Par Partnership ip Plan Plan 2.0 UnitedHealthcare re/Ox Oxfo - - PowerPoint PPT Presentation

Par Partnership ip Plan Plan 2.0

UnitedHealthcare re/Ox Oxfo ford rd w welcomes You t to the State o

• f Co

Conne nnecticut Partnership Plan n 2.0

Benefits: The Partnership Plan 2.0 offers a rich plan design, featuring the same no no-referral al Point-of-Service (POS) plan design offered to State employees, providing:

• In- and Out-of-Network coverage
• 100% coverage for In-Network preventive care (tiered benefits do not apply)
• Coverage for naturopathic care, chiropractic care and acupuncture
• An extensive local and national network through UnitedHealthcare/Oxford
• Health Enhancement Program (HEP)
• Dedicated Service Team
• The Healt

alth E Enhancement P Program am (HEP) is a program designed to promote preventive screenings, wellness visits and chronic disease education and counseling for employees and, as a result, saves money on health care in the long term by focusing health care dollars on prevention. Care Management Solutions, Inc. (CMSI) will provide additional information on the HEP program

• The Partnership Plan 2.0 has a dedicated team of individuals who are your point of contact throughout

the process. You will not be lost in the shuffle with questions or concerns about enrollment, billing, or claims

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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Most Questioned B Benefits

Benefit In In-Netwo work C Cove verage Out-of-Network C rk Covera rage Preventive Care: Adult and Pediatric No Copay Deductible Plus Coinsurance Immunizations/Vaccines No Copay Deductible Plus Coinsurance Primary Care and Specialist Sick Visits $0 (Preferred)/$15 Copay Deductible Plus Coinsurance Naturopathic Physician Visits $15 Copay Deductible Plus Coinsurance Emergency Room $250 Copay

*Waived if Admitted

$250 Copay

*Waived if Admitted

Urgent Care Center $15 Copay Deductible Plus Coinsurance Routine Vision Exam & Refraction $0 (Preferred)/$15 Copay

• 1 Exam Per Calendar Year

Deductible Plus 50% Coinsurance

• 1 Exam Per Calendar Year

Infertility Services $15 Copay Office No Copay Inpatient and Outpatient Hospital Deductible Plus Coinsurance Outpatient PT/OT No Copay

• Unlimited Visits

*Medical necessity required

Deductible Plus Coinsurance

• 30 Visits Per Calendar Year

*Medical necessity required

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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Most Questioned B Benefits – Contin inued

Benefit In In-Netwo work C Cove verage Out-of-Network C rk Covera rage Speech Therapy No Copay

• Unlimited Visits if the treatment is

related to one of the specific diagnoses

• utlined in the SPD. All other physician-

prescribed speech therapy has a 30 visit per calendar year limit and requires Prior Authorization

Deductible Plus Coinsurance

• 30 Visits Per Calendar Year if the

treatment is related to one of the specific diagnoses outlined in the

• SPD. All other physician prescribed

speech therapy has a 30 visit per year combined In-and-Out-of-Network limit and requires Prior Authorization

Acupuncture

• 20 Visits Per Calendar Year

Combined In- and Out-of-Network

$15 Copay Deductible Plus Coinsurance Durable Medical Equipment No Copay Deductible Plus Coinsurance Foot Orthotics No Copay Deductible Plus Coinsurance Nutritional Counseling

• 3 Visits per person per calendar

year

No Copay Deductible Plus Coinsurance

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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

• Out-of-Network Deductible: $300 (individual) / $900 (family) *Deductible is Plan Year
• Out-of-Network Coinsurance: 80/20
• Out-of-Network Out-of-Pocket Maximum: $2,300 / $4,900 (includes deductible)
• In-Network Out-of-Pocket Maximum: $2,000 / $4,000

*For a complete listing of covered services, please review the Summary Plan Description (SPD), available on the State Comptroller’s website for the Partnership Plan. See page 12 for website information.

Tiered PC PCP P an and S Special alis ist Copay ay

• If a member utilizes a “Preferred” Primary Care Physician (PCP) or a specialist in one
• f the 10* specialties below in Connecticut ONLY the copay will be as follows:

– Allergy & Immunology

• - Ophthalmology*

– Cardiology

• - Orthopedic Surgery

– Endocrinology

• - Rheumatology

– ENT

• - Urology

– Gastroenterology

• - OB/GYN
• “Preferred” (two solid blue hearts ) - $0 Copay
• “Non-Preferred” (less than two solid blue hearts) - $15 Copay
• Deductible and Coinsurance for Out-of-Network providers
• Any specialist type not listed above that is In-Network will be a $15 copay

*Ophthalmology providers do not follow the blue heart designation. You can find a list of “Preferred” Ophthalmology providers on the dedicated website for Partnership Plan members (see page 11 for website information)

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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Provide der N Network Information – Lo Loca cal

Local N Networ

• rk:

: “Oxford F Freedom” m” As a UnitedHealthcare/Oxford member, you will have access to a large network of providers in the Connecticut, New York* and New Jersey tri-state area. In the tri-state, you will utilize the Oxfor

• rd F

Freedom

• m
• network. Oxford members can seek services from any participating Oxfor
• rd F

Freedom

• m provider in

Connecticut, New York * and New Jersey without a referral. When seeking services from a Primary Care Physician (PCP), or a specialist in one of the 10 specialties on page 4, please remember to pay attention to the physician’s heart status for your cost-share.  Note: When speaking to your physician about their participation status, please use “Oxford d Freedom

• m,”, not “the State Plan”

*The following counties in New York are considered within the Oxford Freedom network area: New York, Bronx, Dutchess, Kings, Nassau, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Sullivan, Ulster and Westchester. All other counties in New York would be considered out of the Oxford Freedom area, so members would utilize the UnitedHealt lthc hcare C Choi

• ice Plus

s national network (see next page for information on Choice Plus)

Sear arch f for l local O al Oxfor

• rd F

Freedom

• m prov
• viders o
• nline:

– Visit https://connect.werally.com/plans/oxhp – Select “Freedom” from the list of Oxford Networks – Click on “Change Location” to search by an address or zip code – then click “Update Location” – You can then search by specialty, provider name or practice name – then click “Search” – On the results page, you will have filter options on the left-hand side to narrow your search even further  Look for the two solid blue hearts for Connecticut PCP and specialists in the 10 specialties for a $0 copay

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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Provide der N Network Information – Nat ational al

Nat ational N l Net etwork: : “UnitedHealt lthcar are Choice e Plus” s” When traveling outside of the tri-state area, if you live out of the area, or if you have a child attending school out of the area, you also have seamless access to the UnitedHealt althcar are C Choi

• ice P

Plus national

• network. By finding one of our UnitedHealt

althcare C Choice P Plus physicians, your services will be treated just as if you were still at home. Please note that office visits for providers outside of Connecticut are not subject to the tiered benefit level, and visits for non-routine services will apply a member cost-share.  Please note only those providers located outside the tri-state service area are considered participating Choice Plus providers for Oxford members

*The following counties in New York are considered within the Oxford ford F Freedom network area: New York, Bronx, Dutchess, Kings, Nassau, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Sullivan, Ulster and Westchester. All other counties in New York would be considered out of the Oxford F d Freedo dom area, so members would utilize the UnitedHealt lthc hcare C Choi

• ice P

Plus national network.

Sear arch f for C ChoicePlus p prov

• viders o
• nline:

– Visit: https://connect.werally.com/plans/uhc/1 – Choose “Choice Plus” from the list of available plans – Click on “Change Location” to search by an address or zip code near you – then click “Update Location” – You can search by provider name or provider specialty by entering your search criteria in the rectangular box and hitting “Search”. You can also search a list of providers by specialty, service type, condition, etc. by selecting one

• f the blue boxes below

– On the results page, you will have filter options on the left-hand side to narrow your search even further

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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Clin linical al Pr Programs

• All Partnership Plan 2.0 members have access to the following clinical programs:

*For more in-depth information on any of these programs, please see the enclosed “State of Connecticut Partnership Plan Health, Wellness and Clinical Management Programs” handout

• All Partnership Plan 2.0 members also have access to the Rall

ally W Web eb P Portal l on oxfordhealth.com

– For additional information on Rally please visit http://partnershipstateofct.welcometouhc.com and put your cursor over “Online Tools & Resources”, then click on “Your Member Website” – Additionally, after your effective date, you may log into your account, then click on the “Health and Wellness” tab

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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

UnitedHealthcare/Oxford Clinical Programs

PHS 2.0: Personal Health Support Nurse Team CKS: Comprehensive Kidney Solutions NL: Oxford On-Call Nurse Line TRS: Transplant Resource Services WC: Telephonic Wellness Coaching UBH: Full Care Management TDS: Treatment Decision Support HPP: Healthy Pregnancy Program CHD: Congenital Heart Disease MIP: Managed Infertility Program CSP: Cancer Support Program NRS: Neonatal Resource Services CRS: Cancer Resource Services HeN: HealtheNotes

Si Site o

• f Ser

Service Progr gram for Lab and d Di Diagn gnostic Radiology

• This program is for lab and diagnostic radiology services, and ONLY applies to services

rendered in the state of Connecticut or Westchester county in New York; it does not apply to services rendered in any other NY county, NJ or any other state

• You pay the standard copay for these services when they are performed during the course of an
• ffice visit at a physician or specialist’s office (for a Preferred Provider office visit the standard

copay is $0; $15 for all others). Imaging and lab work performed at your physician’s office is covered under Site of Service at no cost to you.

• A list of “Preferred” lab and radiology providers is posted on the State of CT Partnership

dedicated Member website: http://partnershipstateofct.welcometouhc.com/home

• Members will be responsible for the following cost-shares:
• $0 copay for “Preferred” lab and diagnostic radiology providers
• 20% In-Network Coinsurance for “Non-Preferred” In-Network providers
• Deductible and 40% Out-of-Network Coinsurance for Out-of-Network providers

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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Pr Prior A Authoriz ization

The following services require prior authorization*:

Air Ambulance Oral Surgery Chemotherapy Organ Transplant Colonoscopy Orthoptic Exercises Dialysis Outpatient Physical and Occupational Therapy Durable Medical Equipment Over $500 Outpatient Surgery High Cost Diagnostic Imaging (MRI, CT Scan, etc.) Private Duty Nursing Infertility Treatments Skilled Nursing Facility Admission Inpatient Admissions Specialized Formula Inpatient Hospice Specialized Infant Formula Inpatient Mental Health / Substance Abuse Specialty Hospital Admission Inpatient / Outpatient Sleep Study Substance Abuse Residential Treatment

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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

*Please note, this list is not complete and is subject to change. It is best to have your physician call UnitedHealthcare/Oxford for confirmation prior to services being rendered. Also, any authorizations obtained with your previous carrier will not carry over to UnitedHealthcare/Oxford. A new authorization will need to be obtained.  Members who obtain non-emergency services from a Non-Network Provider without obtaining the required Prior Authorization may be subject to a penalty equal to $500 or 20% of the cost of such services, whichever is

• less. To inquire if a specific procedure that you are interested in is covered and/or requires prior authorization,

please obtain the procedure code from your physician and call Customer Service at the numbers on slide 11. If you are utilizing a participating provider, it is that provider’s responsibility to obtain the authorization for you.

Transitio ion of Care e and Sched eduled ed Procedu edures

Tran ansition

• n o
• f Car

are

• Transition of Care is a process in which a member may be allowed to access non-network providers
• n an In-Network basis to continue a course of treatment during a transitional period. Transitional

Care is sometimes referred to as “Continuity of Care”

• If a member is currently undergoing treatment for a disabling or life threatening disease or condition,
• r is in their second or third trimester of pregnancy, and their physician will not be participating with

UnitedHealthcare/Oxford (Oxford Freedom Network) as of the effective date of the plan, members can qualify to continue using their physician for 60 d 60 days after transition at the In-Network level of care

• To qualify for Transition of Care, a member’s physician must complete a Transitional Care Agreement

form, accepting Oxford’s clinical guidelines and fees as payment in full Currently S y Scheduled P Proce cedures

• If you or a dependent in your family, do not fall within the criteria above, but are currently scheduled

for a procedure that requires Prior Authorization after the effective date of the policy, the Prior Authorization under your current carrier will not transfer to UnitedHealthcare/Oxford. Your physician will be required to obtain the necessary approvals before the procedure will be covered by UnitedHealthcare/Oxford

• If you or a dependent in your family falls into this category, please notify you HR team.

UnitedHealthcare/Oxford will work with your HR team during the transition, and once the group has been loaded into the system and an ID number generated, we can begin working with your physician to begin the clinical review process. Please note that this is not a guarantee of coverage, but we will work with your physician to identify the steps necessary to obtain any necessary approvals

• Many of UnitedHealthcare/Oxford’s medical policies can be found online at the link on page 12

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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Contact Informat atio ion

UnitedHealt althcare/Ox Oxfor

• rd Contac

act I Infor

• rmation

UnitedHealthcare/Oxford has proudly served the State of Connecticut since 2005 with a designated service team. The following numbers are staffed by individuals who understand the State’s benefits, and are there to help you through this process. Customer S Service A Acce ccess: : 8:00a 0am – 6:00pm EST Prior r to to Effe Effecti tive D Date: 800-760-4566

• When prompted, state “Become a Member”
• Hold the line and the next available representative will answer your call

After E Effective Date: 800-385-9055

• Hold the line and the next available representative will answer your call

Member W Webs bsites: Partnership Plan Dedicated Site: http://partnershipstateofct.welcometouhc.com/home

• Contains information regarding the Partnership Plan, HEP information, how to search for a provider, links to
• ther vendors in Partnership and more

Oxford Secure Member Portal: https://www.oxfordhealth.com/

• Secure site for members to look up claims information, wellness information, order ID cards and more after

the effective date of the plan

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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Additio ional al Contac act Informatio ion

Oxford’s Behavioral Health Site - https://www.liveandworkwell.com/public/

• Secure site for members to search for a behavioral health provider near them and find reference information on

Behavioral health assistance

To Perform a behav avior

• ral

al healt lth p prov

• vider s

sear arch on LiveandWorkWell.com:

• Click on “I don’t know my access code”
• Select Oxford Health Plan in the drop down menu and click “enter”
• Click the “Find a provider” quick link in the “How can we help you” drop down menu
• The following page will allow you to search for a Provider or a Facility by geographic location, or by Name
• The results page will let you further narrow down your search by level of the clinician (definitions provided online),

by treatment options, by availability and much more

For information pertaining to Oxford’s medical and administrative policies, please visit: https://www.oxhp.com/secure/policy/medical_administrative_policy_index.html To review in-depth coverage information, please visit the Comptroller’s website: http://www.osc.ct.gov/ctpartner/index.html

• Scroll to the bottom of the page and click on “Medical Documents”
• This will bring up the Summary Plan Description (SPD)

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Confidential Property of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.