your health care counts specialty discussion our health plan: what do you need to know? door...

Your Health Care Counts

Specialty DiscussionOur Health Plan: What Do You Need to Know?

Door Kewaunee Health Insurance Purchasing Cooperative – Sturgeon Bay

November , 2012

UNITEDHEALTHCAREDENTAL

Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

Value Add Features

Prenatal Dental Care Program• Members may receive additional cleanings or perio maintenance during that period• Covered at 100%• Deductible does not apply

Oral Cancer Screening

• One screening per benefit period

• Adult Members

UNITEDHEALTHCARE VISION


Vision Care and Your Health

Facts:

• Vision disorders are the 2nd most prevalent

health problem1

• Eye exams may detect early warning signs

of serious health conditions2

- diabetes- hypertension- high cholesterol- vascular disease- glaucoma- cataracts

1 Employee Benefit News, April 15, 2009 2 Health News Digest, December 2008


In-Network Benefits At a Glance

Frequency BenefitsComprehensive Eye Exam Every 12 months $15 copay

A complete pair of eyeglass lenses* Covered selection of contact lenses (lens fitting included)* *after copay

Every 12 months $30 copay

• Frame Every 24 months $130 allowance

• Single vision, lined bi-focal, lined tri-focal or lined lenticular lenses

(Other lens options available at a discounted rate)

• Standard scratch coating

Every 12 months

Covered in full

Covered in full

Covered in full

Lens Options See benefit summary for details

Elective Contact Lenses

• Contact lenses that fall outside the covered selection.

(Copay does not apply)

Every 12 months $105 allowance

Additional Materials 20% off

UNITEDHEALTHCARECritical Illness and

Accident Protection


What about Critical Illness?

1 Heart and Stroke Statistical Update, American Heart Association 2010 2 American Cancer Society, Cancer Facts & Figures 2010

3 Center for Studying Health System Change 2008

Facts you should know:• Every 34 seconds someone has a

heart attack1

• Men have a 44% chance of getting

cancer and women have a 38%

chance of getting cancer in a lifetime2

• Nearly 20% of insured Americans

have problems paying their medical

bills3

Critical Illness -What’s Covered?*

*Partial Benefit -- See Benefit Summary or Certificate of Coverage for specific provisions.All features may not apply. Some states have restrictions.

Cardiovascular

Heart Attack

Heart Failure

Ruptured Aneurysm

Stroke

Coronary Artery Bypass*

Critical Illness – Other

Chronic Renal Failure

Paralysis

Severe Burns

Severe Brain Damage

Coma

Major Organ Failure (except heart)

Cancer

Cancer

Carcinoma in Situ*

1

32


Coverage Options

Employee: Increments of $1,000 from $5,000 to a maximum of $20,000

Dependents:

Spouse/Domestic Partner $10,000

Child(ren) $2,500


Why Accident Insurance?

Facts you should know:

• Accidents are the 5th leading cause of death in the United States 1

• More than 180,000 people die from injuries each year – 1 person every 3 minutes 2

• Injuries are the leading cause of death for people ages 1-44 in the US 3

•42% of American workers say they are living paycheck to paycheck4

1 National Vital Statistics Reports, January 2012 2 National Highway Traffic Safety Administration, 2008

3 National Highway Traffic Safety Administration , 2008 4 Careerbuilders, August 2011


Accident - What’s Covered?


Base Plan - 24 Hour Coverage

Silver Plan

Accidental Death & Dismemberment Initial Care Hospital Care-Life

-Both hands or feet or combination-One hand or foot

-Two or more fingers or toes or combination

-One finger or toeChild benefit – 50% of

employee/spouse

$20,000$20,000

$10,000$4,000

$2,000

Ground Ambulance

$200 Hospital Admission

$800

Air Ambulance

$1,200

Hospital Inpatient Stay(per day up to 365 days)

$160

Emergency Room

Treatment

$100 Hospital Intensive Care

Unit ICU Admission

$2,500

Accidental Death Common Carrier

(while on public transportation)Child benefit – 50% of

employee/spouse

$80,000Physician Office

Urgent Care (per visit)

$40Hospital ICU Inpatient Stay

(per day up to 30 days)

$500

Waiver Premium Yes

What’s Covered? Enhanced Plan


Enhanced Benefit Coverage (sample of benefits included) Scheduled Benefit

Follow Up Care

Major Diagnostic Exam $160

Follow Up Physician Visit $40

Medical Appliances (equipment) $140

Physical Therapy (per day up to six days} $ 30

Prosthetic•One device•Two or more devices

$500 $1,000

Rehabilitation Unit (per day up to 30 days) $ 80

Common Injuries (for complete list, see Summary of Benefits)

Abdominal/Thoracic (abdomen/chest) Surgery•Surgery to repair•Exploratory without repair

$1,000 $ 100

Blood/Plasma/Platelets $280

Burns•2nd Degree (at least 36% of body surface)•3rd Degree (9-34 sq. inches)•3rd Degree (35 or more sq. inches)Skin Graft – 25% of burn benefit

$500 $8,000

Coma $10,000

Concussion (once per 12 month period) $140

Dental EmergencyBroken teeth repaired with crown(s)Broken teeth resulting in extractions

$ 200 $80

Eye Surgery $200

Critical Illness and Accident Additional Features

Wellness Benefit - $100 per year for Employee and Spouse

• Mammogram• Colonoscopy• Pap Smear• Chest X-rays• Fasting blood glucose test• Blood test for triglycerides• PSA (blood test for prostate cancer)• Additional screenings listed in enrollment packet


Q & A

15Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.

your health care counts specialty discussion our health plan: what do you need to know? door...

Documents

unitedhealthcare vision

health facts

unitedhealthcare dental

health plan

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cancer facts

heart cancer carcinoma

health news digest