies
eligibility online with
the pharmacy vendor.
At the same time, the
pharmacy is notified
of any amount you
owe at the point of
sale.
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3
You pay
pharmacy any
co-pays or
amounts not
covered by
available
coinsurance
United Behavioral Health
Providing evidence-based behavioral health and wellness
programs that empower the people we serve to lead healthier
and more productive lives.
 Navigate life’s challenges with expert help
 Tap into confidential, specialized help when you need it for:




Anxiety
Stress
Depression
Coping with change
 Connect with licensed and certified professionals and treatment
facilities
 Get support and answers to questions you may have about
treatment
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Complementary & Alternative Medicine
Oxford members have access to our network of over 4,500
complementary and alternative medicine (CAM) providers in
Connecticut, New York and New Jersey, including:
 Acupuncturists
 Naturopaths (CT only)
 Nutritionists
 Yoga Instructors
 Chiropractors
Oxford has negotiated contracted rates with all of our network
CAM providers in Connecticut, New Jersey and New York. These
rates vary by specialty and region, and in most instances reflect a
discount from the provider's normal fee.
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Oxford Service Area
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Our local Oxford Freedom Network in Connecticut, Metro New York
and New Jersey has more than 83,000 physicians and other
healthcare professionals, who practice at more than 125,000 office
locations, and more than 220 hospitals.
Tri-State Service Area
State
Counties
Connecticut
Fairfield
Hartford
Litchfield
Middlesex
New Haven
New London
Tolland
Windham
New Jersey
Atlantic
Bergen
Burlington
Camden
Cape May
Cumberland
Essex
Gloucester
Hudson
Hunterdon
Mercer
Middlesex
Monmouth
Morris
Ocean
Passaic
Salem
Somerset
Sussex
Union
Warren
New York
Orange
Putnam
Queens
Richmond
Rockland
Suffolk
Sullivan
Ulster
Westchester
New York
Bronx
Dutchess
Kings
Nassau
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National Network Access
UnitedHealthcare’s Choice Plus National Network has you
covered.
 If you’re on vacation and you or your child needs a doctor, you may
visit one of over 626,000* physicians and health care professionals
nationwide, and your visit will be covered in-network.
 If your son or daughter attends an out-of-state college, our plans
provide him or her with seamless in-network care, just as if they were
home.
 If you need to visit a hospital outside of your service area, you have
access to 5,503* hospitals throughout the country.
* Data as of 3/2010
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What you should think about
 Review this simple, four-step checklist as you decide:
1
Find your doctor in our network
2
Understand your total cost of health care
3
Understand what each plan covers
4
Review and compare the “extras”
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Find your doctor – Step 1
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Visit www.oxfordhealth.com to find your doctor or facility
 Search by name, specialty, condition or procedure
Most likely,
your doctor is
in our network
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Find your doctor – Step 2
Select a doctor based on:
 Office hours
 Gender
 Education
 Address and driving directions
 Languages spoken
 Specialty
 Condition or Procedure
 Premium designation
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UnitedHealth Premium® Designation Program
Making information transparent to give you more control
over your health care decisions.
 Identifies doctors in 22 specialties and cardiac facilities that follow
nationally recognized medical guidelines
 Compare quality and cost of health care facilities in treating specific
conditions
 Look for the
when you search for a physician
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Online Benefits
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
www.oxfordhealth.com
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Helpful, personal, powerful:
Comprehensive online resource for members
•Check benefits
•Find doctors and
hospitals
•Look up claims
•Estimate costs
ahead of time
•Learn about how
to stay healthy
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Wellness tools and resources
 Personal health assessment
 Health improvement programs
 Personal health record
 Discounts on health and wellness products
 Health information libraries
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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Personal Health Assessment
Take your first step towards a healthier life by taking a
free, personalized health assessment.
 Online health questionnaire
 Receive immediate feedback on the current state of your health
 Get personalized recommendations for free online services
tailored to your health goals
 Get feedback on your progress toward living a healthier life
 Receive information to support a more detailed conversation with
your doctor
Log on to www.oxfordhealth.com
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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Online Health Coaching
 Enroll in one of seven six-week Online Health Coaching Programs:







Fitness
Weight Loss
Nutrition
Stress
Smoking Cessation
Diabetes Lifestyle
Heart Health
 Program participation is recommended based on Health
Assessment and Personal Health Record data.
 Log on to www.oxfordhealth.com
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Personal health record
 Find all of your health
information in one place:
 Conditions
 Medications
 Treatments and procedures
 Lab results
 Log on to
www.oxfordhealth.com for
more information
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Health Education
Information on a wide range of health and wellness topics is
available at www.oxfordhealth.com
 Diseases and Conditions: Access evidence-based standards for diagnosis
and management of common conditions.
 Lifestyle Centers: Motivate consumers with content for physical activity,
nutrition, mental heath, etc.
 Tests and Procedures: Help consumers get prepared and educated.
 Health Encyclopedia: Review clinical information on conditions, treatments
and health facts.
 Exclusive articles: Read about the latest health news and trends (2x a week).
 Drug Guide: Raise awareness about drug interactions.
 Tools: Access Symptom Checker, walking trackers, BMI calculator, food
pyramids.
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Managing Disease
Oxford has designed these programs to educate
members and help them manage chronic conditions.
•
•
•
•
•
•
•
•
Better Breathing® - Asthma Management
Living with DiabetesSM
Depression Program
Heart SmartSM
Rare Chronic Care
Cancer Support Program
Osteoporosis Program
Chronic Obstructive Pulmonary Disease (CODP)
Program
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Oxford On-Call®
Puts you in touch with an informed registered nurse any
time of day or night. Use Oxford On-Call to:
 Better manage an illness or injury
 Recognize urgent and emergency symptoms
 Locate doctors and hospitals in your area that meet criteria for
quality and efficiency
 Understand medication interactions and how to reduce your
prescription costs
 Gain access to general health information and a health
information library
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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Healthy Bonus®
 The Healthy Bonus program offers access to discounts and special
offers on products and services to help you achieve fitness, weight,
and stress management goals.
 Discounts for 2009 include:
 Brookstone
 Weight Watchers®
 GVS General Vision Services
 SpaFinder
 Runningshoes.com
 And MANY more
4Healthy
Bonus offers are not insured benefits and are in addition to, and separate from, your benefit Oxford coverage. These arrangements have been made for the
benefit of members, and do not represent an endorsement or guarantee on our part. Offers may change from time to time and without notice and are applicable to the
items referenced only. Offers are subject to the terms and conditions imposed by the vendor. We cannot assume any responsibility for the products or services provided
by vendors or the failure of vendors referenced to make available discounts negotiated with us; however, any failure to receive offers should be reported to Oxford
Customer Service by calling the number on your Member ID card.
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Questions?
 Prospective members:
 1-800-760-4566
 HR department
 Current members:
 www.oxfordhealth.com
 Member Services telephone number on your member ID
cards
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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United Healthcare Dental
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
Dental
Effective 1/1/2011 UnitedHealthcare will be
your carrier for Dental Benefits
Confidential property of UnitedHealth Group. Do not distribute or reproduce without the express permission of UnitedHealth Group.
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UnitedHealthcare Dental®
Large national preferred provider organization (PPO) network
of over 144,000 dentists and specialists including over 10,000
dentists in New York.
 Visit any of the dentists in our national network
 See any specialist you want, without a referral
 Preventive care, including exams and cleanings, at little or no out-of-pocket
cost
 You don’t have to submit a claim form when you visit a network dentist
 Access Customer Care toll-free, day or night
 Easy access to benefit information at www.myuhcdental.com
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Dental
Two Dental Options to Choose From
 Option 1 – PPO Plan
 Option 2 – Base In Network Only (INO) Plan
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Dental Options
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INO
PPO
In
Network
Out of
Network
In
Network
Out of
Network
Periodic Oral Evaluation
100%
100%
100%
0%
Radiographs
100%
100%
100%
0%
Lab and Other Diagnostic Tests
100%
100%
100%
0%
Dental Prophylaxis (Cleaning)
100%
100%
100%
0%
Fluoride Treatment
100%
100%
100%
0%
Sealants
100%
100%
100%
0%
Space Maintainers
100%
100%
100%
0%
Restorations (Amalgams or Composite)
90%
80%
80%
0%
Emergency Treatment/General Services
90%
80%
80%/80%
80%/0%
Simple Extractions
90%
80%
80%
0%
Oral Surgery (incl. surgical extractions)
90%
80%
80%
0%
Periodontics
90%
80%
80%
0%
Endodontics
90%
80%
80%
0%
Inlays/Onlays/Crowns
60%
50%
50%
0%
Dentures and Removable Prosthetics
60%
50%
50%
0%
Fixed Partial Dentures (Bridges)
60%
50%
50%
0%
Orthodontia
50%
50%
50%
50%
Orthodontia Eligibility
Child (up to age 19)
Diagnostic Service
Preventive Services
Basic Services
Major Services
Orthodontic Services
Child (up to age 19)
$50/$150
$50/$150
$0/$0
No
No
No
No
Annual Max
$1,000
$1,000
$2,000
$2,000
Lifetime Ortho Max
$1,000
$1,000
$2,000
Deductible
Deductible applies to Prev. & Diag.
Waiting Period applies
Out of Network Basis
$0/$0
$2,000
No
No
UCR 90th
MAC
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Plan 1 – PPO
PPO Benefit
 Incentive PPO Plan where In Network Benefits
are slightly richer at In Network Providers
• In Network: 100% - Preventive Service, 90% - Basic Services, 60%
for Major Services, $1000 Annual Max; 50% for Ortho, $1000 Max
• Out of Network: 100% - Preventive Service, 80% - Basic Services,
50% for Major Services, $1000 Annual Max; 50% for Ortho, $1000 Max
 Best Option If You Plan on Using Dentists In and
Out of Network
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Plan 2 – In Network Only
In Network Only (INO) Benefit
 This plan provides services at In Network
Providers Only
 Utilizes our National PPO Network
 Benefits not as Rich as in PPO Plan
• In Network: 100% - Preventive Service, 80% - Basic Services, 50% for
Major Services, $2000 Annual Max; Ortho – 50%, $2,000 Max
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New Feature
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Max Rollover Benefit
 Allows you to rollover a portion of your unused annual
max from one year to another
 Examples:
• In PPO Plan with Max of $1,000 – you can rollover up to $350 to the
following year
• In the INO plan with a Max of $2,000 – you can roll over up to $600
each year
Original
Annual
Maximum
Annual
Claim
Threshold
Annual
Account
Award
Annual
Network
Bonus
Annual
Award+
Bonus
MaxMultiplier
Account
Limit
$1,000
$500
$250
$100
$350
$1,000
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New Feature
Prenatal Dental Care Benefit
 A link between Periodontal Disease and
Premature Birth has been established
 All fees and expenses for cleanings, deep scaling
and periodontal maintenance will be waived for
women in 2nd or 3rd trimester
 Deductibles are waived and services do not count
towards annual max
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Online Access
Website: www.myuhcdental.com
 Look up In-Network Dental Providers
 Answers to Frequently Asked Dental
Questions
 Check Dental Claims
 Compare Costs with Treatment Calculator
 Customer Service
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Enrollment Form
• To Enroll in Dental, Must Fill Out Enrollment
Form
• On the Enrollment Form Be Sure to Indicate
Which Dental Plan you are Selecting
 Option 1 – PPO
 Option 2 – Base INO
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Questions??
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