Not for Consumer Use
Agenda
1. 2015 Overview – Affordable Care Act (ACA)
2. 2015 ACA Plans
3. Additional Provisions
4. UnitedHealthcare Resources
2015 ACA Overview
3
OH Individual ACA Health Plans 2015
Overview
License:
UnitedHealthcare of Ohio, Inc.
Exchange Model: The healthcare marketplace is approved,
regulated and managed by the Federal Government.
4
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Networks
UnitedHealthcare Compass®
 Customers must choose a primary care
physician
 A referral is required to see a specialist
 In-network coverage only except for
emergency care
5
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Not for Consumer Use
Sample ID Card
6
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Not for Consumer Use
2015 UnitedHealthcare Individual
Exchange Health Plans
7
Ohio
Top Counties
1.
2.
3.
4.
5.
Hamilton
Mahoning
Trumbull
Stark
Butler
On Exchange
plan availability
8
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Not for Consumer Use
Product Grid
9
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Not for Consumer Use
Product Grid
10
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Not for Consumer Use
Silver Level Cost-Sharing
Reduction Plans (CSR)
● For individuals and families whose income does not exceed 250% of the
Federal Poverty Limit (FPL), there are special “cost-sharing reduction”
versions of plans. These cost-sharing reduction (CSR) health insurance plans
reduce the out-of-pocket expenses enrollees pay toward deductibles,
copayments, and coinsurance.
● There are three different levels of Silver-CSR Plans. All depend on income
eligibility. As the table below demonstrates, the lower the enrollee’s income,
the higher the cost-sharing reductions the enrollee will receive.
CSR Silver Plan for
Enrollees with
Incomes up to 150%
FPL
CSR Silver Plan for
CSR Silver Plan for
Enrollees with
Enrollees with
Standard Silver
Incomes up from
Incomes from 151%
Plan
201% FPL to 250%
FPL to 200% FPL
FPL
Portion of medical
expenses typically paid by
the health plan (i.e.
actuarial value)
94%
87%
73%
70%
Portion of medical
expenses paid for by
typical enrollee
6%
13%
27%
30%
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Not for Consumer Use
Pricing Competitiveness Summary
Ohio Market
Individual Business Estimated 1/1/2015 On Exchange Lowest Silver Plan Premium* by Rating Area - Ohio, Single Age 40 As of 10/23/2014.
Lowest vs
Rating Area
UHC - On
(01) Toledo
-32%
1
359
2
Buckeye Community
Health Plan
236
Buckeye Community
Health Plan
269
UHC - On
CareSource
326
UHC - On
346
(02) Lima /
Northwest
-25%
(04) Cincinnati
-29%
(05) Southwest
(09) Columbus
-22%
-33%
(11) ClevelandLorain-Elyria
-25%
(12) Akron
-34%
(13) YoungstownWarren
-12%
(15) CantonMassillon
-26%
UHC - On
3
4
CareSource
HealthSpan, Inc
244
248
Paramount Insurance
Company
285
HealthSpan, Inc
5
Paramount Insurance
Company
278
Aetna
InHealth
Medical Mutual
326
357
Premier Health Plan,
Inc
276
Humana Health Plan of Ohio
HealthSpan, Inc
232
270
Buckeye Community
Health Plan
236
253
UHC - On
HealthSpan, Inc
CareSource
Aetna
342
268
UHC - On
CareSource
366
298
Paramount Insurance
Company
282
CareSource
HealthSpan Integrated Care
322
244
Buckeye Community
Health Plan
242
279
Molina Healthcare of
Ohio
281
268
Molina Healthcare of
Ohio
299
UHC - On
CareSource
369
243
252
Buckeye Community
Health Plan
260
UHC - On
HealthSpan, Inc
327
287
Buckeye Community
Health Plan
258
UHC - On
UHC - On
350
6
296
InHealth
307
Aetna
InHealth
307
Aetna
268
304
Molina Healthcare of
Ohio
278
HealthSpan Integrated Care
Aetna
Summa
285
286
298
Aetna
CareSource
Anthem
Medical Mutual
293
294
309
CareSource
Aetna
261
265
306
AultCare Insurance
Company
267
283
Anthem
276
* Competitor rates reflect 2015 rate filing information (may not be approved/final rates) and are subject to change.
12
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Not for Consumer Use
Pricing Competitiveness Summary
Ohio Market
Individual Business Estimated 1/1/2015 On Exchange Lowest Silver Plan Premium* by Rating Area - Ohio, Single Age 40 As of 10/23/2014.
Lowest vs
Rating Area
UHC - On
(01) Toledo
-32%
(02) Lima /
Northwest
(04) Cincinnati
(05) Southwest
(09) Columbus
-25%
-29%
-22%
-33%
(11) ClevelandLorain-Elyria
-25%
(12) Akron
-34%
(13)
YoungstownWarren
-12%
(15) CantonMassillon
-26%
7
Molina Healthcare of
Ohio
306
AultCare Insurance
Company
365
8
9
10
InHealth
Medical Mutual
Anthem
323
329
338
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AultCare Insurance
Company
365
Anthem
Assurant
372
430
Molina Healthcare of
Ohio
Aetna
InHealth
Anthem
Medical Mutual
281
298
319
353
Anthem
Medical Mutual
322
360
Anthem
Medical Mutual
342
352
Paramount Insurance
Company
302
300
AultCare Insurance
Company
365
AultCare Insurance
Company
365
Medical Mutual
301
Paramount Insurance
Company
302
InHealth
316
Summa
298
12
13
Assurant
453
AultCare
Insurance
Company
365
Assurant
478
Assurant
437
Assurant
435
AultCare Insurance
Company
365
AultCare Insurance
Company
365
InHealth
Anthem
326
346
Medical Mutual
Anthem
InHealth
309
AultCare Insurance
Company
365
HealthSpan Integrated
Care
298
314
332
Summa
Assurant
375
398
Medical Mutual
InHealth
Assurant
301
332
380
Summa
Assurant
373
488
Assurant
483
* Competitor rates reflect 2015 rate filing information (may not be approved/final rates) and are subject to change.
13
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Not for Consumer Use
Provider Search
www.unitedhealthcareonline.com
www.uhc.com/xoh
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Not for Consumer Use
UnitedHealthcare Resources
15
myHealthcare Cost Estimator
• Helps members easily find personalized
information before seeing a doctor, helping
them to "take charge of their health care and
know more.“
• Estimates used are based on available fee
schedules or contracted rates (when fee
schedules/contracted rates are not available, estimates
are based on claims averages for the particular provider)
• Fully integrated with customer service and
clinical support
• Once members know the 4 Ps–Procedure,
Provider, Price and Place–there's no telling
how far they can go in improving their health
and increasing their savings.
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Health4Me App
• UnitedHealthcare Health4Me™ is
designed to make managing a
member’s health a lot simpler
• Members can easily
•
•
•
•
Share their ID card
Check H.S.A. account balance
Check claim status
Access my Healthcare Cost Estimator
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Smart Patient App
Members can use their mobile device to
get the most from their doctor visit
•
Track the five numbers that are keys to
good health
•
•
•
•
•
•
•
•
•
Blood pressure
Blood sugar
Body mass index (BMI)
Cholesterol
Waist circumference
Keep track of medical appointments
Checklists to use at doctor visit
Store text or voice notes
Video tips
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UHCtv
UHC TV is an online television network
that presents relevant, focused,
educational and entertaining video
programs about good health and living
well to help people get inspired to grow
healthy and live better. From expert advice
on healthy living to side-splitting comedy,
it's available online anytime.
19
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Collaterals to Educate and Inform Consumers and
Business Partners of UHC IHX Products and Services
Producer Guide
Tri-fold
Pocket Guide Enroll Now Flyer
Display
Consumer Guide
Navigator Guide
Live 11/15/2014
20
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Not for Consumer Use
Thank You
Open Enrollment:
November 15, 2014 February 15, 2015
Questions:
Navigator Hotline
1-866-698-1739
uhc.com/navigator
uhc.com/join
21
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