Your Health Care Counts
Our Health Plan: What Do You Need to Know?
Employee Benefits Orientation - 2014
Coverage effective dates: July 1, 2014 - June 30, 2015
You probably have a lot of questions
Is my doctor in
the network?
What is my
total cost of
health care
including
premiums?
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What health care
coverage best fits
my needs?
What extras do I get
with my health plan?
Eligibility and Family Status Changes
Active full-time or part time
employees (scheduled to work at
least 17.5 hours per week in a 35
hour work week or at least 20
hours per week in a 40 hour work
week) and their eligible dependents.
Benefits are effective after 30 days
of continuous employment, assuming
all applicable actions and documentation
have been received in good order.
Residents – No waiting period for
Medical coverage (only) and is effective on
first date of employment.
Temporary Employees
for benefits
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are not eligible
Eligible Dependents – include
spouse, domestic partner (with signed
affidavit), dependent child(ren) up to
age 26.
Legal documentation is required to
enroll your eligible
dependents(marriage license, birth
certificate, court order, etc.)
Making changes to your benefits –
if you experience a family status event
such as - marriage, divorce, birth, death,
loss of dependent status, etc., you
have 30 days from the date of the
event to make applicable changes to
your benefits.
All employee benefits terminate on your last
date of employment
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
What health care
coverage best fits my
needs?
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UnitedHealthcare Choice Plus Plan
• Freedom to choose any network doctor, including
specialists, without referrals
• Coverage for non-network care
• No need to choose a primary care physician
• 100% preventive care coverage in our network
• Care management if you require hospital stay or surgery
• Copayments, coinsurance and/or deductible
You have
coverage if
you receive
care
outside our
network.
Definitions
Copayment - is a fixed amount you pay when you receive the service. The amount can vary by
the type of service. You may also have a copay when you get a prescription filled.
Coinsurance - is your share of the costs of a health care service (ie: hospitalization, outpatient
procedures) and usually figured as a percentage of the total charge for the service.
Deductible - is the amount you pay for health care services before your health insurance begins
to pay.
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Choice Plus Basic Option
Type of Coverage
In Network
Out of Network
Deductible
Individual / Family
$500 / $1,500
$1,000 / $3,000
Out-of-pocket Maximum
Individual / Family
$2,500 / $7,500
$7,500 / $22,500
Lifetime Plan Maximum
Organ Transplant
Unlimited
Plan Maximum
Unlimited
$30,000 maximum
Primary Care Physician
Office Visit
$30 copayment
50% after deductible
Specialist Office Visit
$50 copayment
*Use of MSM physician - $10
*Use of MSM physician - $10
reduction in co-pay.
50% after deductible
reduction in co-pay.
Emergency Room Visit
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$100 copayment
$100 copayment
waived if admitted
waived if admitted
Urgent Care Center Visit
$30 copayment
50% after deductible
Inpatient Hospital Stay
90% after deductible
50% after deductible
Choice Plus High Option
Type of Coverage
In Network
Out of Network
$0 / $0
$300 / $ 900
Out-Of-Pocket Maximum
Individual / Family
$2,000 / $6,000
$1,500 / $4,500
Lifetime Plan Maximum
Organ Transplant
Unlimited
Plan Maximum
Unlimited
$30,000 maximum
Primary Care Physician
Office Visit
$25 copayment
50% after deductible
Deductible
Individual / Family
Specialist Office Visit
*Use of MSM physician - $10 reduction in co-pay.
$50 copayment
50% after deductible
*Use of MSM physician - $10 reduction in co-pay.
Emergency Room Visit
Urgent Care Center Visit
Inpatient Hospital Stay
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$100 copayment
$100 copayment
waived if admitted
waived if admitted
$25 copayment
50% after deductible
90% after deductible
50% after deductible
Visit and register at : www.myuhc.com
What’s available:
• Print/request
membership cards
• Search for a
doctor/hospital or
urgent care center
• Track claim status
• Claim forms
• Estimate medical
cost
• Receive health
product discounts
• Keep personal
health records
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Preventive Health Care Coverage
• Preventive care is covered at 100%
for in-network services only.
Out-of-network services subject to
deductible and coinsurance.
• Regular preventive care helps
• Reduce risk of disease
• Detect health problems early
• Protect you from higher costs down
the road
• May save your life
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In-Network
Services
No deductible.
No copayment.
No coinsurance.
100% coverage.
UnitedHealthcare Pharmacy
Retail
Tier 1
Tier 2
Tier 3
Mail Order *
$10 Copay
$20 Copay
31-Day Supply
90-day supply
$30 Copay
$60 Copay
31-Day Supply
90-day supply
$50 Copay
$100 Copay
31-Day Supply
90-day supply
Important: Tier 1 FDA approved contraceptives are covered at 100%, in accordance with Health Care
Reform.
*Ordering your prescriptions via mail service is fast and convenient. If you are managing long-term or chronic
conditions, using our mail service pharmacy makes sense - you can purchase up to a three-month supply of
most prescription medications. Learn more about using the OptumRx Mail Service Pharmacy.
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Specialty Pharmacy
Specialty medication is a high-cost, injectable, oral, infused, or inhaled medication if it
has one or more of the following attributes:
 self-administered or administered by a health care provider and used or obtained in either an
outpatient or home setting.
 special storage or handling requirements such as needing to be refrigerated.
 may need close monitoring, on-going clinical management, and complete patient education and
engagement.
 may not be available at retail pharmacies.
Conditions Include:
Anemia, Cancer, Hemophilia, Hepatitis B and C, HIV/AIDS, Infertility, Multiple
Sclerosis , Rheumatoid Arthritis, and more
Services
• 24/7 access to pharmacists, providing support focused on you
• Adherence and clinical programs to help you better manage your
condition
We focus on you
• Proactive reminders and timely delivery
and the total
• Online support and medication information for you
condition, not just
drug utilization.
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Medical Plan Rates – Effective July 1, 2014
Basic Option
Total Monthly
Rates**
Employee
Bi-weekly Rates
Total Monthly
Rates**
Employee
Bi-weekly Rates
$ 500.84
$ 26.83
$
533.16
$ 46.68
Employee + Child(ren) $ 976.58
$ 80.50
$ 1,078.62
$ 135.13
Employee + Spouse
$ 1,047.75
$ 104.90
$ 1,157.24
$ 167.07
Family
$ 1,529.32
$ 168.33
$ 1,689.12
$ 243.24
Employee
** Total monthly rates equal cost paid by MSM and employee
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High Option
Dental Plan Benefits
•
Over 165,000 service providers nationwide
•
Savings on Services from Network Dentists – you access
negotiated discounts, thereby maximizing your dental benefits
•
No claim forms for Network Services
•
Preventive Care, including Exams and Cleanings, at little or no
out-of-pocket cost
•
Freedom to Visit Out of Network Dentists – you will be
reimbursed only for up to reasonable & customary amount for
each service, and you could be responsible for excess charges.
•
Benefit Information at www.myuhcdental.com
Please refer to the Summary Plan Description, for full details.
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Dental Plan Benefits
Dental Services
In-Network
Out-of-Network
100%
100%
Minor Restorative
80%
80%
Single Extractions
80%
80%
Endodontics and Periodontics
80%
80%
Oral Surgery
80%
80%
Crowns/ Bridges
50%
50%
Dentures
50%
50%
Orthodontia
50%
50%
Annual Deductible
$ 50 / 150
$ 50 / 150
Annual Benefit Limit
$2,000
$2,000
Lifetime Ortho Maximum –
Adults and Children
$2,000
$2,000
Preventive and Diagnostic
Basic Services
Major Services
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Dental Plan Rates – Effective July 1, 2014
Coverage Level
Total
Monthly
Rates**
Employee
Bi-weekly
Rates
Employee
$ 36.30
$ 1.81
Employee + Child(ren)
$ 70.78
$ 5.42
Employee + Spouse
$ 75.94
$ 7.06
Family
$ 110.84
$ 11.34
** Total monthly rates equal cost paid by MSM and employee
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Unitedhealthcare Vision
…the difference is clear
•
Comprehensive eye exams
• Eyeglasses (lenses and frames)
• Contact lenses
• No ID Cards needed
• Basic plan information and provider directory at www.myuhcvision.com
• Discounted laser eye surgery
• Go out of the network with a scheduled reimbursement
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Vision Benefits at a Glance
Frequency
In-Network
Out –of- Network
Reimbursements
Comprehensive Eye Exam
Every 12 months
$10 copay
up to $40
A complete pair of eyeglass lenses or
covered-in-full contact lenses after
copay
Every 12 months
$10 copay
N/A
Every 24 months
$130 allowance
up to $45
Every 12 months
Covered in full
Single vision up to $40
Frame
Lens Options
• Single vision, lined bi-focal, lined
tri-focal or lined lenticular lenses
(Other lens options available at a
discounted rate)
• Standard scratch coating
Bifocals up to $60
Covered in full
Covered in full
Trifocal up to $80
Lenticular up to $80
Elective Contact Lenses
• Contact lenses that fall outside the
covered-in-full selection.
(Copay does not apply)
Additional Materials
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Every 12 months
20% off
$10 copay
up to $210
20% off
Vision Plan Rates – effective July 1, 2014
Coverage Level
Total
Monthly
Rates**
Employee
Bi-weekly
Rates
Employee
$ 4.55
$ 0.23
Employee + Child(ren)
$ 8.87
$ 0.68
Employee + Spouse
$ 9.52
$ 0.89
Family
$ 13.89
$ 1.42
** Total monthly rates equal cost paid by MSM and employee
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Flexible Spending Accounts (FSA)
Medical and Dependent Care
Flexible Spending Accounts allow you to set aside before-tax money from your paycheck
to pay for certain health care expenses including deductibles, copayments, certain
services not covered by your health plan, and dependent day care expenses. After paying
your provider you then file a claim for reimbursement (unless using the UHC debit card
to pay for expenses).
Important:
These accounts have some restrictions on allowable expenses, and any money left in your account at
the end of the year ( January – December) will be forfeited; it cannot be rolled over in the next year or
paid out.
Two Types of Flexible Spending Accounts
Healthcare (FSA) is used to pay for out-of-pocket medical expenses not covered by insurance
(exclusions exist). A list of exclusions can be found on www.myuhc.com.
Dependent Care (FSA) is used to pay for non-medical day care expenses for your eligible dependent
child(ren) up to age 13, elder dependents and disabled dependents ( incapable of self support). Nonmedical day care expenses include before/after-school care and summer day camp.
Annual Plan Limits:
Minimum Contribution $200
Maximum Contribution $2,500 Healthcare; $5,000 Dependent Care
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Flexible Spending Accounts (FSA)
Medical and Dependent Care… cont.
Contributions are unique. To determine your contribution amount, you should consider
what you typically spend each year on out-of-pocket healthcare and daycare expenses.
Include expenditures for yourself and eligible dependents, even if you are not covering
your dependents under the medical, dental or vision plans. Additional dollars can be
added ONLY if a family status event occurs (birth, day care expenses increase, etc.)
When enrolling in the UHC FSA plan(s), you will receive a Debit card for your
convenience. When using your FSA Debit card or submitting claims for eligible expenses,
be sure to save all of your itemized receipts as the Internal Revenue Service (IRS) requires
proof of payment on some claims.
Any money left in your account at the end of the plan year cannot be rolled over
into the next year or paid out to you, so plan carefully! “Use it or lose it “rule does
apply!
FSA Savings calculator: www.welcometouhc.com, click on Tools & Resources.
Claims may be submitted electronically at www.myuhc.com.
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Life and Accident Insurance
Benefit
Features
Basic Life
MSM automatically provides life insurance coverage in an amount equal
to 2x’s your base annual salary (up to a maximum of $500,000). A
beneficiary designation is necessary to have on file.
MSM pays
cost
Accidental Death &
Dismemberment ( AD&D)
Accident insurance provides protection to you and/or your beneficiaries if
you die or are seriously injured in an accident. MSM automatically
provides accident insurance coverage in an amount equal to 2x’s your
base annual salary (up to a maximum of $500,000). It does not cover a death
MSM pays
cost
resulting from illness or natural causes.
Supplemental Life
- Employee
You may purchase coverage up to 1x’s your base annual salary (up to a
maximum of $500,000). Proof of good health is required for amounts
exceeding $200,000.
Employee Paid
Employee must enroll in supplemental life in order to purchase spouse or dependent
child(ren) supplemental life coverage.
Supplemental Life
- Spouse
You may purchase life insurance for your spouse in units of $5,000 up to a
maximum of $150,000. Any amount greater than $50,000 will require proof of
good health (cannot exceed 50% of the employee’s amount of supplemental life
Employee Paid
coverage).
Supplemental Life
- Dependent Child(ren)
You may purchase insurance for your dependent children in units of $2,500 up
to a maximum of $10,000. Each dependent child will be covered at the same
amount of insurance.
Employee Paid
Employee Life & AD&D (Basic and Supplemental)– Coverage reduces to 65% at age 65. At age 70 it reduces to 45% of your original benefit. At age 75 it
reduces to 30% of your original benefit. Coverage terminates at retirement. Reductions do not apply to your family coverage.
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Income Protection – Short and Long Disability
No one can predict what the future holds, but you can prepare for it.
Short Term Disability
Long Term Disability
Income replacement of up to 60% of pre-disability income**
Employee paid
Employer paid
$2,500 maximum weekly benefit
$12,500 maximum monthly benefit
Benefits begin on the 15th day
after a cover illness/injury occurs
Benefits begin 180 days after disability
Benefits end at recovery or at 26 weeks
Benefits end at recovery or at Social Security
Normal Retirement Age (SSNRA)
AFLAC
More information available
by calling (800) 433-3036
Policy # 0000012663
Additional income protection such as Accident, Critical Illness, and
Hospital Indemnity coverage is available; for details and bi-weekly rates
please click the AFLAC Brochure link. Please complete the application,
if enrolling.
Employee
Paid
** These benefits may also be reduced by any other income that you may be receiving (i.e. social security or workers’
compensation benefits, etc.). The Plan will not cover any Disability during the first 12 months after your effective date of coverage that
is caused by or contributed to, or resulting from, a Pre-Existing Condition or medical or surgical treatment for a Pre-Existing Condition.
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Employee Assistance Program (EAP)
Care24® services
Care24 services offers you access to a wide range of health and wellbeing information—seven days a week, 24 hours a day. Life is full of ups
and downs, you have access to a great source for support and
information who can help with almost any problem ranging from medical
and family matters to personal legal, financial and emotional needs.
When you call 1- (888) 887- 4114 you will have access to experienced
professionals:
} Childhood illnesses
} Minor illnesses and
injuries
} Medication safety
} Relationship worries
} Choosing appropriate
medical care
} Stress and anxiety
•
•
•
•
Registered nurses
Master’s-level counselors
Legal and financial professionals
Community resources
} Coping with grief and
loss
} Personal legal and
financial issues
} Self-care information
You receive three (3) face to face counseling sessions * and unlimited telephonic
conversations.
* If additional counseling sessions are needed you may be referred through the mental health benefit, part of the
medical program, if you are currently enrolled.
Additional information can be found on www.myuhc.com and selecting mental
health benefit.
} Help finding a doctor
} Information on
medications
} General health
information
Retirement Planning – 403(b)
Participating in a retirement savings plan is one of the best things you can do to save for your future.
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
Start immediately: Start savings for retirement with your first paycheck. You decide how
much you want to contribute to the plan, and the deduction is automatically taken out of
your paycheck.

Maximize your dollar: Your contributions come out of your paycheck before federal and
state taxes are taken. This reduces your taxable income, and you pay less in taxes.
•
Eligibility: Employees are eligible to defer from their salary into the 403(b) Plan immediately, provided they
meet the benefits eligibility requirements.
•
Employer Contribution: Employees in certain employment classes qualify for a 7% employer contribution
(Residents, Postdoc Fellows and Research Scholars do not qualify)
•
Entry Date: Employees may enroll at any time.
•
Salary Deferrals: may equal between 1% and 100% of your compensation on a pre-tax basis. The Internal
Revenue Service (IRS) sets maximum deferral limits, which may change each year; please refer to the COLA
table on the Internal Revenue Services (IRS) at www.irs.gov for the current year limit.
•
Catch-Up Participants: over the age of 50 (or who will attain age 50 by the end of the calendar year), and have
or will reach the initial maximum deferral limit, may make additional contributions to the Plan. Please see the
COLA table referenced above, for the current year limit.
•
Rollovers: Rollovers from a previous 401(a) Plan, 403(a) Plan, 403(b) Plan, or an IRA are accepted into the
plan.
Retirement Planning – 403(b) continued
Loans: Your plan permits loans. The minimum amount that can be requested is $1,000.
The maximum number of outstanding loans at any given time is one (1). The interest rate
applicable is the prime rate, as found in the Wall Street Journal on the date of the loan,
plus 1%. Non-residential loans must be repaid within 5 years; residential loans must be
repaid in no more than 15 years.
Distributions: You may take a distribution from the 403(b) plan only for the following
qualifying events: termination of employment, attainment of age 59 ½, retirement,
permanent disability or death. Your distribution options are determined based on the
Individual Agreements that you are invested in. Financial Hardship withdrawals are
available if you qualify (based on IRS definition of hardship)
Please complete the Retirement Plan Enrollment Form, in order to start your
deferral.
Retirement Planning – 403(b)
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