2017 Benefit Plans
County of Santa Barbara
Y0066_160802_100703
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Welcome
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Why We’re Here
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Medicare Basics
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Plan Benefits
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Questions & Answers
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Why UnitedHealthcare?
UnitedHealthcare is here for you.
At UnitedHealthcare, we can help you understand what you can do to
make the most of your plan. We help connect you to the care you need,
when you need it. And we are dedicated to giving you the programs,
resources and tools to help you live a healthier life.
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Original Medicare Basics
The ABCs of Medicare
© 2015 United HealthCare Services, Inc., Medicare Made Clear™ initiative
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Medicare Parts A & B (Original Medicare)
Medicare Parts A & B (Original Medicare)
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Medicare Part C (Medicare Advantage Plans)
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When are you eligible for Medicare?
You’re eligible for Original Medicare (Parts A and B) if:
You’re 65 years old, or you’re under 65 and qualify on the basis of
disability or other special situation.
AND
You’re a U.S. citizen or a legal resident who has lived in the United
States for at least five consecutive years.
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Plan Benefits
MAPD High and Low Option
HMO
Your Medicare Advantage plan
The advantages of a single plan.
Medicare Advantage (Part C) plans are provided through private insurers, like
UnitedHealthcare. They include Part A and Part B coverage and often Part D — all
in one plan. Medicare Advantage plans also generally offer additional benefits
beyond doctor and hospital visits.
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All the benefits of Part A
• Hospital stays
• Skilled nursing
• Home health
All the benefits of Part B
• Doctor’s visits
• Outpatient care
• Screenings and shots
• Lab tests
Prescription drug coverage
• Included in many Medicare
Advantage plans
Additional benefits, programs
and features
• May be bundled with the plan
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Your plan overview (HMO)
Getting the health care coverage you may need.
Coverage for visiting doctors, clinics and hospitals in one plan
Prescription drug coverage
Generally, you choose from within an approved network of doctors and hospitals
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Your doctors (HMO)
This plan offers a large network of doctors, specialists and hospitals.
There’s a chance your doctor is already part of our network. To find out, consult our online
Provider Directory at www.UHCRetiree.com.
If you need help finding a doctor, we’re here to help. Just call us.
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MAPD - HMO
You Pay
Annual Deductible
Annual out-of-pocket maximum
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No Deductible
$6,700
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MAPD - HMO
Benefit Coverage
In Network High Option
In Network Low Option
Primary care provider
(PCP) office visit
$5 co-pay
$15 co-pay
Specialist office visit
$5 co-pay
$25 co-pay
Urgently needed care
$5 co-pay
$15 co-pay
Inpatient hospitalization
$0 co-pay
$500 co-pay
Outpatient surgery
$0 co-pay
$250 co-pay
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MAPD – HMO
Preventive Services
Benefit Coverage
High Option HMO
Low option HMO
Annual physical
$0 co-pay
$0 co-pay
Annual Wellness Visit
$0 co-pay
$0 co-pay
Immunizations
$0 co-pay
$0 co-pay
Breast Cancer screening
$0 co-pay
$0 co-pay
Colon Cancer screening
$0 co-pay
$0 co-pay
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MAPD HMO
Benefit Coverage
High Option
Low Option
Medicare-covered
podiatry
$5 co-pay
$25 co-pay
Medicare-covered
chiropractic care
$5 co-pay
50% cost-share
Medicare-covered vision
services
$5 co-pay
$25 co-pay
Medicare-covered
hearing services
$5 co-pay>]
$25 co-pay
Emergency room
$50 co-pay
$50 co-pay
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Your Prescription Drug Plan
More than 67,000 network pharmacies nationwide — many national drugstore chains and
independent pharmacies are included.
Thousands of covered brand name and generic drugs.
Prescriptions can start as low as $<1.50> through our Pharmacy Saver program1
[Bonus drug coverage in addition to Medicare Part D drug coverage.]
Check your plan's drug list or call Customer Service to see if your prescription drugs are covered.
1Drugs
and prices may vary between pharmacies and are subject to change during the plan year. Prices
are based on quantity filled at the pharmacy. Quantities may be limited by pharmacy based on their
dispensing policy or by the plan based on Quantity Limit requirements; if prescription is in excess of a
limit, co-pay amounts may be higher.
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Drug Payment Stages
No Annual deductible
In this drug payment stage:
Your plan sponsor is providing additional
coverage through the gap:
After your total out-of-pocket costs
reach $4,950:
You pay a co-pay or co-insurance
(percentage of a drug’s total cost.)
The plan pays the rest
You continue to pay the same co-pay
or co-insurance as you did in the initial
coverage stage
You pay a small co-pay or
co-insurance amount
You stay in this stage until your
total drug costs reach $3,700
You stay in this stage until your total
out-of-pocket costs reach $4,950
You stay in this stage for the rest
of the plan year
Total drug costs: The amount you pay (or others pay on your behalf) and the plan pays for prescription drugs
[starting January 2017]. This does not include premiums.
Out-of-Pocket costs: The amount you pay (or others pay on your behalf) for prescription drugs [starting January
2017]. This does not include premiums, or the amount the group health plan, former employer, or plan sponsor pays
for prescription drugs.]
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Your Part D High Option plan (PDP) benefits
Tier
Prescription
Drug Type
Your Costs
Retail
(30-day supply)
Mail Order
(90-day supply)
Tier 1
Generic and some
Brands
$7 co-pay
$14 co-pay
Tier 2
Preferred Brands
and some generics
$14 co-pay
$28 co-pay
Tier 3
Non-Preferred
Brands and some
generics
$14 co-pay
$28 co-pay
Tier 4
Specialty Drugs and
some generics
$14 co-pay
$28 co-pay
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Your Part D Low Option (PDP)/benefits
Tier
Prescription
Drug Type
Your Costs
Retail
(30-day supply)
Mail Order
(90-day supply)
Tier 1
Generic and some
Brands
$10 co-pay
$20 co-pay
Tier 2
Preferred Brands
and some generics
$25 co-pay
$50 co-pay
Tier 3
Non-Preferred
Brands and some
generics
$40 co-pay
$80 co-pay
Tier 4
Specialty Drugs and
some generics
$40 co-pay
$80 co-pay
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Diabetic Testing & Monitoring Supplies
Your plan will provide coverage for the following brands of
blood glucose testing strips and meters:
OneTouch® Ultra® 2
ACCU_CHEK Aviva
OneTouch® Verio™
ACCU_CHEK SmartView
OneTouch® UltraMini™
OneTouch® Verio® FlexTM
System Kit with OneTouch®
Verio® test strips
When you use one of these brands, your cost-share for diabetes testing and
monitoring supplies is $0 co-pay.
These supplies include the above brands of test strips and meters, and any brand
of lancets, lancing device, glucose control solution (to test the accuracy of your
meter), and replacement batteries for your meter.
You may be required to get a new prescription from your doctor. If you are using a
different brand than identified above, a temporary supply of your current brand
can be requested.
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Pharmacy SaverTM Program
You could save on the cost of generic prescription drugs.
With the Pharmacy Saver program, you can fill your prescriptions for as low as $1.50 at
participating pharmacies located in grocery, discount and drug stores where you may already
shop.1
Many, but not all, of the pharmacies in UnitedHealthcare’s national pharmacy network participate
in the Pharmacy Saver program unitedpharmacysaver.com for for more information.]
Note: Other pharmacies are available in our network. Members may use any pharmacy in the
network but may not receive Pharmacy Saver pricing. Pharmacies participating in the Pharmacy
Saver program may not be available in all areas]
1Drugs
and prices may vary between pharmacies and are subject to change during the plan year.
Prices are based on quantity filled at the pharmacy. Quantities may be limited by pharmacy based on
their dispensing policy or by the plan based on Quantity Limit requirements; if prescription is in excess
of a limit, co-pay amounts may be higher.
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Additional Programs and Features
HouseCallsSM - a clinical visit in the comfort of your own home
Virtual Doctor Visits - See a doctor using your computer, tablet or
mobile phone
SilverSneakers® - includes access to exercise equipment, classes
and more than 13,000 participating locations
NurseLineSM - Whether you have questions about a medication or
have a health concern in the middle of the night, a nurse can
answers your call 24 hours a day
Solutions for Caregivers – Extra support for those who take care
of others
Renew by UnitedHealthcare - a member perk that can help you
learn, and start living a healthier, happier life
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Understanding Original Medicare’s Rules
You must be entitled to Medicare Part A and enrolled in Medicare Part B and continue to pay
your Medicare Part B premium.
[You can only be in one Medicare Advantage plan at a time. Enrolling in another plan will
automatically disenroll you from any other Medicare Advantage or prescription drug plan.]
[You must inform us of any current prescription drug coverage or future enrollment that include
prescription drug coverage.]
[If you do not enroll in a Medicare Part D prescription drug plan or a Medicare Advantage plan
that includes prescription drug coverage, or you do not have other creditable prescription drug
coverage, you may have to pay Medicare’s Late Enrollment Penalty.]
[<If/When> you are a member,] [You must read the plan’s Evidence of Coverage (EOC),
including appeals and grievance rights [which can be found [at <URL>][or][in the plan Annual
Notice of Change.]
• The EOC also covers specific plan benefits, co-pays, exclusions, limitations and other terms.]
Please review the full text of the Statement of Understanding in your 2017 enrollment kit.
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UHCRetiree.com
After your coverage begins, register online at UHCRetiree.com to
access plan information, materials and programs.
Medical and Drug Claim Search
Health Needs Assessment
Plan Materials
Temporary or replacement member ID cards
Provider Search
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Thank You
We look forward to welcoming
you to our Medicare family.
Additional Information
This document is available in alternative formats. If you receive full or partial subsidy for your premium from a plan
sponsor (former employer, union group or trust), the amount you owe may be different than what is listed in this
document. For information about the actual premium you will pay, please contact your plan sponsor’s benefit
administrator directly.
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. [Benefits, ][<[P/p]remium and/or co-payments/co-insurance> may change on
January 1 of each year.
The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when
necessary.
You must continue to pay your Medicare Part B premium, if not otherwise paid for under Medicaid or by another third
party.
Out-of-network/non-contracted providers are under no obligation to treat <Plan/Part D Sponsor> members, except in
emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your
provider to ask us for a pre-service organization determination before you receive the service. Please call our customer
service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to outof-network services.
Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies. For Medicare
Advantage and Prescription Drug Plans: A Medicare Advantage organization with a Medicare contract and a Medicareapproved Part D sponsor. Enrollment in these plans depends on the plan’s contract renewal with Medicare.
[United Pharmacy Saver] Drugs and prices may vary between pharmacies and are subject to change during the plan
year. Prices are based on quantity filled at the pharmacy. Quantities may be limited by pharmacy based on their
dispensing policy or by the plan based on Quantity Limit requirements; if prescription is in excess of a limit, co-pay
amounts may be higher. Other pharmacies are available in our network. Members may use any pharmacy in the
network, but may not receive Pharmacy Saver pricing. Pharmacies participating in the Pharmacy Saver program may
not be available in all areas.
Other pharmacies are available in our network.
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Additional Information
[SilverSneakers] 1Connsult a health care professional before beginning any exercise program. Availability of the
SilverSneakers program varies by plan/market. Refer to your Evidence of Coverage for more details. Healthways and
SilverSneakers are registered trademarks of Healthways, Inc. and/or its subsidiaries. © 2016 Healthways, Inc. All rights
reserved.
[NurseLine] This service should not be used for emergency or urgent care needs. In an emergency, call 911 or go to
the nearest emergency room. The information provided through this service is for informational purposes only. The
nurses cannot diagnose problems or recommend treatment and are not a substitute for your doctor's care. Your health
information is kept confidential in accordance with the law. The service is not an insurance program and may be
discontinued at any time.
[Solutions for Caregivers] 2Solutions for Caregivers assists in coordinating community and in-home resources. The
final decision about your care arrangements must be made by you. In addition, the quality of a particular provider must
be solely determined and monitored by you. Information provided to you about a particular provider does not imply and
is in no way an endorsement of that particular provider by Solutions for Caregivers. The information on and the
selection of a particular provider has been supplied by the provider and is subject to change without written consent of
Solutions for Caregivers.
[Mail Order Pharmacy] 3You are not required to use OptumRx home delivery for a [90- or 100- day] supply of your
maintenance medication. If you have not used OptumRx home delivery, you must approve the first prescription order
sent directly from your doctor to OptumRx before it can be filled. New prescriptions from OptumRx should arrive within
ten business days from the date the completed order is received, and refill orders should arrive in about seven
business days. Contact OptumRx anytime at 1-888-279-1828, TTY 711. OptumRx is an affiliate of UnitedHealthcare
Insurance Company.] [$<0> co-pay is applicable for tier 1 and tier 2 medications during the initial coverage phase and
may not apply during the coverage gap; it does not apply during the catastrophic stage.
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