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United Healthcare Medicare Advantage Plan Plan Guide 2021 Take advantage of all your Medicare Advantage plan has to offer. University of Arkansas System UnitedHealthcare® Group Medicare Advantage (PPO) Group Number: 13551 Effective: January 1, 2021 through December 31, 2021 Table of Contents Introduction..................................................................................................................................... 3 Plan Information Benefit Highlights...................................................................................................................6 Plan Information..................................................................................................................... 9 Summary of Benefits........................................................................................................... 19 Drug List Drug List............................................................................................................................... 34 Additional Drug Coverage...................................................................................................57 What’s Next Here's What You Can Expect Next..................................................................................... 64 How to Enroll........................................................................................................................ 65 Enrollment Request Form................................................................................................... 67 Statements of Understanding.............................................................................................83 Y0066_GRPTOC_2021_C UHEX21MP4713484_000 Introducing the Plan UnitedHealthcare® Group Medicare Advantage plan Dear Retiree, Take advantage of Your former employer or plan sponsor has selected UnitedHealthcare® healthy extras with to offer health care coverage for all eligible retirees. As a UnitedHealthcare UnitedHealthcare® Medicare Advantage plan member, you’ll have a team committed to understanding your needs and helping you get the care you need. Let us help you: HouseCalls • Get tools and resources to help you be in more control of your health • Find ways to save money on health care, so you can focus more on what matters most to you • Get access to the care you need when you need it In this book you will find: Gym Membership • A description of this plan and how it works • Information on benefits, programs and services — and how much they cost • Details on how to enroll • What you can expect after your enrollment Health & Wellness Experience How to enroll 1 Find the Enrollment Request Form(s) in the “Enrollment” section of this book 2 Fill out the form(s) completely — make sure you sign and date the form(s) 3 Return your completed form(s) in the enclosed envelope before your enrollment deadline You can get 2021 plan information online by going to the website below. You will need your Group Number found on the front cover of this book to access your plan materials. Questions? We’re here to help. Call toll-freetoll-free 1-800-533-2743, T,T TTYY 711 , www.UHCRetiree.com 8 a.m. - 8 p.m. local time, 7 days a week Y0066_SPRJ54629_060220_M UHEX21MP4716597_000 SPRJ53800 3 This page left intentionally blank. 4 Plan Information UHEX21MP4713485_000 Benefit Highlights University of Arkansas System 13551 Effective January 1, 2021 to December 31, 2021 This is a short description of your plan benefits. For complete information, please refer to your Summary of Benefits or Evidence of Coverage. Limitations, exclusions, and restrictions may apply. Plan Costs In-Network Out-of-Network Annual medical deductible Your plan has an annual combined in-network and out-of-network medical deductible of $500 each plan year. Annual medical out-of- Your plan has an annual combined in-network and out-of-network pocket maximum (The most out-of-pocket maximum of $1,000 each plan year. you pay in a plan year for covered medical care) Medical Benefits Benefits covered by Original Medicare and your plan In-Network Out-of-Network Doctor’s office visit Primary Care Provider: $25 Primary Care Provider: $25 copay copay Specialist: $40 copay Specialist: $40 copay Virtual Doctor Visits: $0 copay Virtual Doctor Visits: $0 copay Preventive services $0 copay for Medicare-covered preventive services. Refer to the Evidence of Coverage for additional information. Inpatient hospital care $450 copay per stay $450 copay per stay Skilled nursing facility (SNF) $20 copay per day: days 1-28 $20 copay per day: days 1-28 $0 copay per additional day up $0 copay per additional day up to 100 days to 100 days Our plan covers up to 100 days in a SNF per benefit period. Outpatient surgery $200 copay $200 copay Outpatient rehabilitation 20% coinsurance 20% coinsurance (physical, occupational, or speech/language therapy) Mental health (outpatient Group therapy: $25 copay Group therapy: $25 copay and virtual) Individual therapy: $25 copay Individual therapy: $25 copay Virtual visits: $25 copay Virtual visits: $25 copay Diagnostic radiology 20% coinsurance 20% coinsurance services (such as MRIs, CT scans) 6 Medical Benefits Benefits covered by Original Medicare and your plan In-Network Out-of-Network Plan Information Lab services $0 copay $0 copay Outpatient x-rays $0 copay $0 copay Therapeutic radiology 20% coinsurance 20% coinsurance services (such as radiation treatment for cancer) Ambulance $100 copay $100 copay Emergency care $65 copay (worldwide) Urgently needed services $50 copay (worldwide) $50 copay (worldwide) Additional benefits and programs not covered by Original Medicare In-Network Out-of-Network Routine physical $0 copay; 1 per plan year* $0 copay; 1 per plan year* Foot care - routine $40 copay $40 copay (Up to 6 visits per plan year)* (Up to 6 visits per plan year)* FirstLine Essentials $0 copay; Members receive $40 each quarter to use on approved over-the-counter products as shown in the catalog or website. Dollars will expire the last day of each quarter. Hearing - routine exam $0 copay $0 copay (1 exam per plan year)* (1 exam per plan year)* Hearing aids Through UnitedHealthcare Hearing aids ordered through Hearing, the plan pays up to a providers other than $500 allowance for hearing aids UnitedHealthcare Hearing are every 3 years. not covered. Hearing aid coverage under this plan is only available through UnitedHealthcare Hearing. Vision - routine eye exams $40 copay $40 copay (1 exam every 12 months)* (1 exam every 12 months)* Fitness program through You have access to Renew Active™ at no additional cost. Renew RenewActiveTM Active is the gold standard in Medicare fitness programs for body and mind. It includes a gym membership at a fitness location you select from our nationwide network. To get started, log in to your plan website, go to Health & Wellness and look for Renew Active. You can also call the number on the back of your UnitedHealthcare member ID card. 7 In-Network Out-of-Network Post-Discharge Meals $0 copay; Coverage for up to 84 home-delivered meals immediately following one inpatient hospitalization or skilled nursing facility stay when referred by a UnitedHealthcare Clinical Advocate. Benefit is offered one time per year through the provider Mom’s Meals. Restrictions apply. NurseLine Receive access to nurse consultations and additional clinical resources at no additional cost. *Benefits are combined in and out-of-network Prescription Drugs Your Cost Initial Coverage Stage Network Pharmacy Mail Service Pharmacy (30-day retail supply) (90-day supply) Tier 1: Preferred Generic $15 copay $30 copay Tier 2: Preferred Brand $45 copay $90 copay Tier 3: Non-preferred Drug $80 copay $160 copay Tier 4: Specialty Tier $80 copay $160 copay Coverage gap stage After your total drug costs reach $4,130, the plan continues to pay its share of the cost of your drugs and you pay your share of the cost Catastrophic coverage stage After your total out-of-pocket costs reach $6,550, you will pay a $3.70 copay for generic (including brand drugs treated as generic), and a $9.20 copay for all other drugs Your plan sponsor has elected to offer additional coverage on some prescription drugs that are normally excluded from coverage on your drug list (formulary). Please see your Additional Drug Coverage list for more information. Retiree plan prospects must meet the eligibility requirements to enroll for group coverage. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premium and/or copayments/coinsurance may change each plan year. The Drug List (Formulary), pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. Y0066_GRMABH_2021_M UHAR21PP4730435_000 8 Plan Details Plan Information UnitedHealthcare® Group Medicare Advantage Medicare Advantage (PPO) coverage: Your former employer or plan sponsor has chosen a UnitedHealthcare® Group Medicare Advantage plan. The word “Group” means this is a plan designed just for a former Medicare Part A employer or plan sponsor, like yours. Only eligible retirees of Hospital your former employer or plan sponsor can enroll in this plan. “Medicare Advantage” is also known as Medicare Part C. + These plans have all the benefits of Medicare Part A (hospital coverage) and Medicare Part B (doctor and outpatient care) plus extra programs that go beyond Original Medicare (Medicare Parts A and B). Medicare Part B Doctor and outpatient Make sure you know what parts of + Medicare you have You must be entitled
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