TAKE ACTION NOW:
Go to <myuhc.com>.
<PID>
[Optional Endorsement Line]
[To the parent(s)/guardian(s) of:]
<Member Name>
<Address 1>
<Address 2>
<City>, <ST> <Zip>
It's time to choose your medication fill preference.
[Dear][To the parent(s)/guardian(s) of:] <Member Name>,
We recently sent you a letter about an important decision you need to make regarding your medication.
Your medication listed below is part of the OptumRx® Mail Service Member SelectSM Program.1 The program is offered by OptumRx,
your health plan's pharmacy benefit manager, and allows you two fills at your retail pharmacy for the medication you take regularly.2
As of <claims through date>, you are approaching your final retail fill, so it's important to choose one of two options available to you.
Otherwise, you will pay the full cost for your medication at a retail pharmacy. We think the convenience of home delivery makes sense,
but if you choose to fill at retail, we respect that choice.
<MEDICATION 1>
<MEDICATION 2>
<MEDICATION 3>
Choose your fill preference now:
1
Enroll in home delivery by going to <myuhc.com>. <Select Manage
My Prescriptions and Get Started.> Or call <1-XXX-XXX-XXXX>,
TTY 711, any time and we’ll take care of the rest.
OR
2
Disenroll from the Mail Service Member Select Program and
continue filling your prescription at a retail pharmacy for your standard
co-pay or cost share by going to <myuhc.com>. <In the pharmacy
section, go to My Account and Manage My Mail Service Options.>
Or call <1-XXX-XXX-XXXX>, TTY 711.
Why choose home delivery?
C
ost savings. You may pay less for
your medication with a three-month
supply through OptumRx home delivery.
T
ime savings. Your medication is sent to
your home with free standard shipping.
M
edication support. A knowledgeable
pharmacist is available to answer
questions any time.
[< Automatic refills. Through the
Hassle-Free FillSM Program.>]
We appreciate the opportunity to serve you and are committed to helping you make the best use of your pharmacy benefits.
Sincerely,
<UnitedHealthcare®>
[<P.S. Manage your medicine cabinet from any smartphone or tablet. Download the <Health4MeTM><OptumRx> App today.3>]
<Event Date>
Questions?
Frequently asked questions
What happens if I do nothing?
Before you reach your maximum number of two fills, you have to take one of the two actions described on page 1 or your claim
will be rejected at the pharmacy. You will then pay the full cost for your medication until you choose a fill preference.
What happens if I disenroll from the Mail Service Member Select Program?
If you disenroll, you can continue filling your prescriptions at a retail pharmacy for the cost of your plan's standard co-pay or cost share.
However, you can switch to OptumRx home delivery at any time, even if you disenroll from the Mail Service Member Select Program.
Are all medications included in Mail Service Member Select?
No. Short-term medication, such as antibiotics, are not included. This program only applies to certain medication taken on an
ongoing basis.
I am a teenager. Why am I receiving this?
If you are a young adult (age 13 to 17) covered under a parent or guardian's health plan, privacy regulations require us to communicate
with you directly. You can communicate with us directly if you choose, however, many young adults want help from their parent(s) or
guardian. You can have a parent or guardian help you online or when you call.
How do I get started?
Go to <myuhc.com> to begin using home delivery right away. <Select Manage My Prescriptions and Get Started.> You can then
choose the medication you want shipped directly to you. Or call <1-XXX-XXX-XXXX>, TTY 711, any time. We will help transfer
your medication to OptumRx.
<1. Medication coverage is subject to change. Not all medication listed may be covered under your benefit plan. Please review your plan documents to see
what medication is covered and for specific coverage information.>
2. If you have an out-of-network pharmacy benefit, you may submit a paper claim to the address on the back of your health plan ID card for reimbursement
under your out-of-network benefit. To determine if you have an out-of-network benefit, call the number on the back of your health plan ID card.
[<3. App is available for download on both Apple and Android devices.>]
Please note: If you have recently switched to home delivery or chosen to
disenroll from the Mail Service Member Select Program, no action is needed.
<New prescriptions should arrive within 10 business days from the date the completed order is received by the OptumRx. Completed refill orders should arrive in
about seven business days. OptumRx will contact you if there will be an extended delay in the delivery of your medication. Please feel free to use our online order
status to check on the progress of your request. This document and others if attached contain information from OptumRx that is privileged, confidential and/or
may contain protected health information (PHI). We are required to safeguard PHI by applicable law. The information in this document is for the sole use of the
person(s) or company named above. Proper consent to disclose PHI between these parties has been obtained. If you received this document by mistake, please
know that sharing, copying, distributing or using information in this document is against the law. If you are not the intended recipient, please notify the
sender immediately and return the document(s) by mail to OptumRx Privacy Office, 17900 Von Karman, M/S CA016-0203, Irvine, CA 92614.
OptumRx is an affiliate of UnitedHealthcare Insurance Company.>
<UnitedHealthcare® and the dimensional U logo are registered trademarks owned by UnitedHealth Group Incorporated. All branded medications are trademarks
or registered trademarks of their respective owners.
© 2015 United HealthCare Services, Inc. >UHC8402_150501
[Legal Code 1]