2008 broker resource guide - oxhpunitedhealth premium® designation program voluntary consumer...

2008 Broker Resource Guide

Overview

Your 2008 Broker Resource Guide

This guide is designed to make it easier to conduct business with us. It provides easy

access to a wealth of information on Oxford and UnitedHealthcare* products and

services, including:

• Frequently used phone numbers and addresses

• Product charts and descriptions

• Online functionalities for all audiences (Look for the handy indicating

Web functionality.)

• Group and member eligibility information

• And many more topics

Use this guide along with the broker Web sites at www.oxfordhealth.com and

www.unitedeservices.com to access the information you need.

As always, contact your sales representative with any questions you may have.

Please note: The information in the Broker Resource Guide is current as of January 2008. The BrokerResource Guide has been designed to provide you with important information in a user friendly format regardingyour relationship with Oxford and UnitedHealthcare. To the extent any of the information in the Broker ResourceGuide is inconsistent with the terms of your Broker Contract, the Broker Contract will be controlling.

*The second half of this guide provides you with specific information about doing business with UnitedHealthcare.

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1 Customer Service for Brokers

Client Services DepartmentOxford Express® IVR for Brokers and Benefits AdministratorsImportant Phone Numbers and Addresses

5 Commissions

Commission BasicsBroker of RecordCommissions Payment Schedule

9 Web site: www.oxfordhealth.com

Broker, Employer, Member and Provider SitesSign Up TodayOnline Member EnrollmentUnitedHealth Premium Designation Physician SearchIdea Management SystemSM

Online AdministrationOxford Benefit ManagementSM

15 Oxford® Products

Service Area MapTri-State Plus Service Area MapIn-area Product Enrollment Counties MapProduct ChartProduct ContinuumConsumer-Driven ProductsSpecialty Products

31 Oxford Programs

How We Help Members Stay HealthyManaging Chronic ConditionsHealthy Bonus®

Health Risk AssessmentCommercial Pharmacy ProgramsUnitedHealth Premium® Designation ProgramVoluntary Consumer Programs

39 Group Enrollment and Eligibility

Large Group Eligibility by StateSmall Group Eligibility by State

Table of Contents – Oxford

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headTable of Contents – Oxford

49 Billing and Payments

Billing BasicsMember Effective/Termination Dates and Premium DueRemittance AdviceCheck Billing on the Web and Oxford Express®

Frequently Asked Billing QuestionsDirect Debit Authorization

53 Member Enrollment and Eligibility

Large Group Requirements by StateSmall Group Requirements by StateIndividual and Mandated ProductsHealthy NY: Small Group/Individual/Sole ProprietorOxford Sole Proprietor ProductOxford HSA

73 Renewals

Contract RenewalOxford Renewal ProcessOnline Renewals – Idea Management SystemSM

75 Claims

Claim SubmissionClaim Filing Deadlines

77 Miscellaneous Items

Brokers Acting on Behalf of Benefits AdministratorsHealth Insurance Portability and Accountability Act (HIPAA)Oxford Confidentiality PolicyMedical Policy InformationRate Quotes for Large GroupsCOBRATermination and DisenrollmentGroup ConversionsCoordination of Benefits (COB)Tax Forms Oxford® ID Cards

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Table of Contents – UnitedHealthcare

89 Customer Service for Brokers

Important Contacts

91 Commissions

Commission BasicsAgent of Record (AOR)Commissions Payment Schedules

95 Web

Comprehensive, Convenient Online ToolsUnitedeServices®

EmployereServices®

OnlinEnrollSM

myuhc.com®

103 Products

Service Area MapProvider Accessibility StandardsProduct ContinuumConsumer-Driven ProductsDefinity Health Savings Account (HSA)Definity Health Reimbursement Account (HRA)Choice Plus and Choice ProductsGolden Rule®

What Your Get with All UnitedHealthcare PlansSimply AccountableSM

109 Programs

Proactive Health SolutionsUnitedHealth WellnessCare24SM

United Behavioral Health (UBH)United Pharmaceutical SolutionsHealthy Pregnancy ProgramCare ManagementDisease ManagementSpecialized Solutions for Complex Medical Conditions

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Table of Contents – UnitedHealthcare

115 Enrollment

Online AdministrationOffline AdministrationMember Enrollment and Eligibility Information

119 Billing and Payments

Employer eServices Online BillingPaying Paper InvoicesPayment Due Date

121 Renewals

Small Group RenewalsLarge Group Renewals

123 Claims

Claim InformationCoordination of Benefits (COB)Claim Submission

127 Specialty Products

UnitedHealthcare Specialty BenefitsSM

Packaged Savings Program®

UnitedHealthcare Dental®

Dental ProductsUnitedHealthcare VisionSM

Vision ProductsLife and Disability Products

135 Miscellaneous Items

HIPAAMedical Extension of BenefitsImportant Notice Regarding ERISAQualified Medical Child Support OrderWaiving CoverageUnitedHealthcare ID Card

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head

1

Customer Service for Brokers

Client Services Department

Monday through Friday, 8:00 AM to 5:00 PM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-888-201-4216

What is Client Services?

• Primary customer service contact for brokers and all group accounts

• Supports brokers and benefits administrators (BAs) regarding all aspects of plan administration:

• Verifies enrollment and eligibility status for both members and groups• Facilitates small group renewals• Responds to general inquiries on member benefits• Assists with billing questions• Advises on policies and procedures

[email protected]

• [email protected] is an e-mail box created specifically for both brokersand benefits administrators to interact with us for both issue resolution and general inquiries.

• This e-mail address offers a service distribution channel for our customers to further enhancethe overall accessibility of service provided by Client Services.

• For confidentiality, all e-mails are verified using the e-mail address of the sender. Only general information can be obtained from this e-mail address unless the sender is clearlyidentified as an authorized broker1 or benefits administrator.

Types of inquiries sent to [email protected]

• Any client service-related inquiry can be sent to the e-mail box. The following are someexamples of issues that would be well served via the e-mail box1:

• Benefits administrator or contact name changes• Corrections/missing information on Member Enrollment Forms (e.g., date of hire,

date of marriage, Social Security number, complete address, gender)• Requests for materials, copies of invoice and renewal rate options• Eligibility verification

Turnaround time for inquiries sent to [email protected]

• The Oxford Client Services team will generally respond within one business day of receivingan e-mail. This response will either provide an answer to the question posed or state that theinquiry is being processed.

1 Brokers need to obtain a HIPAA consent form to act on behalf of a group or individual member where protected healthinformation is involved. Please see Brokers Acting on Behalf of Benefits Administrators on page 11 of this guide.

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2

Oxford Client Services 1-888-201-4216 8 AM to 5 PM, Mon. – Fri.

Commissions 1-888-666-6844 8 AM to 4:30 PM, Mon. – Fri.

Customer Service 1-800-444-6222 8 AM to 6 PM, Mon. – Fri.

Web Help Desk 1-800-811-0881 8 AM to 6 PM, Mon. – Fri.

Oxford Express® 1-888-201-4216 24 hours/7 days a week

Oxford On-Call® 1-800-201-4911 24 hours/7 days a week

Oxford Behavioral Health 1-800-201-6991 8 AM to 6 PM, Mon. – Fri.

Asian Broker Unit 212-801-1995 9 AM to 5 PM, Mon. – Fri.

Provider Services 1-800-666-1353 8 AM to 6 PM, Mon. – Fri.

Individual Product Sales 1-800-216-0778 9 AM to 5 PM, Mon. – Fri.

Pharmacy Customer Service 1-800-905-0201 24 hours/7 days a week (except Thanksgiving & Christmas)

Prospective Medicare Members 1-800-303-6720 8 AM to 5:30 PM, Mon. – Fri.

Important Phone Numbers

Oxford Express® IVR for brokers and benefits administrators

The Oxford Express interactive voice response (IVR) system allows you to access the following by telephone:

• Member eligibility status information, such as member ID number, effective date of coverage,plan and network, and dependent information when subscriber number is entered.

• Billing and payment information, such as current balances, last payment amount, last fivechecks posted, and copies of past invoices.

• Group status and benefits information, such as valid tier types, employee contribution percentage, group deductibles and coinsurance, and group pharmacy copayment.

• Broker status, including phone and fax numbers on file and Broker of Record status (only brokers are given this option).

• Material requests, such as ID cards, rosters, claim forms, and self-help literature.

• General Oxford addresses.

The Oxford Express® IVR system is just one more avenue for our customers to

obtain the information they need, when they need it. If you have any questions,

please contact Client Services, or e-mail us at [email protected].

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3

New Group Submissions: Oxford Group Enrollment 14 Central Park DriveHooksett, NH 03106

Group Renewals/ Oxford Group Enrollment Group Changes: P.O. Box 7085

Bridgeport, CT 06601-7085

Commissions: Oxford Broker Commissions & Licensing Dept.48 Monroe TurnpikeTrumbull, CT 06611

Member Enrollment: Oxford Enrollment Department P.O. Box 7085Bridgeport, CT 06601-7085

Claims: Oxford Claims Department P.O. Box 7082Bridgeport, CT 06601-7082

Oxford MyPlansm Health Reserve Account Claims DepartmentP.O. Box 1021Eatontown, NJ 07724

Claims Resubmission: Oxford Corrected/Resubmitted Claims P.O. Box 7017Bridgeport, CT 06601-7017

Mail Order Medco By Mail Pharmacy Service: P.O. Box 747000

Cincinnati, OH 45274-7000

Clinical Appeals: Oxford Clinical Appeals P.O. Box 7078Bridgeport, CT 06601

Important Addresses



4

Large Group Billing

New York, New Jersey & Connecticut: Oxford Health InsuranceP.O. Box 26973New York, NY 10087-6973

New York: Oxford P.O. Box 10275Newark, NJ 07193-0275

New Jersey: Oxford P.O. Box 10273Newark, NJ 07193-0273

Connecticut: Oxford P.O. Box 10274Newark, NJ 07193-0274

Small Group Billing

New York, New Jersey & Connecticut: With or without remittance advice, send to:

Oxford Health InsuranceP.O. Box 1697Newark, NJ 07101-1697

New York: With or without remittance advice, send to:

Oxford P.O. Box 1368Newark, NJ 07101-1368

New Jersey: With or without remittance advice, send to:


Connecticut: With or without remittance advice, send to:


Pennsylvania: With or without remittance advice, send to:

Oxford Health InsuranceP.O. Box 1697Newark, NJ 07101-1697

Important Addresses

Address for Oxford HealthInsurance Products

For Oxford products

For Oxford products

For Oxford products

For Oxford Health Insurance products

Address for Oxford HealthInsurance Products

For Oxford products

For Oxford products

For Oxford products


Commissions

5

Commission Basics

Commissions are mailed by the 15th of each month. A broker must be licensed andappointed as an agent of Oxford to solicit, negotiate and affect coverage. No broker will beinstalled on a group or paid commissions until they are licensed and appointed with us.

• Commission statements and checks are generally mailed to brokers by the 15th of the monthfollowing the month in which the group premium is received. Questions regarding broker andcommissions status should be directed to the following address/phone number:

Oxford Broker Commissions & Licensing Department48 Monroe TurnpikeTrumbull, CT 06611Phone: 1-888-666-6844

Fax: 203-459-3296 or 203-459-3294

Hours: 8:00 AM to 4:30 PM, Monday through Friday

• E-mail inquiries should be directed to [email protected].

How to become licensed and appointed with us:

• Broker submits a fully completed and fully executed Oxford Broker Contract and W-9 Form to theCommissions Department, along with copies of his or her current state health insurance license(s).

• The Commissions Department will set up the broker in our system, send a license appoint-ment form to the respective state Department of Insurance office, and assign the broker anOxford Broker Code (vendor ID).

• A welcome letter is mailed to the broker with the assigned Oxford Broker Code. This codeshould be used on all correspondence to us from the broker, particularly in the broker sectionof the Group Enrollment Application.

Broker of Record (BOR)

What is a Broker of Record?

The Broker of Record is a broker designated by the group as the current servicing broker. TheBroker of Record’s name and Oxford Broker Code must be specified clearly on the initialGroup Enrollment Application completed for each new group.

How to become a Broker of Record:

• Broker of Record letters must be on company letter head and signed by the president, officer orother decision maker of the employer group and should include a fax number for confirmationpurposes. Letters of authorization that are not on company letterhead will not be accepted.

• We do not recognize “Letters of Authorization” from an in-force group allowing other brokers,besides the Broker of Record, to access information on an existing Oxford client.


Commissions

6

• The Broker of Record letter must be confirmed by the Commissions Department by the lastbusiness day of the month for the new Broker of Record to be eligible for commissionseffective the first of the following month.

• The Broker of Record letter must be SENT DIRECTLY to the Commissions Department(please route the original letter through your General Agent if you are required to do so). Broker of Record letters may be mailed to:

Oxford Commissions Department48 Monroe TurnpikeTrumbull, CT 06611

You can fax the BOR letter directly to the Commissions Department at 203-459-3296 or 203-459-3294, or e-mail a PDF of the BOR letter [email protected]

• We cannot guarantee your Broker of Record change unless it is sent directly to the Commissions Department.

• Upon receipt of the Broker of Record letter, the Commissions Department will send confir-mation of the effective date of assignment to both the new and the previous broker. If youhave not received your confirmation within 48 hours of submission, call the CommissionsDepartment at 1-888-666-6844. Broker of Record letters must be confirmed by theCommissions Department, or they will not be honored.

• The previous broker has 10 days from date of the confirmation notice to dispute the newassignment. Oxford sales management will settle such disputes.

• The group for which you are being designated Broker of Record will receive a letter of notification and a copy of the letter that was sent to the previous broker.

• All cases sold by a direct Oxford representative are vested for one year. Any Broker ofRecord letter submitted after a group’s coverage begins will become effective upon therenewal date.

Check commissions online

Visit the Broker site at www.oxfordhealth.com by logging in with your usernameand password. You can check commissions from the mouse-over menus on the MyAccount tab or from the Transactions tab.

5500 Rules

5500 Rules are automatically sent to groups with over 100 members, if you would like torequest 5500 rules for other groups contact your Oxford sales representative e-mail [email protected]

2008 commissions percentage

New York – 4%; New Jersey – 5.5% first year, 4.5% renewal; and Connecticut 5%

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SUN MON TUE WED THU FRI SATSUN MON TUE WED THU FRI SATSUN MON TUE WED THU FRI SAT


SUN MON TUE WED THU FRI SATSUN MON TUE WED THU FRI SAT

SUN MON TUE WED THU FRI SATSUN MON TUE WED THU FRI SAT SUN MON TUE WED THU FRI SAT

Commissions

7

2008 Commission Payment Schedule

1

2 3 4 5 6 7 8

9 10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 2930

July September

April May June

January February March

SUN MON TUE WED THU FRI SAT

1 2 3 4 5 6

7 8 9 10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30

October November December

Company HolidaysExpected Commission Payment Mailing Dates

1 2 3 4

5 6 7 8 9 10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

August

1 2 3 4 5 6

7 8 9 10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29

1 2

3 4 5 6 7 8 9

10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29

1

2 3 4 5 6 7 8

9 10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 2930 31

1 2 3 4 5

6 7 8 9 10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30

1 2 3 4 5

6 7 8 9 10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

1 2

3 4 5 6 7 8 9

10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29 3031

1 2 3

4 5 6 7 8 9 10

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

1 2 3 4 5

6 7 8 9 10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31


30 31

Web site: www.oxfordhealth.com

9

Check: Billing, Eligibility, Benefits,Commissions, New Group EnrollmentStatus

Request: ID Cards, Materials

Create: New Proposals, Rate Tables,Enroll New Group, Enroll Member

Change: E-mail Address, Username,Password

Search for: Doctors & Specialists,Hospitals & Health Facilities,Complementary & Alternative Care,Participating Pharmacies, Laboratories

Additional Features & Functionality:

Idea Management SystemSM, Oxford Prescription Drug List, medcohealth.com, Oxford BenefitManagementSM, Health Risk Assessment

Broker, employer, member, and provider sites provide reference information and onlinetransaction capability. To visit these sites, visitors must authenticate by entering their selectedusername and password on the appropriate login page.

Brokers can:

Check: Billing, Eligibility, Benefits,

Enroll: Employee/spouse/dependent; Terminate a Member

Request: Subscriber/Member Lists,Materials, ID Cards

Change: Member information, E-mail address, Username, Password



Idea Management SystemSM, Oxford Prescription Drug List, medcohealth.com, Oxford BenefitManagementSM, Health Risk Assessment

Employers can:

Check: Benefits, Claims, Referrals,Billing (IP only), Disenroll (IP only)

Notify Us: Pregnancy/Birth

Request: Materials/ID Cards

Change: Physician/OB-GYN, Address,E-mail Address, Username, Password



Oxford Prescription Drug List, medcohealth.com, Health RiskAssessment

Members can:

Check: Eligibility, Benefits, Claims,Referrals & Precertification Status

Submit: Referrals, Claims,Precertification Requests

Request: Materials

Change: Address, E-mail Address, Username, Password, Referral FaxNumber



Oxford Prescription Drug List, MD On-line

Providers can:



10

Sign Up Today

Brokers who do not have a username and password can register online atwww.oxfordhealth.com by following these steps:

1. Go to www.oxfordhealth.com

2. Click on Brokers3. Click the Need to register? button4. Fill in the requested information5. Begin to manage your account

Brokers can also call the Web site help desk at 1-800-811-0881 for assistance in obtaining ausername and password instantly.

Easy navigation. Enhanced functionality.

Our web site features a sleek four-tab layout which enables you to quickly access information,tools and transactions to help you grow and serve your book of business.

My Account

Our enhanced Business Center, located on the left of the page, makes it easy to search productinformation via convenient pull down menus.

Search for information by:• State – Connecticut, New Jersey or New York• Group size/type – Small, large, individual, or state-mandated• Search criteria – Product Information, How to Sell or Forms

The Featured Product section, located in the top right of the Business Center, changes periodically to highlight new Oxford plans.

Broker Highlights are listed in the center of the page. They rotate frequently, providing instantaccess to our latest news and product information. The broker highlight archive contains thehighlights that have rotated off the page.

Our innovative Idea Management SystemSM is only a click away on the right side of the MyAccount Screen. See page 13 of this guide for details on how this tool enables you manageyour entire block of Oxford small group business with ease!

Tools and Resources

Access forms and materials online – Requested forms and materials can be sent to the broker’s mailing address, or be mailed directly to their clients.

Stay informed. View recent communications online – Brokers can view all communi-cations sent to Oxford brokers within the last year, including broker web highlights newsletters,Commission Checkpoints, blast e-mails, and invitations to Oxford events.

Help your groups stay healthy – Brokers can access our wellness library, learn about ourmember programs, read Oxford publications and take the Health Risk Assessment.

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11

Transactions

Check commissions

• Inquire about Commissions and Commission History going back three months.• Select desired month. Click on Current Commission Calculation or Adjustments this

Period. View commissions for all groups or a specific group.

View Summary of Benefits online

Brokers and employer groups can access member Summaries of Benefits online. • Simply click on Check Benefits, and enter a valid Oxford member ID number or Social

Security number.

Check member eligibility

Simply enter the member’s Oxford member ID number or Social Security number and getinstant status of the member’s eligibility.

Check billing

• View Invoice Summaries for your groups simply by entering the group’s Oxford ID number.• Select a billing group you would like to view. Note that non-group COBRA billing groups

are not included.• Once you have selected a billing group, you will be taken to the latest Invoice Summary

for that group. To inquire about payments received since the invoice was generated, clickon Payment Inquiry.

Brokers Acting on Behalf of the Benefits Administrator

Brokers or benefits administrators can make updates to members’ accounts for those membersassigned to the benefits administrator’s billing groups. The following updates can be made:

• Change name (first name, last name, middle initial, suffix)• Update gender if “unknown” was selected on enrollment form• Change date of birth• Change Social Security number• Change subscriber address and e-mail information• Change subscriber home and business phone numbers • Make initial primary care physician (PCP) and OB/GYN selection• Change member contract specific package (CSP) and billing group• Change member coverage information• Enroll and/or terminate dependents

Brokers acting on behalf of the benefits administrator will only have access to the BA Self-Administration function through the employer site. See the Brokers Acting on Behalf of theBenefits Administrators section on page 77of this guide.

Search

Brokers, BAs and members can search for participating doctors, specialists, hospitals andhealth facilities, complimentary and alternative care providers, pharmacies, and laboratories.



12

UnitedHealth Premium® Designation Physician Search

To find information about physicians and other health care providers meeting PremiumDesignation standards, you just have to look for the stars.

Log on to www.oxfordhealth.com, to do a physician or hospital search and look for theUnitedHealth Premium designation blue star icon (*= quality physician or hospital;

**= quality and efficiency of care physician or hospital); Oxford members may call CustomerService at the number on their Oxford ID card.

Refer to the Oxford Programs section for more details on the UnitedHealth Premium®

Designation Program.

Streamline the enrollment process with real-time online member enrollment

To enroll a new member to an existing group, follow these easy steps:

• Go to www.oxfordhealth.com• Log in to the Web site with your username and password• Mouse over Enroll for the drop down list or go to the transaction tab and look at the

Enroll column. • Make your selection for adding, changing or terminating a member • Follow the simple instructions, and in minutes you receive the member’s Oxford ID

For more information visit the broker site at www.oxfordhealth.com

To enroll new members as part of IDEA online group enrollment

(2-50 lives only)

• Continue from Group Enrollment Manager by clicking the Member Enrollment button and follow the simple on screen instructions.

• Once online forms are completed the Oxford member ID will be immediately available • If appropriate, the member's spouse and dependents can be added from the Add

Employee Results screen

Note: To return to the Group Enrollment Manager at a future time, select "check groupenrollment status" to search for the group in question, and click Group EnrollmentManager in the Action column.

Online Member Enrollment



13

Our Idea Management SystemSM enables you to manage your entire Oxford book of businessonline. Our Interactive Distribution & Electronic Administration (IDEA) system will save youtime, aggravation, and money, while making it easier to find the right Oxford plan. More than anapplication, IDEA is an ongoing strategy — an example of our innovation, forward thinking, anddesire to meet your needs. With the ability to handle quote generation, online new groupenrollment and online renewals, you’ll experience total control like never before.

Small business services Available for groups with 2-50 enrolling employees

IDEA for Brokers

Get an instant quote Enter group information, design a benefit plan, get rates,

compare designs and rates, create and send a proposal

Enroll your groups • Create proposal before enrolling• Enroll group from an existing proposal• Check group enrollment status

Enroll members Enroll members in real time, receive new member IDsin minutes

Create rate tables Create your own generic rate tables for reference andcommunication (New York & Connecticut only)

Your proposals Retrieve and review proposals that are in progress

Your groups' renewals Review your groups that are within 60 days of their annual renewal, create optional plan designs, and submit the request for changes to us

Log on to Idea Management SystemSM today.

IDEA is accessible from the broker My Account, Transactions, and Tools and Resourcestabs on www.oxfordhealth.com.

You can now run the IDEA demo live from the broker Web site by clicking this button anywhere it appears:

IDEA for Employer Groups

The IDEA renewal tool is also available to employer groups. An IDEA icon will appear on theemployer group's home page 60 days prior to their renewal. The benefits administrator cancreate new business quotes, review their renewal, examine plan options prepared by their broker and finalize the renewal option of their choice. It’s that easy.

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idea management systemSM



14

Online Administration — Fast and Efficient

Here are some great uses of www.oxfordhealth.com for you and your clients:

• Online Enrollment – Employer groups can save time and cut down on paperwork byenrolling employees, dependents and spouses online. Terminating a member is also easy– takes just a few clicks. Encourage your clients to use these timesaving tools.

• Oxford Prescription Drug Lists (PDL) are available without logging in. Our PrescriptionDrug Lists are easy to understand, with a legend that clearly distinguishes between drugtier levels, quantity and precertification requirements. The links in the red Get to KnowOxford section at the bottom of the home page allow access to the PDL and a limitednumber of other resources without the need to log in.

Oxford Benefit ManagementSM Quotes Online in Seconds

Log on to www.oxfordbenefitmanagement.com, a singlesource solution for specialty benefits. Rates, benefit informationand all the necessary forms are all on our Web site. Go to page30 to learn more about Oxford Benefit Management products.

Online Tools Help us Keep Your Groups Healthy

Helping you and your clients stay healthy by putting health care information at your fingertips. You can find links to our online partners in the Manage Your Health section on theTools and Resources tab.


Oxford Products

15

Oxford Product Service Area

Bronx

Dutchess

KingsNassau

NY

Orange Putnam

Queens

Richmond

Rockland

Suffolk

Sullivan

Ulster

WestchesterFairfield

HartfordLitchfield

MiddlesexNew Haven

NewLondon

TollandWindham

Atlantic

Bergen

Burlington

Camden

CapeMay

Cumberland

Essex

Gloucester

Hudson

Hunterdon

Mercer

Middlesex

Monmouth

Morris

Ocean

Passaic

Salem

Somerset

Union

Warren

Sussex

Oxford Core Service Area

� New York

� New Jersey

� Connecticut


Oxford Products

16

Berkshire

Hampden

Worcester

Bronx

Broome

Columbia

Delaware

Dutchess

Greene

Kings

Nassau

New York

OrangePutnam

Queens

Richmond

Rockland

Suffolk

Sullivan

Ulster

Westchester

Berks

Bucks

Carbon

Chester

Columbia

Cumberland

Dauphin

Delaware

Lackawanna

Lancaster

Lebanon

Lehigh

Luzerne

Lycoming

Monroe

Montgomery

Montour

NorthamptonNorthumberland

Perry

Philadelphia

Pike

Schuylkill

Sullivan

Susquehanna

Wayne

Wyoming

York

Fairfield

HartfordLitchfield

Middlesex

New Haven

New London

TollandWindham

Kent

New

Castle

Sussex

Atlantic

Bergen

Burlington

Camden

Cape

May

Cumberland

Essex

Gloucester

Hudson

Hunterdon

Mercer

Middlesex

Monmouth

Morris

Ocean

Passaic

Salem

Somerset

Sussex

Union

Warren

BristolKent

Newport

Providence

Washington

Contiguous Tri-State Network

Outside Contiguous Tri-State Network

(Choice Plus National Network)

Tri-State Plus Service Area Map


Oxford Products

17

In-area Product

Enrollment

Counties Map

In-area Expanded Enrollment Counties:

Members residing in these counties

should have in-area Oxford products with

out-of-network benefits (PPO/POS) or

an Oxford NY EPO2 product to allow

access to Choice Plus network providers.

In-area Enrollment Counties: Members

residing in these counties have access to all

available Oxford products marketed in specific

counties (PPO/POS/HMO/EPO2).

Out-of-Area Counties: Members residing

in these counties must be enrolled in the

Oxford USASM products.

1MA, RI, PA, DE and Upstate NY sitused groups may only purchase a UnitedHealthcare or DefinitySM product.

2Oxford’s EPO in New York is currenty the sole in-network only product with access to the Choice Plus network.

Enrollment counties based on

Member residence in New York,

New Jersey, Connecticut,

Massachusetts, Rhode Island,

Pennsylvania, and Delaware1 for

groups underwritten in states

where Oxford products are sold -

New York, New Jersey, and

Connecticut.

Albany

Allegany

Bronx

Broome

Cattaraugus

Cayuga

ChautauquaChemung

Chenango

Clinton

Columbia

Cortland

Delaware

Dutchess

Erie

Essex

Franklin

Fulton

Genesee

Greene

Hamilton

Herkimer

Jefferson

Kings

Lewis

Livingston

Madison

Monroe

Montgomery

NassauNY

NiagaraOneida

Onondaga

Ontario

Orange

Orleans

Oswego

Otsego

Putnam

Queens

Rensselaer

Richmond

Rockland

St. Lawrence

Saratoga

Schenectady

Schoharie

Schuyler

Seneca

Steuben

Suffolk

Sullivan

Tioga

Tompkins

Ulster

Warren

Washington

Wayne

Westchester

WyomingYates

Adams

Allegheny

Armstrong

Beaver

Berks

Bedford

Cambria

Clearfield

Clinton

Huntingdon

Blair

Bradford

Bucks

Butler

Cameron

CarbonCentre

Chester

Clarion

Columbia

Crawford

Cumberland

Dauphin

Delaware

Elk

Erie

Fayette

Forest

FranklinFultonGreene

Indiana

Jefferson

Juniata

Lackawanna

Lancaster

Lawrence

Lebanon

Lehigh

Luzerne

Lycoming

McKean

Mercer

Mifflin

Monroe

Montgomery

Montour

NorthamptonNorthumberland

Perry

Philadelphia

Pike

Potter

Schuylkill

Snyder

Somerset

Sullivan

SusquehannaTioga

Union

Venango

Warren

Washington

Wayne

Westmoreland

Wyoming

York

Fairfield

HartfordLitchfield

Middlesex

New Haven

NewLondon

Tolland Windham

Kent

NewCastle

Sussex

Atlantic

Bergen

Burlington

Camden

CapeMay

Cumberland

Essex

Gloucester

Hudson

Hunterdon

Mercer

Middlesex

Monmouth

Morris

Ocean

Passaic

Salem

Somerset

Sussex

Union

Warren

BristolKent

Providence

Washington

Berkshire

Essex

Franklin

Hampshire

Middlesex

Norfolk

SuffolkWorcester

Hampden

Barnstable

Bristol

Dukes

Nantucket

Plymouth

Newport


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Please Note: All product information is based on a 1/1/08 effective date or later except Oxford Ease.* Oxford Ease will be available to New York and New Jersey small groups with second quarter effective date.** Oxford Consumer Options Suite is an electronic tool that provides employers groups of 51-99 eligible employees with flexibility in

both pricing and plan design selection. By offering four plan types (Access, Classic, Direct and EPO) we offer a wider range ofoptions to meet the diverse needs of your clients.


Oxford Products

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Oxford Products

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Overview

Flexible Spending Accounts – A Flexible Spending Account (FSA) is a benefit offered toan employee by an employer, which allows a fixed amount of pre-tax wages to be set aside forqualified expenses.

Health Reserve Accounts – A Health Reserve Account (HRA) is an annual financialaccount, funded by the employer, that cover the first half of their employees' deductible, but iscontrolled by the member.

Health Savings Accounts – A Health Savings Account (HSA) is a special tax-advantagedsavings account owned by employees to pay for qualified medical expenses for medical billsthat is coupled with a high deductible health plan (HDHP).

For more information on FSA or HRA administration, or if your clients are interested in aProcessWorks administered FSA or HRA, visit www.myprocessworks.com or contact yourOxford sales representative.

* Medical expenses allowed as deductions are determined by Section 213(d) of the Internal Revenue Service code.

Comparison: FSA HRA HSA

Unused dollars

Rollover

Portability

Covered items

Funding/contributions

Eligibility

Administration

Unused amount is lost.

N/A

Employer choice

Employer’s discretion.Medical FSAs confined byQualified EligibleHealthcare Expenses*

Benefit funded by theemployee

If an employer offers anFSA, all eligible employ-ees can opt to use it.

Funds are managed bythe employer’s chosenbenefits company such asProcessWorks, Inc.

Unused amount is lost;However, employers canchoose to include arollover option

Employer choice

Employer choice

Employer’s discretion.Used for items coveredunder SEC 213(d) that areapplied to the first half ofthe member’s deductible

Annual account funded bythe employer

If an employer offers aplan design to theiremployees enrolled inthat plan automaticallyhave a HRA

Funds are managed bythe insurance carrieroffering the plan or by a designated benefitscompany such asProcessWorks, Inc.

Unused amount is yoursto keep

Yes, always

Yes, always

No, employer control.Qualified EligibleHealthcare Expenses +COBRA & Medicarepremiums

Tax sheltered savingsaccount funded by anycombination of employerand employee

Only those employeesenrolled in a highdeductible health plan(HDHP) are eligible toopen an HSA.

The health savings accountis opened, managed andadministered through adesignated federal bankinginstitution such asOptumHealth Bank


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The Oxford Health Savings Account (HSA)

Overview

The Oxford Health Savings Account (HSA) combines Oxford medical coverage with HSAmanagement from OptumHealth Bank, Member FDIC. This tax-advantaged account givesmembers a new way to pay for health care expenses and plan for retirement, while givingemployers a lower premium without sacrificing the quality they have come to expect from us.

Eligibility

• Health Savings Accounts are available to almost everyone if they are covered by a qualified,high-deductible health insurance plan. An individual enrolled in an HSA eligible plan cannothave other health care coverage that covers the same services as the HSA. Vision, dental,accident, disability, auto, and certain other insurance policies are permitted.

• Individuals enrolled in Medicare are not eligible to contribute to HSAs. However, they can stillspend money they have previously accumulated in their HSA.

• Individuals who can be claimed as a dependent on another person’s tax return are not eligible.

Using your Health Savings Account

• Account holders may use the HSA to pay for qualified medical expenses, but are not requiredto use it. The money belongs to them, and they may elect to spend it or save it in the tax-advantaged account as they see fit.

• All expenses under Section 213d of the IRS code are eligible for reimbursement by the HSAon a tax-free basis:

• Doctor visits, hospital expenses, lab, x-ray, and other diagnostic services• Prescription drugs, dental care, vision care, hearing aids• Visit the HSA section on www.oxfordhealth.com for a full list of all eligible expenses

• The HSA may be used for a number of expenses in addition to those outlined in Section213d, including COBRA and short-term premium.

• The account holder is responsible for ensuring that expenses paid from the account are qualified medical expenses.

• The HSA may be used for eligible expenses incurred by any spouse or dependent.

• HSA funds used for purposes other than the above are considered taxable income and anadditional excise penalty of 10% applies.

• It is the responsibility of the account owner, not the employer, to substantiate the proper useof these funds. The IRS may question disbursements from an HSA, so the account holdermust keep adequate records concerning the use of the HSA funds.


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New Investment Options for 2008

Our HSAs now deliver a simpler, more personal consumer experience through an innovativeapproach that allows consumers to customize their HSA to closely match their health carespending, savings patterns and overall financial philosophy.

• Health eAccess HSA — Low-cost HSA designed for active health care spenders who donot carry a large balance and prefer a lower monthly maintenance fee. No interest is paid onaccount balances.

• Health eSaver HSA — A good choice for a broad range of needs, easy access to pay current expenses, competitive interest rates, moderate fees and the option to invest balancesin no-load mutual funds with no additional fee.

• Health eInvestor HSA — Designed for employees with less of a need to spend now, andwho plan to contribute to and grow their HSA balances. Ability to invest more money in mutual funds by paying an additional investment fee.

1 ACCOUNTS WITH A BALANCE BELOW $100:For accounts opened on or after 10/27/07, a portion of the Monthly Maintenance Fee ($3.00) applicable to balancesbelow $100 will be reimbursed to the HSA for the first 3 months after account funding. For accounts opened before10/27/07 with a balance below $100, a portion of the Monthly Maintenance Fee ($3.00) will be reimbursed to theHSA through March 2008 in months when the balance on the account is below $100. For existing accounts, thecurrent Monthly Maintenance Fee includes fees that were previously disclosed as “Monthly Maintenance Fees” and“Below Minimum Balance Fees.” All reimbursement amounts will be reflected on the monthly statement following themonth in which the fee occurred. Fees may reduce earnings on the account.

2 Annual Percentage Yields (APYs) as of 09/1/2007, subject to change at anytime.3 The bank account balance must remain at or exceed the Investment Threshold each time a new investment is made.4 Investment Fee (where applicable) is only assessed after the establishment of an investment.

Health eAccess Health eSaver Health eInvestor

Monthly

Maintenance

Fee1

(required minimum balance does not include investment funds)

$0 if balance exceeds $500

$1 if balance is

$100 - $499.99

$4 if balance is below $100

$0 if balance exceeds $5,000

$3 if balance is

$100 - $4,999.99


$0 if balance exceeds $5,000

$3 if balance is

$100 - $4,999.99


Balance

Required to

Obtain APY

Annual Percentage Yield

(APY) 2


(APY) 2


(APY) 2

$0-$499.99 0.00% 0.50% 0.50%

$500-$999.99 0.00% 1.26% 1.26 %

$1,000-

$1,999.990.00% 2.27% 2.27%

$2,000-

$4,999.990.00% 2.78% 2.78%

$5,000-

$14,999.990.00% 3.82% 3.82%

$15,000+ 0.00% 4.91% 4.91%

Investment

Threshold3 $2,000 $2,000 $500

Monthly

Investment Fee4 $3 $0 $2.50


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Oxford Products

Full Suite of Specialty Products

Looking for specialty products beyond Oxford medical coverage to offer your clients? Look nofurther. For over 20 years, Oxford has been a trusted name for your health care needs. Andnow, we’ve got even more to offer you, including an innovative selection of specialty productsand services — dental, vision, life, disability, and prepackaged benefit plans. All the specialtyproducts your clients have been asking for...

Dental

UnitedHealthcare Dental is an experienced dentalbenefit organization with more than 20 years ofindustry experience and a large national preferred provider organization (PPO) network of over85,000 dentists and dental specialists.2 UnitedHealthcare Dental offers a flexible dental prod-uct portfolio with varying employee expense options including Dental Options PPO, in-networkonly (INO), voluntary, dental plus vision and Indemnity plans.

Dental product features:

• Industry-leading dental products providing flexibility and convenience• National average PPO discount of 37%• 24-hour access to benefits information and interactive voice response

(IVR) system• Interactive member Web site at www.myuhcdental.com

Vision

UnitedHealthcare Vision has been providing visioncare benefits since 1964. As one of the top visionbenefit companies in the United States, they have provided and administered vision care benefitsfor over 18 million members nationwide. UnitedHealthcare Vision offers many plan options toreceive coverage for eye examinations, lenses and frames, or contacts (in lieu of eyeglasses).UnitedHealthcare Vision’s network includes more than 25,000 contracted vision providers, includ-ing private practice and retail chains.3

Vision product features:

• State-of-the-art, company-owned optical lab• Preferred pricing on materials and selection options• No claim forms to submit and no separate vision ID card• 24-hour access to benefit information and interactive voice response

(IVR) system• Informative Web site at www.uhcspecialtybenefits.com

2 Data as of February 2008.3 Current as of February 2008.

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Life & Disability

UnitedHealthcare Specialty Benefits unites a comprehensive portfolio of specialty insuranceproducts from one credible source. Our broad array of products includes group and voluntary insurance, as well as non-insurance programs and worksite products.

Life features

• Portfolio of basic, dependent and supplemental life insurance policies • AD&D benefit available with purchase of a basic policy• Accelerated death benefit up to 50% of covered amount, under certain

circumstances• Portability for supplemental coverage• Informative Web site at www.uhcspecialtybenefits.com

Disability features

• Array of standard benefits and optional enhancements• Emphasis on employee productivity and return to work• Claims management expertise• Informative Web site at www.uhcspecialtybenefits.com

Oxford Benefit Management

Oxford Benefit ManagementSM (OBM) provides access to a unique selection of prepackaged benefit plans.

Prepackaged benefit plans

OBM prepackaged benefit plans provide access to a unique selection of discount and fullyinsured specialty products from the following UnitedHealth Group companies: UnitedHealthcareDental, UnitedHealthcare Vision, UnitedHealthcare Specialty Benefits and UnitedHealth Allies.Using these products, we’ve created four competitively priced plans to offer a range of choicesto suit varying needs — each providing dental coverage, vision coverage, work and life services,and health discounts. When purchasing any of the OBM specialty options, employers may alsoelect to include a basic life insurance product from UnitedHealthcare Specialty Benefits – coverage is available in flat amounts of $10,000 or $25,000.

Prepackaged benefit plan features

• All specialty products are bundled into one convenient package providing a single monthly bill and one ID card

• Instant online rate quotes• Competitive pricing• Informative Web site at www.oxfordbenefitmanagement.com

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How We Help Members Stay Healthy

We know our members want to stay healthy, and we want to help them along on the path tobetter health. That’s why we’ve come up with several ways to help our members feel their best.Our preventive programs feature various services that can help members stay well.

Oxford On-Call® offers health care guidance from registered nurses 24 hours a day, seven days a week.

Complementary & Alternative Medicine Program offers access to a credentialed net-work of approximately 4,400 complementary & alternative medicine providers in New York,New Jersey and Connecticut — from massage therapists to chiropractors.4

Oxford Healthy Mother, Healthy Baby® complements the care that expectant membersreceive from their doctor by providing educational information from expert sources on prenataland newborn care. Expectant mothers who notify us of their pregnancy and/or delivery willreceive these materials.

Reminder mailings are sent to members who have not received a preventive exam withinthe recommended time period — based upon clinical guidelines — to remind them to makeappointments for the preventive care they need.

Healthy Mind Healthy Body® magazine features articles on prevention, exercise, nutrition,health, and wellness. It also includes information about accessing Oxford resources and external support organizations, as well as updates on administrative policies and procedures.

4 Based upon 1/1/07 provider data. Includes acupuncturists, massage therapists, chiropractors, naturopaths, nutritionists, and yoga instructors. Providertype and availability vary by state and plan.


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Managing Chronic Conditions

Our disease management programs are designed to assist members with chronic conditions,such as asthma or heart disease. These programs help members take an active role in managingtheir condition. Additional information is available at www.oxfordhealth.com.

Better Breathing® program

The Better Breathing program is designed to help educate children and adults with asthma.Members participating in this program receive information about the triggers of asthma and howto avoid them, as well as the proper way to administer medication. Eligible program members canreceive a complimentary peak flow meter and/or spacer to help them manage their asthma.

Living with DiabetesSM program

This program emphasizes patient education to improve self-management and to keep physiciansinformed about the current guidelines of the American Diabetes Association. Eligible programmembers may receive a cookbook with healthy recipes for people with diabetes.

Heart SmartSM program

This program helps members with cardiovascular disease (CVD) and congestive heart failure(CHF) understand and improve their health and quality of life. Materials are available to educatemembers about hypertension, cholesterol management, the needs associated with medicationcompliance, and lifestyle modification.

Active Care EngagementSM (ACE) program

The Active Care Engagement (ACE) program is a comprehensive health management programfor high-risk members with congestive heart failure, coronary artery disease and diabetes. Theprogram is designed to help members manage their chronic condition, resulting in improvedhealth status and quality of life. Member support includes regular telephonic nursing interventionfocusing on lifestyle modification, education of the disease process, symptom management, andmedication adherence.

Additionally, the ACE program helps assist physicians in their successful management of thechronically ill member. Physicians with members participating in the program receive disease-specific guidelines for care, patient-specific data reports, and a variety of educationaland support materials geared toward improving adherence to nationally recognized care guidelinesfor cardiac and diabetic conditions.

Oxford Cancer Support program

The Oxford Cancer Support Program is a comprehensive program designed to empower membersthrough education and assist with coordination of cancer care through care management forcertain diagnoses. We encourage members to have important screening tests for early detectionof cancer and provides members who have cancer with access to quality, coordinated cancer care.

For more information about these programs, log onto www.oxfordhealth.com, go tothe Tools and Resources tab and select Managing Disease.

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Healthy Bonus®

Our Healthy Bonus discount program offers special savings to our members on vision care,weight loss, fitness, nutrition, and spa services.

• Puritan’s Pride® Vitamins – 10% savings on over 1,400 products.

• Birth And Beginning Year TM – Receive the ABC’s of Prenatal Fitness Mini-Poster for $12.

• FIJI Water – $50 off a one year subscription to FIJIWater Home Delivery.

• Premier Martial Arts – One month of unlimited martial arts classes, an official Premier Martial Arts uni form and a private introductory class for $49.

• SpaWish, Inc. – $10 off a purchase of $100 or more.

• STOTT PILATESTM – 15% off suggested retail prices on STOTT PILATES videos and equipment.

• Today’s CaregiverTM Magazine – 40% off one-year subscription cover price.

• Tiger Schulmann’s MMA – A month of karate and a uniform for $49, plus one free privatelesson.

• QuitNet® – A lifetime membership to QuitNet for $65, a 35% discount off the regular membership price.

• Diabetic Express – 10% off a wide selection of diabetes-related products.

• National Allergy Supply – 10% on products designed to make living with allergies and asthma easier.

• How to Teach Nutrition to Kids – This book is available to Oxford members for $11.97 – 40% off the cover price.

• ActiveForever – 10% off a selection of medical, rehabilitation and convenience products.

• Weight Watchers® – Receive free registration, $10 off the at-home deluxe kit and $10 off a three-month online subscription.

For more information on the discounts available, log on to www.oxfordhealth.com and go to the Tools and Resources tab.

Note: Offers are valid through December 31, 2008. These discounts are offered in addition to, and separate from, the member’s Oxfordbenefit coverage. These arrangements have been made for the benefit of members, and do not represent an endorsement or guaranteeon our part. Discounts may change from time to time and without notice and are applicable to the items referenced only. We cannotassume any responsibility for the products or services provided by vendors or the failure of vendors referenced to make available discountsnegotiated with us; however, any failure to receive discounts should be reported to Customer Service at 1-800-444-6222.

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Health Risk Assessment

We believe good health starts with education and empowerment. Our online health assessmenttool is designed to help members create goals for health care behaviors they wish to change.

The Health Risk Assessment is available on the member site of www.oxfordhealth.com.

Once a member has completed the health assessment, they will receive a personalized healthreport focusing on these 18 key health areas:

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• Fitness• Alcohol• Smoking and tobacco• Safety: driving, home safety• Nutrition: full analysis of diet• Body image: body mass index (BMI)• Back pain • High blood pressure• Cholesterol

• Stress• Depression• Family planning• Pregnancy • Family health history• Preventive measures• Cancer risks • Diabetes• Heart disease


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Commercial Pharmacy Programs

Our prescription drug plan is comprised of a comprehensive package of benefits that includesa complete Prescription Drug List (PDL) and pharmacy management programs. These pro-grams are updated as new drug products are approved by the Food and Drug Administration(FDA) and when new pharmaceutical information becomes available.

Pharmacy Customer Service 1-800-905-0201 24 hours/7 days a week (except for Thanksgivingand Christmas)

Pharmacy Program Frequently Asked Questions

Where can members go to find out more about prescription drugs?

Members can log on to www.oxfordhealth.com and select Oxford’s PrescriptionDrug List on the Tools and Resources or Search tab. Members may also log on toMedco’s web site, www.medcohealth.com.

What are tier designations, and how do they affect what members actually pay at

the pharmacy? What is the difference in copayments between brand and generic

medications?

Prescription medications are categorized within tiers, and each tier is assigned a copaymentamount (an amount members pay when they fill prescriptions at a retail pharmacy or orderthem through our mail-order service). If a member has a two-tier pharmacy benefit, the copayment will be lower for generic medications and higher for brand medications. If a member has a three-tier pharmacy benefit, the copayment will be lowest amount for medica-tions in Tier 1, higher for medications in Tier 2, and highest for medications in Tier 3.

Regardless of whether a member has a two-tier or a three-tier pharmacy benefit, generic med-ications generally have lower copayments than brand name medications. Below are someexamples of our two- and three-tier pharmacy benefit plans.

Some examples of our two-tier pharmacy benefit plans.

Tier 1 Tier 2

$5.00 $10.00$5.00 $15.00$7.00 $20.00

Some examples of our three-tier pharmacy benefit plans.

Tier 1 Tier 2 Tier 3

$5.00 $15.00 $35.00$7.00 $20.00 $50.00$10.00 $25.00 $50.00

(Please note: Copayment levels will vary depending on the pharmacy benefits selected by the employer group.)

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Why do we require precertification or prior approval on certain medications?

We have a mission to help our members maintain and improve their overall health through theappropriate use of medications. To this end, we have established programs to encourage medication therapy that is appropriate and economical for our members.

For most members with pharmacy benefit coverage, certain medications on the PrescriptionDrug List (including generic equivalents, if available) generally require precertification based onour coverage criteria. Precertification, also known as prior authorization, requires the member’sdoctor to formally submit a request and receive approval for coverage of certain prescriptionmedications.

To obtain precertification, a member should ask his or her doctor to call 1-800-753-2851,Monday through Friday, from 8:00 AM to 9:00 PM (EST).

Why do we limit the quantity covered at one time for certain medications?

For certain medications, there is a maximum quantity that can be covered for one prescription,one copayment or one month. These quantity limits are based upon the manufacturer’s packagesize, dosing indications that are included in the FDA labeling, and medical literature or guide-lines. If a member’s prescription exceeds the limit, his or her pharmacist will be notified of thequantity covered.

The member will have the option to:

• Accept the established quantity limit.• Pay additional out-of-pocket costs for amounts that exceed the quantity limit.• Discuss alternatives with his or her doctor before deciding whether to fill the prescription.• Request precertification for the additional amounts (when precertification is available).

In all cases, our goal is to encourage appropriate use of medications by our members basedupon published clinical evidence.

What’s a Prescription Drug List, and what does it mean to a member’s coverage?

The Prescription Drug List (PDL)* is a tool that helps our members and their doctors select out-patient prescription medications. The PDL includes brand-name and generic medications thathave been approved by the FDA as safe and effective.

It is important to note that the listing of a medication in the PDL does not guarantee coverage,as certain products are excluded due to benefit plan design limitations specific to your pharmacybenefit. The PDL only applies to outpatient prescription medications dispensed by participatingpharmacies and does not apply to inpatient medications or to medications obtained from and/oradministered in a doctor’s office. Members should check their Summary of Benefits andPrescription Drug Rider for details on their pharmacy plan, including any exclusions that may apply.

* We offer a Traditional and an Advantage PDL. PDL selection is dependent upon the group’splan design.


Can a member order prescription medications by mail?

To obtain prescription medications filled through our mail-order pharmacy, Medco By Mail, amember’s coverage must include a mail-order benefit. If a member is not sure if they have amail-order benefit, they should call Pharmacy Customer Service at 1-800-905-0201.

If a member has mail-order pharmacy coverage, he or she should log on towww.oxfordhealth.com as an Oxford member, click on Tools & Resources,Practical Resources, Your Pharmacy Coverage, then Medco Health’s Prescription Mail Order Program for specific instructions on filling prescription medications by mail.

It is important to note that only certain medications used on an ongoing basis can be filledthrough the mail-order benefit.

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UnitedHealth Premium® Designation Program

The UnitedHealth Premium®

designation program provides members with important tools anddata to help them make informed health care decisions. This program identifies physicians andhospitals with services that meet or exceed the externally developed standards we use in evaluating quality and efficient care. Doctors* practicing in the following medical specialtieshave been evaluated against these standards for quality and efficiency:

• Cardiac & cardiac surgery (heart)• Oncology (cancer)• Orthopaedic (musculoskeletal, rheumatology)• Respiratory (allergies, lungs)• Metabolic (diabetes, endocrine glands, thyroid, kidneys)• Nervous system (neurology)• Spine care• Adult primary care/internal medicine• Pediatrics• Obstetrics & gynecology (OB/GYN)*Assessment for this program is based on data from services delivered in theUnitedHealthcare commercial, Oxford Freedom Network, and Oxford LibertyNetwork (New York and New Jersey) products.

UnitedHealth Premium designation makes the choice easier with our UnitedHealthPremium designation rating system. It clearly shows which doctors and cardiac facilitiesmeet the quality and efficiency standards we use.

To find information about physicians and other health care providers meeting those standards,you just have to look for the stars. Log on to www.oxfordhealth.com, to do a physicianor hospital search and look for the UnitedHealth Premium designation blue star icon (*= quality physician or hospital;**= quality and efficiency of care physician or hospital). Oxford members may call Customer Service at the number on their Oxford ID card.


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Voluntary Consumer Programs

UnitedHealth Pharmaceutical Solutions (UHPS), the designated pharmacy benefit manager (PBM)for Oxford commercial members, has established voluntary consumer programs to educate andinform members about potential cost savings available through their pharmacy benefit.

These programs are committed to providing information to members to help them makeinformed decisions about prescription medications and to get the most value from their pharmacybenefit. UHPS sends periodic mailings to members who may benefit from these programs.

Educates members about lower cost, high value prescriptionalternatives and over-the-counter (OTC) alternatives.

Generates monthly mailings to fully insured members, who aretaking certain Tier 3 medications, to inform them about theavailability of high value, lower cost Tier 1 alternatives.

Members who are utilizing a medication included in the HalfTablet Program will:• Receive a notification letter in the mail informing them of the Half

Tablet Program. (This occurs automatically for fully insured members).• Be advised to discuss the program with his or her physician or

pharmacist.• If they decide that the program is appropriate, the member's

physician writes a new prescription for the higher-strengthdosage with instructions to take one half tablet.

• Realize a cost savings through a reduced copayment if they participate

• Receive instructions for obtaining a free tablet splitter.

Addresses the value of using mail order through consumer savings,safety and satisfaction and strives to increase mail order use byproviding members with personalized, money-saving information.

Identifies potential over-utilizers of narcotic medications or thosemembers that seek narcotics inappropriately.

Encourages the use of this vital piece of equipment which willhelp ensure control of the member's blood sugar, delaying orreducing the risk of complications from diabetes.

Applies to self-administered medications covered under thepharmacy benefit.

Informs members of their medication use, the costs incurred and information on lower cost alternative medications that may be available.

High Value

Alternatives

Generics Program

Half Tablet Program

Mail Order Program

Narcotics High

Utilization

Free Glucose Meter

Program

Specialty Pharmacy

Program

Personal Prescription

Summary (PPS)


Group Enrollment and Eligibility

39

Large Group (51+ Lives) Eligibility Requirements by State

New York Large Group

All group enrollment forms are available on the broker site at www.oxfordhealth.com.

New York Large Group

51 or more full-time employees

51 or more eligible employees

Full-time employees must work the minimum hours set by the group but no fewer than 30 hours per week

Residence out of country (Contact an Oxford sales representative regarding eligibility of union, 1099, COBRA, and part-time employees)

Must be at least 50%

12 months

Manual: Based on plan design, effective date, location, industry, and demographics (generally 51-100 lives)Experience: Based on the group’s experience and in mostcases, blended with manual rates (generally 100+ lives)Community (HMO/Liberty Network): Based on benefits chosen, effective date, and location of business

Full Conversion: 75% participation of in-area eligible employeesOffering: Minimums may apply

Must not be a P.O. BoxMust have a home or branch office in the Oxford New Yorkservice area

Go to page15 for the Oxford product service area map

Eligibility Requirements

# of employees

# of eligible employees

Full-time hours

Ineligible employees

Employer contributions

Length of contract

Rates

Plan participation

Primary address

Service area

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New Jersey Large Group


New Jersey Large Group




Residence out of country (Contact an Oxford sales representative regarding eligibility of union, 1099, COBRA, andpart-time employees)


12 months

Manual: Based on plan design, effective date, location, indus-try, and demographics (generally 51-100 lives)Experience: Based on the group’s experience and, in mostcases, blended with manual rates (generally 100+ lives)


Must not be a P.O. BoxMust have a home or branch office in the Oxford New Jerseyservice area

Go to page15 for the Oxford product service area map


# of employees


Full-time hours



Length of contract

Rates

Plan participation

Primary address

Service area

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41

Connecticut Large Group


Connecticut Large Group




Residence out of country (Contact an Oxford sales representative regarding eligibility of union, 1099, COBRA, andpart-time employees)


12 months

Manual: Based on plan design, effective date, location, indus-try, and demographics (generally 51-100 lives)Experience: Based on the group’s experience and in mostcases blended with manual rates (generally 100+ lives)


Must not be a P.O. BoxMust have a home or branch office in the Oxford Connecticutservice area

Go to page 15 for the Oxford product service area map


# of employees


Full-time hours



Length of contract

Rates

Plan participation

Primary address

Service area

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Small Group Eligibility Requirements by State

New York Small Group

Enroll your small groups online with Idea Management SystemSM on the broker

site at www.oxfordhealth.com

* COBRA employees and retirees are not included in the employee count but can still be enrolled.


# of employees


Full-time hours



Length of contract

Rates

Plan participation

Primary address

Service area

Pre-existing conditions

Effective Dates


50 or fewer full-time employees

Minimum of two eligible employees, at least one enrolled in anOxford product

Full-time employees must work the minimum number of hoursset forth by the group, but no fewer than 20 hours per week

Employees not eligible and not in the employee count includeunion, 1099, COBRA*, part-time, and residence out of country

No state-mandated employer contributions

If the initial effective date is on the first of the month, the groupwill renew on the first of the same month each year (12months); If the initial effective date is on the 15th of the month,the group will renew on the first of the following month (12.5months)

Community rated based on benefits chosen, effective date andlocation of business

No minimum percentage of participation required• At least one active eligible employee must be enrolled • No more than 75% of enrollees may reside outside the Oxford

service area; Expanded area membership is included in the in-area total

Must not be a P.O. Box. Primary business address must be with-in the Oxford New York service area


See New York Small Group Member Eligibility section on page60 for pre-existing condition rules

May choose the 1st or the 15th of the month; Packets must bereceived on or before the chosen effective date

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Healthy NY Small Group

Enroll your Healthy NY groups online with Idea Management SystemSM on the brokersite at www.oxfordhealth.com.


State-mandated HMO product offered to New York small groups that meet the following requirements:

• 50 or fewer eligible employees

• 30% of the employees must earn wages of $36,500* or less

• Employer must certify that they have not provided coverage for both medical and hospitalcoverage for their employees within the last 12-month period preceding the requestedeffective date on the Healthy NY application

• A small employer is considered to have provided health insurance if the employerhas BOTH arranged for and contributed more than $50 (or $75 if the business is located in the Bronx, Kings, Nassau, New York, Orange, Putnam, Queens,Richmond, Rockland, Suffolk, or Westchester counties) per employee, per monthtoward health insurance

• 50% of the eligible employees must participate in the program, and at least oneparticipant must earn annual wages of $36,500* or less

• Employees who have health insurance coverage through another source maycount towards the 50% participation requirement

• Employer is responsible for contributing at least 50% toward the premium

• Business must be located within New York State

* Adjusted annually for inflation

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Business Organizations in Operation more than 12 months

Sole Proprietors:• Provide at least one of the following from most recent tax year:

• Schedule C – Profit & Loss From Business (Sole Proprietorship)• Schedule C-EZ – Net Profit From Business (Sole Proprietorship)• Schedule F – Profit & Loss From Farming

• Provide a current signed copy of first two pages of U.S. Individual Tax Return Form 1040• Any W-2 forms reported on the sole proprietor’s 1040 must be submitted• Gross income from Schedule C, C-EZ or F must exceed any W-2 income the applicant may have received.

• Sign the Sole Proprietor and Group of One Attestation Form

S-Corporations:• Provide an IRS Form 1120-S – Income Tax Form for S Corporations• Provide a Schedule K-1

• Schedule K-1 must show 100% ownership (i.e. sole S-Corp shareholder) for prospective insured.

• Provide a W-2• Received by the shareholder-employee from the S-Corporation under which group coverage with us is sought. In addition, if applicable, S-Corporation shareholder must provide any other W-2s reported on their 1040 from other business organizations.• Gross income from IRS Form 1120-S must exceed any W-2 income the applicant may have received from other business organizations.

• Provide current signed copy of the first two pages of the U.S. Individual Tax Return Form1040 and Schedule E (if applicable) for the S-Corporation shareholder who seeks coverage.

• Sign the Oxford Sole Proprietor and Group of One Attestation Form

Business Organizations in Operation less than 12 months

• Provide the following:• Certificate of Incorporation (for S-Corporations only)• NYS Business License (if applicable)• Copy of Business Bank Statement (for Sole Proprietors only)

• Sign the Oxford Sole Proprietor and Group of One Attestation Form

We reserve the right to modify the above eligibility requirements and required documentation.

• Deadline for application receipt (both paper and online) is the day before the effective date.

Oxford Sole Proprietor Product: New York

Enroll your sole proprietors online with Idea Management SystemSM on the broker

site at www.oxfordhealth.com.

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45

New Jersey Small Group

Enroll your small groups online with Idea Management SystemSM on the broker site at www.oxfordhealth.com.

* COBRA employees and retirees are not included in the employee count but can still be enrolled.


# of employees


Full-time hours



Length of contract

Rates

Plan participation

Primary address

Service area


Effective dates

NNeeww JJeerrsseeyy SSmmaallll GGrroouupp

2-50 full-time employees; Employer groups of one are not covered in New Jersey

Minimum of two eligible employees, at least one enrolled in anOxford product

Full-time employees must work a minimum of 25 hours per week

Employees not eligible and not in the employee count includeunion, COBRA*, part-time, and residence out of country

State mandates 10% minimum of employer contributiontowards employee premiums

If the initial effective date is the first of the month, the groupwill renew on the first of the same month each year; Any effec-tive date after the first of the month, the group will renew onthe first of the following month.

Manually rated based on benefits chosen, location of business, effective date of coverage, number of employees,age and sex of employees, and contract (tier) type

• Minimum of 75% of eligible employees must participate inone of the group’s health plans or must have waived coveragedue to other coverage

• No more than 80% of enrolled employees may reside outsidethe service area; Expanded area membership is included inthe in-area total.

Primary address can be P.O. Box; However, the NJ SmallEmployer Certification Form must contain the group’s physical address within New Jersey; Primary business addressmust be in the state of New Jersey


See New Jersey Small Group Member Eligibility section onpage 60 for pre-existing condition rules

May choose any day of the month; Packets must be receivedon or before the chosen effective date

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Connecticut Small Group

Enroll your small groups online with Idea Management SystemSM on the broker site at www.oxfordhealth.com.

5 Company must be in effect for three consecutive months from their effective date of business as registered with the State of Connecticut whenapplying for their Connecticut State Tax ID.

* COBRA employees are not included in the employee count but can still be enrolled.


# of employees


Full-time hours



Length of contract

Rates

Plan participation


50 or fewer full-time employees5

Minimum of one eligible employee; State mandate provides forcoverage for sole proprietorship

Full-time employees must work a minimum of 30 hours per week

Employees not eligible and not in the employee count includeunion, 1099, COBRA*, part-time, and residence out of country

We require 50% minimum of employer contribution towardsemployee premiums only

If the initial effective date is on the first of the month, the group will renew on the first of the same month each year (12 months); If the initial effective date is on the 15th of themonth, the group will renew on the first of the following month(12.5 months).

Based on benefits chosen, effective date of coverage, location ofbusiness, number of enrolling employees, age of the employee atthe time of the effective date, and contract type

The company must be in business for three consecutive monthsprior to the requested effective date. • No more than 10% of enrollees may be retirees• No more than 49% of enrollees may reside outside the

service area; Expanded area membership is included in the in-area total

• Groups with one life require 100% enrollment • Groups with 2-9 lives require 75% enrollment from active

eligible employees (Note: two-life group that is husband/wiferequires 50% enrollment)

• Groups with 10-50 lives require 65% enrollment from activeeligible employees

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CT Blue Ribbon Small Group Eligibility Requirements

Enroll your Blue Ribbon groups online with Idea Management SystemSM on the broker site at www.oxfordhealth.com.


• State-mandated product offered to Connecticut small groups that meet the following definitions:

• Small employer with 50 or fewer employees, including groups of one person

• Self-employed person who must be actively in business in Connecticut for threeconsecutive months and work a minimum of 30 hours per week

• A one-person group may be eligible for other Connecticut products, but most often isplaced on a Blue Ribbon product


Primary address

Service area


Effective dates

Connecticut (continued)

Must not be a P.O. Box; Primary business address must be inthe State of Connecticut


No pre-existing conditions apply

May choose the 1st or the 15th of the month. Packets mustbe received on or before the chosen effective date

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Billing and Payments

49

Billing Basics

Oxford plans are prepaid – groups receive a bill each month for the following

month’s coverage.

• Each month’s payment should include:

• A remittance advice for each invoice, with the payment amount for that billing groupnoted in the appropriate space

• A check for the total amount due for each invoice. The group may submit a single checkfor multiple invoices. If the group does so, the group should clearly state the amount tobe applied to each invoice.

• Please be advised that we may terminate coverage for any group that does not remit full pay-ment by the end of the grace period on which payment is due. We will terminate groups atthe end of the month (which corresponds to the grace period).

• We will not pay claims incurred after the termination date, and we will not reinstate groupsthat have been terminated due to a delinquent payment history.

Member Effective/Termination Dates and Premium Due

• If the member becomes effective between the 1st and the 15th of the month, the group ischarged for the member for the entire month.

• If the member becomes effective between the 16th and the last day of the month, thegroup will not be charged for the member for that month.

• If the member is terminated between the 1st and the 15th of the month, the group is notcharged for the member for the entire month.

• If the member is terminated between the 16th and the last day of the month, the group willbe charged for the member for the entire month.

Example of the monthly billing cycle for September:

• September premium is due on September 1. The grace period begins on this date.

• Groups that did not remit full payment during grace periods ending in the previous month(August) are terminated, effective as of the end of the grace period.

• On approximately the 8th of September, bills are generated for the following month(October). Additions and terminations made after the bill is generated will be

reflected on the following month’s bill.

• Between the 15th and 18th of September, automatic reminder letters are sent to groupsthat have not paid for September and have a balance due of $1 or more.



50

Remittance Advice

• The group should indicate, in the appropriate box on the front of the form, the amount theyare sending in.

• The group should indicate, on the back of the form, how they would like their paymentapplied. If this is not indicated, payment will be applied to the oldest open invoice.

• How to submit payment:• Include the remittance advice and payment only• Indicate the group number and invoice number on the check• Make sure payment is sent in on or before the due date

Check Billing on the Web and Oxford Express®

• With a username and password, brokers can check a group’s billing status at www.oxfordhealth.com.

• With Oxford Express®, brokers can check:• Current balance• Last payment amount• Date the last payment was credited• Past invoice (fax back available)• General billing addresses (fax back available)

Frequently Asked Billing Questions

Q: Who should a broker call to assist their group with a discrepancy with their bill?

A: They should call Client Services if there is a discrepancy.

Q: If there is a problem with a bill, do groups have to pay in full?

A: Yes. All invoices should be paid as billed. We will adjust for changes and will credit/debit thegroup’s next bill.

Q: Can groups submit additions, terminations and changes with the monthly payment?

A: No. Changes that are submitted to the payment location will not be processed. Please submit all addition/termination/enrollment requests to the Oxford Enrollment Departmentaddress listed in the Important Addresses section of this guide.

Q: When will additions and terminations appear on a group’s Oxford bill?

A: Changes that are entered prior to the 8th of the month will be reflected on the next bill. If processed after the 8th, they will appear on the subsequent bill.

Q: If an employee resigns, is terminated or becomes ineligible for health benefits

per the company’s policies or the provisions of the Oxford coverage, what

should be submitted?

A: An Addition/Termination/Change (ATC) Form must be signed within 31 days of the termination date by the benefits administrator. The form can be mailed to the Oxford Enrollment Department address listed in the Important Addresses section of this guide.

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Direct Debit Authorization

The Direct Debit Authorization Form is available on the Transaction tab, under Request on the employer site at www.oxfordhealth.com


51

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Direct Debit

Overview

How to request

How to enroll

Direct debit is a secure and cost effective process by whichgroups authorize us to withdraw monthly premiums from theirbank account electronically

New groups:• Send group application and binder check as indicated on

the group enrollment package; Once the group receivestheir first bill, the Group Contact should call us at 1-800-366-4148 to request Direct Debit

Existing Groups:• Contact our Financial Operations Department at

1-800-366-4148 to request Direct Debit

• Complete and sign the Direct Debit authorization form• List the group number to be paid by automatic withdrawl

Note: All billing groups for any group number must be drawn from the same account

• Provide a voided check for the account from which thefunds will be drawn

• Fax or e-mail this information to 203-459-7372 or [email protected]


Member Enrollment and Eligibility

53

Large Group Requirements for New York,

New Jersey and Connecticut

Eligibility

Effective dates

How to enroll

Submission


Retirees

Eligibility

Effective dates

How to enroll

Submission

Eligibility

Any employee meeting the eligibility requirements of the group

• Date the employee meets the eligibility lag • Open enrollment• Date of a HIPAA event (See HIPAA section on p. 55)

• Online: www.oxfordhealth.com• Form: Member Enrollment Form • EDI: 100+ life groups via an Account Manager• Note: Supporting documentation may be required

Within 31 days of the effective date

Does not apply

Coverage for retirees must be specified on group application

• Legal spouse • Domestic partner:

Connecticut: opposite sex onlyNew Jersey: same or opposite sex partners who are both age62 or overNew York: all members

• Civil union — Connecticut and New Jersey only• At the same time as the subscriber• Open enrollment• Date of marriage• Date of U.S. immigration on passport• Date of HIPAA event (See HIPAA section on p. 55)• Date of domestic partnership (as specified by group or state)• Date of civil union (Connecticut and New Jersey only)

• Online: www.oxfordhealth.com• Form: Addition/Termination/Change Form • EDI: 100+ life groups via an Account Manager• Note: Supporting documentation may be required


Connecticut and New York:• Regardless of age, any child proven to be disabled• Unmarried child under the age of 19 or between the ages of 19

and 23 (unless otherwise specified in the Summary of Benefits),provided the child is a full-time student (See the StudentVerification section on p. 54)

Enrollment: Employee/Subscriber

Enrollment: Spouse

Enrollment: Dependent

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54

Enrollment: Dependent (Cont.)

Effective dates

How to enroll

Submission

Student verification

Newborn

Adoption

New Jersey:• Unmarried children less than 30 years of age, with no dependent

children of their own, who reside in New Jersey or are a full-time student in another state and do not have coverage underany other health plan

• At the same time as the subscriber • Open enrollment• Date of birth• Date of adoption (per state regulation) • Date of U.S. immigration on passport • Date of HIPAA event (See HIPAA section on p. 55)• NJ Only: Date a dependent under age 30 becomes eligible

• Online: www.oxfordhealth.com• Form: Addition/Termination/Change Form• EDI: 100+ life groups via an Account Manager• Note: Supporting documentation may be required


Student verification Parent Affidavit Form is required at time ofenrollment for all dependents over age of 19, but under the maximum age limit of the group

• New Jersey/Connecticut: Coverage is automatically provided forthe first 31 days from the date of birth, however, the dependentmust be enrolled to continue coverage beyond the first 31 days

• New York: Child must be enrolled within 31days of birthNote: Newborn enrollment is not automatic; Benefitsadministrators should call to verify enrollment of a newborn

New Jersey/Connecticut: All adopted children under age 18 areeligible for coverage from the date of legal adoption or permanent placement in the home; Automatic coverage for thefirst 31 days does not apply

New York: A legally adopted child or proposed adoptive child whois physically placed in the home; Newly born: If the subscribertakes physical custody upon release from the hospital and files apetition pursuant to Section 115-c of the Domestic Relations Lawwithin 31 days of birth, and provided no notice of revocation hasbeen filed and consent for the adoption has been revoked.

International Adoptions: Eligibility for coverage is on the date ofadoption, regardless where the child is living at the time of theadoption; Proposed adoptive children are eligible for coverageduring any waiting period prior to the finalization of the child’sadoption when the insured assumes and retains legal obligationfor support of the child

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55

Health Insurance Portability and Accountability Act (HIPAA)

Types of changes

How to request

change

Special enrollment

period

How to enroll

Eligibility

How to terminate

Submission

Effective dates of termination

Spouse/dependent dates of termination

Any change that needs to be made to the member’s personal information (e.g., address, name, date of birth)

• Online: www.oxfordhealth.com

• Form: Addition/Termination/Change Form

Members may be added to the plan off-cycle for the effective date of any of the following:1. Loss of coverage under another health plan for reasonsincluding, but not limited to:

• Divorce/separation• Death• Termination/reduction in hours• Termination of group coverage/change in contribution• COBRA or continuation has been exhausted

2. Change in family status:• Marriage• Birth of child/adoption or placement of child in home

• Online: www.oxfordhealth.com• Forms:

• Member Enrollment Form if adding subscriber• Addition/Termination/Change Form if adding spouse or dependent

• Note: Supporting documentation will be required (e.g., HIPAACertificate, legal paperwork, etc.)

If employee resigns, is terminated or becomes ineligible forhealth benefits per the group’s policies or the provisions of the Oxford coverage

• Online: www.oxfordhealth.com• Forms: Addition/Termination/Change Form

Within 31 days of the requested date of termination

Groups have one of two lags:1. End of month in which employment was terminated

2. Date employment was terminated

• Divorce, cessation of domestic partnership or civil union• Reaching the age limit set by group• Loss of full-time student status/failure to prove student status• Loss of dependent status due to marriage• NJ Only: Loss of under 30 dependent status

Termination of Coverage

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Changes to Existing Member Information

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56

Small Group Requirements by State


Eligibility

Effective dates

How to enroll

Submission

Pre-existing

conditions

Retirees

Eligibility

Effective dates

How to enroll

Submission

Pre-existing

conditions

Any full-time employee working 20+ hours per week can enroll asan Oxford member

• Date employee meets the eligibility lag• Open enrollment• Date of HIPAA event (See HIPAA section on p. 58)


• Form: Member Enrollment Form • Note: Supporting documentation may be required


Applicable if member had less than 12 months of continuous coverage or a gap in coverage greater than 63 days


• Legal spouse only• Domestic partner (Rider required)

• At the same time as the subscriber• Open enrollment • Date of marriage• Date of U.S. immigration on passport• Date of HIPAA event (see HIPAA section on p. 58)• Date of domestic partnership (as specified by the group or state)


• Form: Addition/Termination/Change Form• Note: Supporting documentation may be required




Enrollment: Spouse

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Eligibility

How to enroll

Submission


Newborn

Adoption

Pre-existing

conditions

• Regardless of age, any child proven to be disabled• Unmarried child under age 19 or between the ages of 19 and

23 (unless otherwise specified in the Summary of Benefits), provided the child is a full-time student (see Student Verification)

• At the same time as the subscriber• Open enrollment• Date of birth• Date of adoption (per state regulations)• Date of U.S. immigration on passport• Date of HIPAA event (See HIPAA section on p. 58)

• Online: www.oxfordhealth.com• Form: Addition/Termination/Change Form• Note: Supporting documentation may be required


Student Verification Parent Affidavit Form is required at the time of enrollment for all dependents over age 19, but under the maximum age limit of the group

Child must be enrolled within 31 days of birthNote: Newborn enrollment is not automatic; Benefitsadministrators should call to verify enrollment of a newborn

A legally adopted child or proposed adoptive child who is physically placed in the home; Newly born: If the subscribertakes physical custody upon release from the hospital and files a petition pursuant to Section 115-c of the Domestic RelationsLaw within 31 days of birth, and provided no notice of revocationhas been filed and consent for the adoption has been revoked

International Adoptions: Eligibility for coverage is on the date ofadoption, regardless where the child is living at the time of theadoption; Proposed adoptive children are eligible for coverageduring any waiting period prior to the finalization of the child’sadoption when the insured assumes and retains legal obligationfor support of the child

Applicable if member had less that 12 months of continuouscoverage or a gap in coverage greater than 63 days


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58

Types of changes

How to requestchange

Special enrollment period

How to enroll

Eligibility

How to terminate

Submission


Spouse/dependent dates of termination

Any change that needs to be made to the member’s personalinformation (e.g., address, name, date of birth)

• Online: www.oxfordhealth.com• Form: Addition/Termination/Change Form

Members may be added to the plan off-cycle for the effectivedate of any of the following:1. Loss of coverage – under another health plan for reasons including, but not limited to:

• Divorce/separation• Death• Termination/reduction in hours• Termination of group coverage/change in contribution• COBRA or continuation has been exhausted


• Online: www.oxfordhealth.com• Forms:

• Member Enrollment Form if adding subscriber• Addition/Termination/Change Form if adding

spouse or dependentNote: Supporting documentation will be required (e.g., HIPAACertificate , legal paperwork, etc.)

If employee resigns, is terminated or becomes ineligible for coverage per the group’s policies or the provisions of the Oxford coverage

• Online: www.oxfordhealth.com• Addition/Termination/Change Form

Within 31 days of the requested date of transmission

Groups have one of two lags:1. End of month in which the member was terminated 2. Date employment was terminated

• Divorce, cessation of domestic partnership• Reaching the age limit set by group• Loss of full-time student status/failure to prove student status• Loss of dependent status due to marriage



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59

New Jersey Small Group

Eligibility

Effective dates

How to enroll

Pre-existing

conditions

Late enrollee

1099 employees

Retirees

Eligibility

Any employee meeting the eligibility requirement for the group

• Date the employee meets the eligibility lag • Open enrollment • Date of a HIPAA event (see HIPAA section on p. 61)


• Form: New Jersey Member Enrollment/Change Request Form• Note: Supporting documentation may be required

Applicable only to 2- to 5-life groups and late enrollees if memberhas less than six months of coverage or a gap in coverage greaterthan 90 daysException: If 10 or more late enrollees enroll within a 30-dayperiod, pre-existing conditions do not apply

If an eligible employee, spouse, or dependent does not enroll with-in 31 days of their effective date, they may enroll any time;However, they may only be effective for one of the following datesbased on when the request was received:

• Prior to the requested effective date — enroll for daterequested.

• After requested effective date — enroll for date of receipt.

Must meet the following criteria to be eligible:• Performs a service for the employer for monetary or other legal

consideration• Works full-time for the employer (not on a temporary basis), min-

imum of 25 hours per week• Serves a substantial business need of the employer and has

established an independent contractor relationship• Has completed and submitted the Employer’s Independent

Contractor Statement (as a 1099, they should have access to thisform required by the state of New Jersey)


• Legal spouse• Civil union spouse• Domestic partner: same or opposite-sex partners who are both

age 62 or over


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Enrollment: Spouse


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60

Effective dates

How to enroll


Eligibility

How to enroll

Submission


Newborn

Adoption

• At the same time as the subscriber• Open enrollment• Date of marriage• Date of U.S. Immigration on passport• Date of HIPAA event (See HIPAA section on p. 61)• Date of domestic partnership: (as specified by group or state)• Date of civil union

• Online: www.oxfordhealth.com• Form: New Jersey Member Enrollment/Change Request Form• Note: Supporting documentation may be required

Applicable only to 2- to 5-life groups and late enrollees if mem-ber has less than six months of coverage or a gap in coveragegreater than 90 daysException: If 10 or more late enrollees enroll within a 30-dayperiod, pre-existing conditions do not apply

• Regardless of age, any child proven to be disabled• Unmarried child under the age of 19 or between the ages of 19

and 23 (unless otherwise specified in the Summary of Benefits),provided the child is a full-time student (see Student Verification)

• Dependents under the ages of 30 that meet the eligibilityrequirements

• Online: www.oxfordhealth.com• Open enrollment• Date of birth• Date of HIPAA event (see HIPAA section on p. 61)• Late enrollee• NJ only: Date a dependent under age of 30 becomes eligible


Student Verification Parent Affidavit Form is required at time of enrollment for all dependents over age 19, but under the maximum age limit of the group

Coverage is automatically provided for the first 31 days from date of birth, however, the dependent must be enrolled to continue coverage beyond the first 31 days

All adopted children under age 18 are eligible for coverage fromthe date of legal adoption or permanent placement in the home;Automatic coverage for the first 31 days does not apply.Note: Benefits administrator should contact us to ensure correct enrollment of any newborn continuing coverage beyondthe first 31 days

Enrollment: Spouse


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61

Pre-existing

conditions

Types of changes

How to request

Special enrollment

period

How to enroll

Eligibility

How to terminate

Submission

Effective dates

Spouse/dependent

dates of termination

Applicable only to 2- to 5-life groups and late enrollees if mem-ber has less than six months of coverage or a gap in coveragegreater than 90 daysException: If 10 or more late enrollees enroll within a 30-dayperiod, pre-existing conditions do not apply



• Form: New Jersey Member Enrollment/Change Request Form

Members may be added to the plan off-cycle for the effectivedate of any of the following:

1. Loss of coverage – under another health plan for reasons including, but not limited to:

• Divorce/separation• Death• Termination/reduction in hours• Termination of group coverage/change in contribution• COBRA or continuation has been exhausted2. Change in family status:• Marriage• Birth of child/adoption or placement of child in home


• Form: New Jersey Member Enrollment/Change Request Form • Note: Supporting documentation will be required (e.g., HIPAA

Certificate, legal paperwork, etc.)

If employee resigns, is terminated; or becomes ineligible forhealth benefits per the group’s policies or the provisions of theOxford coverage


• Form: New Jersey Member Enrollment/Change Request Form


Refer to page 2 of the group’s Enrollment Agreement

• Divorce, cessation of domestic partnership or civil union• Reaching the age limit set by group• Loss of full-time student status/failure to prove student status• Loss of dependent status due to marriage• Loss of under 30 dependent status

Enrollment: Dependent (cont.)



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Enrollment: Spouse

Eligibility

Effective dates

How to enroll

Submission


Retirees

Eligibility

Effective dates

How to enroll

Submission


Eligibility

Any full-time employee working 30+ hours per week, unless noted otherwise in group contract

• Date the employee meets the eligibility lag • Open enrollment• Date of a HIPAA event (See HIPAA section on p. 63)

• Online: www.oxfordhealth.com• Form: A Connecticut Family Health Statement is required and

additional supporting documentation may be required


Does not apply

Coverage for retirees must be specified on group application.

• Legal spouse • Civil union spouse• Domestic partner (Rider required for opposite sex only)

• At the same time as the subscriber• Open enrollment• Date of marriage• Date of U.S. immigration on passport• Date of HIPAA event (See HIPAA section on p. 63)• Date of domestic partnership (as specified by the group

or state) • Date of civil union

• Online: www.oxfordhealth.com• Form: A Connecticut Family Health Statement is required and

additional supporting documentation may be required


Does not apply

• Regardless of age, any child proven to be disabled. • Unmarried child under the age of 19 or between the ages

of 19 and 23 (unless otherwise specified in the Summary ofBenefits), provided the child is a full-time student (See Student Verification section on p. 63)

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Effective dates

How to enroll

Submission


Newborn

Adoption


Types of changes

How to request change

Special enrollment

period

• At the same time as the subscriber• Open enrollment• Date of birth• Date of HIPAA event

• Online: www.oxfordhealth.com• Form: Additon/Termination/Change Form


Student Verification Parent Affidavit Form is required at time of enrollment for all dependents over age 19, but under themaximum age limit of the group

Coverage is automatically provided for the first 31 days from date ofbirth; However, the dependent must be enrolled to continue cover-age beyond the first 31days Note: Benefits administrator should contact us to ensure correctenrollment of any newborn continuing coverage beyond the first 31 days

All adopted children under the age of 18 are eligible for coveragefrom the date of legal adoption or permanent placement in thehome; Automatic coverage for the first 31 days does not apply

Does not apply

Any change that needs to be made to the member’s personalinformation (e.g., address, name, date of birth)



Members may be added to the plan off-cycle for the effectivedate of any of the following:1. Loss of coverage under another health plan for reasons

including but not limited to:• Divorce/separation• Death• Termination/reduction in hours• Termination of group coverage/change in contribution• COBRA or continuation has been exhausted


Enrollment: Dependent (cont.)


www

www




64

How to enroll

Submission

Eligibility

How to terminate

Submission


Spouse/dependentdates of termination


• Forms: • Member Enrollment Form is adding subscriber • Addition/Termination/Change (ATC) if adding spouse or

dependent• Family Health Statement• HIPAA Certificate (only if enrolled for loss of coverage)

• Note: A Connecticut Family Health Statement is required (newborns excluded) as is any supporting documentation (e.g., HIPAA Certificate, legal paperwork, etc.)


If employee resigns, is terminated or becomes ineligible for coverage per the group’s policies or the provisions of the Oxford coverage

• Online: www.oxfordhealth.com• Addition/Termination/Change Form


Groups have one of two lags:• End of month in which employment was terminated • Date employment was terminated

• Divorce, cessation of domestic partnership or civil union• Reaching the age limit set by group• Loss of full-time student status/failure to prove student status• Loss of dependent status due to marriage


www

www

HIPAA (cont.)



65

Individual and Mandated Products

New York and New Jersey Individual Product

Spouse

• Must reside in an Oxford service area within the state in whichthey are applying for coverage (proof of residency required)

• Not be eligible for any other type of similar or group healthinsurance coverage

• Not have been terminated for non-payment of premium withinthe past 12 months (New York only)

• Not be eligible for or currently on Medicare or Medicaid • Not be covered by any other similar health insurance coverage

• At same time as the subscriber• First of any month• Date of HIPAA event (see HIPAA section on p. 67)• Date of civil union (New Jersey only)• Date of domestic partnership (New Jersey only)• Date of U.S. immigration on passport

Call the Oxford Individual Product Sales line at 1-800-216-0778

Prior to the requested first of the month effective date

New York: Applicable if gap in coverage is greater than 63 daysNew Jersey: Applicable if less than 18 months of continuouscoverage or a gap in coverage greater than 31 days

• Legal spouse • Same Sex Domestic Partner (New Jersey only)

Forms:• Addition/Termination/Change Form • NJ only: New Jersey Individual Application/Change Request Note: Supporting documentation may be required

Prior to the requested effective date of coverage

New York: Applicable if gap in coverage is greater than 63 daysNew Jersey: Applicable if less than 18 months of continuouscoverage or a gap in coverage greater than 31 days

Eligibility

Effective dates

How to enroll

Submission

Pre-existing

conditions

Eligibility

How to enroll

Submission

Pre-existing

conditions


Enrollment: Spouse



66

Eligibility

Effective dates

How to enroll

Submission


Newborn

Adoption

Pre-existing

conditions

• Natural, step, adopted, proposed adopted, disabled or newborn child

• Unmarried child under the age of 19 or between the ages of 19and 23 provided the child is a full-time student (See StudentVerification section below)

• 23 provided the child is a full-time student (See Student Verification section below)

• NJ only: In addition to the above, and child related to the policyholder by blood, depends on the policy holder for support/main-tenance and resides in the policy holder’s household.

• At the same time as the subscriber• Open enrollment• First of every month• Date of birth• Date of HIPAA event (See HIPAA section on p. 67)

• Forms: • Addition/Termination/Change Form• NJ only: New Jersey Individual Application/ChangeRequest Form

• Note: Supporting documentation may be required

Within 31 days of the requested effective date

Student Verification Parent Affidavit Form is required at time ofenrollment for all dependents over age 19, but under the maxi-mum age limit of the group

• Notify us within 48 hours of the birth • New York: Coverage is provided only if the child is enrolled

within 31 days of the birth and any applicable premium is paid• New Jersey: Covered for the first 31 days from the date of

birth at no charge. To continue coverage, the child must be enrolled within 31 days of birth and applicable premium paid

Note: Member should contact us to ensure correct enrollment ofany newborn

• New York: See New York Small Group Adoption Guidelines• New Jersey: All adopted children under the age of 18 are eli-

gible for coverage from the date of acceptance or permanentplacement in the home; If enrolled per a court order, the childmust be enrolled within 60 days of the court order

• New York: Applicable if gap in coverage is greater that 63 days• New Jersey: Applicable if less than 18 months of continuous

coverage or a gap in coverage greater than 31 days

Eligibility: Dependent



67

Types of changes

How to requestchange

Special enrollment periods

How to enroll

Eligibility

How to terminate

Submission



Request must be made in writing, containing the member ID anda clear explanation of the requested change

New Jersey members can use the NJ IndividualApplication/Change Request Form


1. Loss of coverage – under another health plan for any ofthe following reasons:• Divorce/separation• Death• Termination/reduction in hours• Termination of group coverage/change in contribution• COBRA or continuation has been exhausted

2. Change in family status:• Marriage• Birth of a child/adoption or placement of child in home

• Forms:• Addition/Termination/Change Form• NJ Only: New Jersey Individual Application/Change

Request FormNote: Supporting documentation will be required (e.g.,HIPAA Certificate, legal paperwork, etc.)

Upon written advance notice from the subscriber.


• Forms: Addition/Termination/Change Form


• On the date the member fails to meet the eligibility requirements

• For cause, if a member:• Fails to pay required premium• Performs an act or practice that constitutes fraud or made

an intentional misrepresentation of a material fact• No longer resides, lives or works in the service area

• Divorce, cessation of domestic partnership or civil union• Reaching age limit• Loss of full-time student status/failure to prove student status• Loss of dependent status due to marriage




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68

Healthy NY: Small Group/Individual/Sole Proprietor

Overview

Eligible

Products

Eligibility

requirements

State-mandated product designed to promote and provide affordable insurance coverage to eligible small business, sole proprietors and individuals. Refer to Group Enrollment section formore information on sole proprietor eligibility and enrollment.

• Small groups (2-50 eligible lives)• Sole proprietors• Individuals (working and uninsured)

• HMO• High deductible with a Health Savings Account (HSA) (refer to

the Oxford Product section on for more information on HSAs)

Individuals:

• Employer does not currently provide health insurance and has not provided group health insurance during the 12-month periodpreceding application

• Gross household income level is at or below 250% of the grossfederal poverty level

• Health insurance coverage has not been in effect for the 12-month period preceding application or have lost that coverage due to a qualifying event

• Must be ineligible for Medicare• Must reside in New York State• Must be employed on a full-time, part-time or episodic basis• Oxford determines final eligibility

Sole Proprietor:

• Uninsured for the 12-month period preceding application or havelost their coverage due to a qualifying event

• Gross household income level at or below 250% of the grossfederal poverty level

• Must be ineligible for Medicare• Must reside in New York State• Must no currently work for an employer that provided health

coverage during the prior12-month period• Eligibility criteria for small businesses is inapplicable to sole

proprietors• We determine eligibility

– You or your spouse must either be currently employed or musthave been employed within the past 12 months

Small Groups: (See New York Small Group requirements on p. 42)




69

Eligibility for individuals

or sole proprietors

who have had prior

insurance

How to enroll

Effective dates

Pre-existing

conditions

Eligibility

Effective dates

How to enroll

Submission

Pre-existing

conditions

An individual or sole proprietor shall be eligible for the HealthyNY program without regard to the existence of health insurancecoverage or the availability of employer provided coverage during the 12-month period preceding application if such healthinsurance coverage terminated due to one of the following:

• Loss of employment• Death of a family member• Change to a new employer• Change of residence• Discontinuation of a group health plan• Termination or cancellation of COBRA coverage• Legal separation, divorce or annulment• Loss of eligibility for group health insurance coverage• Reaching the maximum age for dependent coverage• If eligible for or currently covered through COBRA or other

continuation type coverage, they may apply for Healthy NY


The 1st of every month


• Legal spouse• Domestic partners (Sole proprietor and small group plans only)

• At the same time as the subscriber• Date of domestic partnership • Date of HIPAA event (See HIPAA Section)


Within 31 days of the requested effective date

Applicable if member had less than 12 months of continuouscoverage or a gap in coverage greater than 63 days

Enrollment: Spouse

Enrollment: Employee/Subscriber (cont.)



70

Eligibility

Effective dates

How to enroll

Submission

Newborn

Adoption

Pre-existing

conditions

Types of change

How to request

changes

• Regardless of age, any child proven to be disabled.• Unmarried child under the age of 19 or between the ages of

19 and 23 provided the child is a full-time student (SeeStudent verification)

• At the same time as the subscriber• Date of HIPAA event (See HIPAA section on p. 71)

• Form: Addition/Termination/Change Form • Note: Supporting documentation may be required

Prior to the requested effective date

Child must be enrolled within 31 days of birth

A legally adopted child or proposed adopted child who is physicallyplaced in the home; Newly born: If the subscriber takes physicalcustody upon release from the hospital and files a petition pur-suant to Section 115-c of the Domestic Relations Law within 31days of birth, and provided no notice of revocation has been filedand consent for the adoption has been revoked

Applicable if member had less than 12 months of continuouscoverage or a gap in coverage greater than 63 days






www



71


Special enrollment

periods

How to enroll

Eligibility

How to terminate

Submission


1. Loss of coverage – under another health plan forreasons including but not limited to:• Divorce/separation• Death• Termination/reduction in hours• Termination of group coverage/change in contribution• COBRA or continuation has been exhausted



• Forms: • Healthy New York Application• Addition/Termination/Change Form

• Note: Supporting documentation will be required (e.g., HIPAA Certificate, legal paperwork, etc.)

Coverage will terminate or not be renewed:• Upon written notice from the subscriber• On the date the dependent fails to meet the dependent

eligibility requirements• For cause, if a member:

• Fails to pay required premium • Performs an act or practice that constitutes fraud or made

an intentional misrepresentation of a material fact• No longer resides, lives or works in the service area

Written advance notice

More than one month prior to the requested date of termination


Enrollment

Big company benefits for companies of one — a suite ofproducts designed especially for sole proprietors doing business in the New York metropolitan area

Refer to page 44 of the Group Enrollment section for moreinformation on sole proprietor enrollment and eligibilityrequirements

Oxford Sole Proprietor Products

Overview

Eligibility requirements

www



72

Special enrollment

periods

How to enroll

Eligibility

How to terminate

Submission


1. Loss of coverage – under another health plan forreasons including but not limited to:• Divorce/separation• Death• Termination/reduction in hours• Termination of group coverage/change in contribution• COBRA or continuation has been exhausted



• Forms: • Healthy NY Application• Addition/Termination/Change Form

• Note: Supporting documentation will be required (e.g., HIPAACertificate, legal paperwork, etc.)

Coverage will terminate or not be renewed:• Upon written notice from the subscriber• On the date the dependent fails to meet the dependent

eligibility requirements• For cause, if a member:

• Fails to pay required premium • Performs an act or practice that constitutes fraud or

made an intentional misrepresentation of a material fact• No longer resides, lives or works in the service area

Written advance notice

More than one month prior to the requested date of termination


Enrollment

Oxford HSA

www


Renewals

73

Contract Renewal

Prior to the group’s policy anniversary, we will send groups and their broker/consultant (if applicable) a letter to remind the group of their renewal date.

At this point, changes can be made to the group’s policy, including, but not limited to:• Adding, dropping or changing riders• Changing waiting periods and eligibility requirements (subject to state laws)• Increasing or decreasing deductibles and coinsurance levels

The renewal period is the only time during the year that we will accept changes

to the group’s plan. Renewals and changes are contingent upon the group’s

account with Oxford being current.

Oxford Renewal Process

• Renewal letters are created and distributed to brokers (60-75 days prior to renewal)

• Renewal letters are created and distributed to groups (45-60 days prior to renewal)

• Our systems are updated with the group’s renewal decision, either no changes (“as is”) orwith requested benefit changes (15-45 days prior to renewal). There is a seven-day processingtime from receipt of paperwork.

Small Group Online Renewals (2-50)

Review your groups that are within 60 days of their annual renewal, create optionalplan designs, and submit the renewal or request for changes to Oxford using the IdeaManagement SystemSM. See page 13 for more details.

www

idea management systemSM


Renewals

74

2008 Renewal Rate Availability Chart – Small Group

If the Renewal Month is: You may quote small group rates beginning:

January November 2

February December 3

March January 1

April February 1

May March 2

June April 2

July May 2

August June 2

September July 3

October August 2

November September 2

December October 2


Claims

75

Claim Submission

When members receive care on an in-network basis, there are usually no claim forms to complete. They simply show their Oxford member ID cards and pay any applicable cost shares.

Oxford members may be required to complete claim forms to receive reimbursement, in casessuch as:

• When a member has out-of-network coverage and/or obtain care on an out-of-network basis• When Oxford is the secondary insurance carrier• When a member receives laboratory services from a non-participating laboratory• When a member receives refractive vision services

To submit an out-of-network claim:

• The member must complete an Insurance Claim Form• Send the claim form and the original provider invoice to:

Oxford Claims DepartmentP.O. Box 7082Bridgeport, CT 06601-7082

Claims Resubmissions should be mailed to:OxfordAttn: Corrected/Resubmitted ClaimsP.O. Box 7017Bridgeport, CT 06601-7017


Claims

76

Claim Filing Deadlines

• Filing deadlines are based on the claim’s date of service. The deadline is not based on thedate that the claim was mailed to or received by us.

• Commercial members and participating providers have 90 days to submit an in-network claim to us.

• Commercial members and non-participating providers have 180 days to submit a claim to us.

Clean claims are processed within the regulated time frames which are typically less than 30 business days.

• A clean claim does not require any additional information to be processed and includes ALL of the following:

• Patient name and Oxford member ID # • Oxford provider ID #• Provider information, including federal tax ID number (FTIN) • Date of service • Place of service • Diagnosis code • Procedure code • Individual charge for each service • Provider signature

If you have any questions regarding a particular claim submission, please contact

Client Services or your Oxford sales representative.

Members can check claims online at www.oxfordhealth.com or by calling OxfordCustomer Service at 1-800-444-6222.

If a member is hearing impaired and requires assistance, they may call our TTY/TDD line at 1-800-201-4875. Please call 1-800-303-6719 forassistance in Chinese, or the number on your Oxford ID card for assistance in other languages. Interpreters are available Monday through Fridaybetween 8:00 AM and 6:00 PM.

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Miscellaneous Items

77

Brokers Acting on Behalf of Benefits Administrators

Brokers can act on behalf of benefits administrators to assist them with the day-to-day administrative functions associated with their employees.

What does this mean?

With written consent from the benefits administrator, brokers will have authorization to completethe following transactions*:

• New group applications • Member enrollment forms and other necessary enrollment documents• Renewals

How can you get started?

• The benefits administrator must complete the “Consent Form – Authorization for brokerto Act as Benefits Administrator” (located on the broker site at ww.oxfordhealth.com)and return it to the broker

• The broker is encouraged to call Client Services to review the process prior to sending inthe completed form

• Please allow four to seven business days for us to update our files to recognize that thebroker can now act on behalf of the benefits administrator. Send the “Consent Form –Authorization for Broker to Act as Benefits Administrator” to:

Oxford P.O. Box 7085Bridgeport, CT 06601-7085

Note: Once a broker has obtained the consent form and submits it to us, they may contact theWeb help desk to receive a username and password to administer online transactions onbehalf of their group. Unfortunately, a single username/password for brokers across all groupsis not currently possible. Brokers must get a unique username and password for each groupthat they have consent to administer and wish to administer online.

To obtain a copy of the “Consent Form – Authorization for Broker to Act as BenefitsAdministrator,” log on to www.oxfordhealth.com, go to the Forms and Applicationslink on the Tools and Resources tab and select Authorization Forms for All States.

* In order to perform any transaction that involves protected health information and is not listed under this heading, thebroker needs to obtain a HIPAA Authorization Form from the member(s) involved.


We are pleased to acknowledge that we are HIPAA compliant with both the Privacy provision asof April 14, 2003, as well as the Transactions and Code Sets provision as of October 16, 2003.As of April 20, 2005, we are also compliant with the security requirements of HIPAA. Policiesand Procedures have been developed to ensure that member information is protected and safeguarded according to the law.

Members can contact us directly by phone or mail to obtain a copy of the Privacy Noticeoutlining their individual rights.

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Miscellaneous Items

78

Oxford Confidentiality Policy

For Client Services to release confidential medical information regarding a member’s claims,we require that the member complete and sign the HIPAA Member Authorization Form. Thecompleted authorization form provides us with a signed, written release from the member (orfrom a legal guardian/power of attorney, with appropriate documentation) authorizing us torelease the confidential information to the benefits administrator or broker.

The following explains what information regarding a member’s claim can and cannot bereleased to a broker without the member’s signed, written authorization:

An Authorization Form is NOT required for:

• Oxford member ID number• Claims payment date • Check number • Claim status (paid, denied, currently in process)• Amount paid on the claim• Amount on a particular claim that was applied to copayment, deductible or coinsurance• Denial code if it does not indicate diagnosis • Member’s effective date of Oxford coverage or termination• Name, date of birth, date of hire (verification only)

An Authorization Form is required for:

• Diagnosis codes • Provider names • CPT codes • Explanation of Benefits• Social Security number• Member authorizations on file• Inquiries regarding which members of a group utilized the plan during a retroactive

group disenrollment

To obtain a copy of the Member Authorization Form, log on to www.oxfordhealth.com

and go to the Forms link on the Tools and Resources tab.www


Miscellaneous Items

79

Medical Policy Information

To view our Medical Policy information online, log on to www.oxfordhealth.com and go tothe Medical and Administrative Policies link on the Tools & Resources tab.

Rate Quotes for Large Groups

In addition to plan details, the following items may be needed to obtain a large group rate quote:

Material requirements:

• Census • Current carrier benefit summary• Out-of-area employee zip codes • Employer contribution• Large claims • Current carrier bill• Current and prior area • COBRA information• Current enrollment breakdown • Retiree information• Current rates • Original/renewal effective dates• Renewal rates

Additional material requirements for experience-rated submissions:

• Claims experience• Average/monthly enrollment• Large claim information (detailed)

If you have any questions, please contact your Oxford

sales representative.


Miscellaneous Items

80

COBRA

State

continuation

Qualifying

events:

COBRA

administrative

requirements

Federal law requires employers with group health plans to providecontinuation coverage to former covered employees and their covereddependents in certain instances; Groups exempt from COBRA include:• Companies with fewer than 20 employees on a typical business day

during the preceding calendar year• State and local government plans• Church plans• Federal government employees

State laws require employers with group health plans with fewer than 20 employees on a typical business day during the preceding calendaryear to provide continuation of coverage.Connecticut, New Jersey and New York State continuation provisionsare similar to COBRA.

• Events that qualify the covered employee and his/her covered depend-ent(s) for 18 months of coverage include:

• Voluntary termination of employment• Involuntary termination of employment (excluding gross misconduct)• Reduction in hours of employment (strike, layoff, full-time to

part-time, leave of absence) that no longer qualifies the employee for health coverage

• Events that qualify the covered spouse or covered dependent child(ren)for 36 months of coverage include:

• Death of the employee• Divorce or legal separation from the employee• Dependent child(ren) exceeding the dependent cut-off age

• COBRA administration is complex; The law specifies notice requirements, model notice forms, and timeframes for providing noticeof the COBRA rights, election of COBRA coverage and payment ofCOBRA premium

• Generally, employers need to notify any eligible employee of COBRArights within 14 days of the qualifying event

• Covered employees and their covered dependent(s) have 60 days fromthe qualifying event date or from the date they receive a COBRA noticefrom the employer, whichever is later, to elect to continue coverage

Important Note: This section of the Oxford Broker Resource Guide provides a brief overviewof continuation coverage requirements. It is not intended to be a complete guide to continuationlaw and requirements. Employer groups should consult with their legal counsel regarding theirspecific obligations with respect to continuation coverage.


Miscellaneous Items

81

Methods of

enrollment

Disability

extension

Termination

Requesting

termination

• Addition/Termination/Change Form must be completed to enrollsubscriber and family into COBRA

• A Member Enrollment Form must be completed to enroll a spouseor dependent as the subscriber into COBRA

Note: To ensure accurate billing, it is strongly suggested that anAddition/Termination/Change Form be submitted to terminate anactive employee prior to his/her election of COBRA

• Disabled individuals (New Jersey State Continuation with a qualifying event on or after March 7, 2005 excluded) may qualifyfor an extension that extends the otherwise applicable 18-monthcoverage period to 29 months

• Disability extension will only apply if a qualified beneficiary:• Is determined, under the Social Security Act, to have been

disabled prior to or within the first 60 days of continuation coverage; and

• Applies for the disability extension within 60 days of the date ofthe determination of disability by the Social Security Administration(SSA) and before the end of the 18-month continuation period

• Coverage will terminate:• On the last day of the continuation coverage period;• If any premium payment is not made within the grace period; or• If the employer ceases to provide group health coverage to

employees

• A qualified beneficiary is no longer eligible:• When the qualified beneficiary becomes covered under another

group health plan, which does not limit or exclude a pre-existingcondition; or

• If the qualified beneficiary is entitled to Medicare after the date of election

• The benefits administrator can complete anAddition/Termination/Change Form; or

• The qualified beneficiary can submit a letter requesting thatCOBRA/State Continuation coverage be terminated. The lettershould contain the member’s name, Oxford ID, Oxford group ID,and exact date of termination

The letter should be mailed to:Oxford Commercial Enrollment DepartmentP.O. Box 7085Bridgeport, CT 06601-7085


Miscellaneous Items

82

Termination and Disenrollment

If an employee resigns, is terminated or becomes ineligible for health benefits per the group’spolicies or the provisions of the Oxford coverage, an Addition/ Termination/Change Form mustbe signed by the benefits administrator and sent to us within 31 days.

Addition/Termination/Change Forms should be sent to:

Oxford Enrollment DepartmentP.O. Box 7085Bridgeport, CT 06601-7085

Group Conversions

Location conversions

Location conversions occur when an employer group moves its office location. Plan benefitsand pricing can vary based on an employer group’s county location. Contact your Oxford salesrepresentative to determine if benefits and rates are affected when an employer groupchanges location.

Large group to small group conversions

Large group to small group conversions occur when an employer no longer qualifies for largegroup coverage due to the fact that they no longer have over 50 employees. Upon renewal, ifan employer group falls below 50 employees, contact your Oxford sales representatives to verifythat the group no longer qualifies for large group coverage and to obtain a small group quote.

Small group to large conversions

Small group to large group conversions occur when an employer no longer qualifies for smallgroup coverage due to the fact that they have over 50 employees. Upon renewal, if an employergroup has over 50 employees, contact your Oxford sales representatives to find out what infor-mation is required to determine if the employer group qualifies to receive a large group quote.


Miscellaneous Items

83

Coordination of Benefits (COB) Frequently Asked Questions

What is a Coordination of Benefits?

COB is a provision used to establish the order in which health insurance plans pay claimswhen more than one plan exists.

Why is COB important?

COB contributes to medical cost savings and is an integral component of Oxford’s commitmentto affordability.

What information is needed for COB?

• Carrier name• Policyholder name and all covered dependents• Original effective date of coverage• Telephone number of other carrier• Type of coverage (medical, dental, vision, pharmacy)• Workers’ Compensation and MVA (Refer to www.oxfordhealth.com for more details)

Why do we collect prior coverage information?

Prior coverage information is collected in an effort to reduce a member’s waiting period for certain benefits.

How does a member update COB?

Members may change COB through:• Customer Service • Enrollment forms• Automated phone questionnaires• Providers

When is COB updated?

A member’s COB is updated when we receive other coverage information:• Enrollment forms• Change request • From Medicare• Notification from a member involved in a motor vehicle accident or injured at work• When a provider submits a claim

How often are the member or dependents files updated?

The member is required to update their record with us yearly or more often if they add or terminate other medical coverage or enroll with Medicare.

For more information on Oxford Coordination of Benefits, visit the broker site at www.oxfordhealth.com.


Miscellaneous Items

84

Tax Forms

Below is a list of accepted tax forms to verify a group’s eligibility for group health care coverage in New York.

Official group filing in New York and required documentation:

New Corporation

Articles of Incorporation and W4 for at least two employees

Existing Corporation

NYS-45 (indicating all eligible employees)

New Partnership

Partnership Agreement indicating all eligible partners and W4 for at least two employees

Existing Partnership

K1 indicating at least two eligible partners and NYS-45 (indicating all eligible non-partneremployees)

New Proprietorship

W4 for at least two employees

Existing Proprietorship

Schedule C and NYS-45 (indicating all eligible employees)

New Subchapter S Corporation

CT6 and W4 for each employee

Existing Subchapter S Corporation

1120S and NYS-45 (indicating all eligible employees)

New Limited Liability Corporation

Articles of Incorporation and W4 for at least two employees

Existing Limited Liability Corporation

NYS-45 (indicating all eligible employees)Sole Proprietor: 1040 and one of the following: Schedule C, E or F indicating income of$25,000 or more


Miscellaneous Items

85

Below is a list of accepted tax forms to verify a group’s eligibility for group health carecoverage in Connecticut.

Official group filing in Connecticut and required documentation:

New Corporation

1. UC-5A (Quarterly Wage and Tax Report), 941 or UC2B with a copy of current payroll listing at least two employees

2. Federal and State of Connecticut documents confirming registration of the business, withcopies of current payroll listing at least two eligible employees

Existing Corporation

A copy of the current year’s Form 1120 or 1120S with current payroll listing at least two eligible employees

Partnership or LLC

A copy of the current year’s 1065 and K-1s, with current payroll listing at least two eligibleemployees

Existing Proprietorship

A copy of the current year Schedule C

Non-profit Organization

A copy of the UC1NP Form, with current payroll listing at least two eligible employees

“S” Corporation

A copy of current year’s Form 1120 or 1120S with copies of current payroll listing at least twoeligible employees

Note: Tax forms are not required for New Jersey group enrollment.


86

Miscellaneous Items

Oxford ID Card

Below is a sample of an Oxford ID card. Actual member cards may vary slightly.

Freedom Plan®

John Doe123456*01

Rx Member ID: 123456789321 001 RxGrp: OXFRDHP RxBIN: 123456

PCP Copay: $20.00Specialist Copay: $30.00CAM Copay: $30.00

Dental P

1. Oxford logo

2. Oxford member identification number

3. Primary care physician (PCP) and specialist copayment

4. Pharmacy identification numbers (if applicable)

5. Oxford Customer Service and Oxford On-Call® phone numbers

6. Oxford legal text (varies by plan) outlines emergency, hospital admission, precertification, and the referral (if applicable) instructions

7. In-network access to the UnitedHealthcare Choice Plus national physician network, available with most Oxford plans that have an out-of-network benefit

8. Pharmacy Customer Service number (if applicable)

1

23

4

5

6

8

Precertification (prior review by Oxford) is required for hospital admissions, surgicalprocedures, and certain other services as described in your plan materials. Checkyour plan documents for information/responsibilities on precertification and benefits.By the use of this card, I hereby consent to the release to Oxford and its delegatesof any medical information needed to enable Oxford to administer my coverage.

HHeeaalltthhccaarree PPrroovviiddeerrss CCaann CCaallll:: 880000--666666--11335533Submit Claims to: PO Box 7082, Bridgeport, CT 06601

Submit Claims Electronically to Payer ID 06111www.oxfordhealth.com

Questions? Call Member Services: 800-444-6222 Call an Oxford On-Call Nurse: 800-201-4911

Pharmacy Customer Service: 800-905-0201 Pharmacists Call: 800-922-1557Oxford Health Plans (NY), Inc.

In-NetworkReferralRequired

UnitedHealthcare®

Choice Plus NetworkAvailable - NY north of Ulster Countyand all other states except CT and NJ

7


Miscellaneous Items

87

Oxford USASM ID Card

Below is a sample of an Oxford USA ID card. Actual member cards may vary slightly.

1. Oxford logo

2. Oxford member identification number

3. Primary care physician (PCP) and specialist copayment

4. In-network access to the UnitedHealthcare Choice Plus national physician network

5. Pharmacy identification numbers (if applicable)

6. Oxford Customer Service and Oxford On-Call® phone numbers

7. Oxford legal text (varies by plan) outlines emergency, hospital admission, precertification, and referral (if applicable) instructions

8. Pharmacy Customer Service number (if applicable)

1

234

5

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Precertification (prior review by Oxford) is required for hospital admissions, surgicalprocedures, and certain other services as described in your plan materials. Check yourplan documents for information/responsibilities on precertification and benefits.

HHeeaalltthhccaarree PPrroovviiddeerrss CCaann CCaallll:: 880000--666666--11335533Submit Claims to: PO Box 7082, Bridgeport, CT 06601

Submit Claims Electronically to Payer ID 06111

www.oxfordhealth.com

Questions? Call Member Services: 800-444-6222 Call an Oxford On-Call Nurse: 800-201-4911

NoReferralRequired

Pharmacy Cust Svc: 800-905-0201 Pharmacists: 800-922-1557Oxford Health Plans (NY), Inc.

Oxford USASM

John Doe123456*01

Rx Member ID: 123456789321 001 RxGrp: OXFRDHP RxBIN: 123456

Office Copay: $20.00

UnitedHealthcare®

Choice Plus NetworkAvailable - NY north of Ulster Countyand all other states except CT and NJ


UnitedHealthcare

89


Broker & Employer Customer Support 1-888-UHC-HLP1Primary contact for questions, inquiries (1-888-842-4571)and information related to:

• Billing information• Claims information• Enrollment services• Eligibility• Medical benefit information• Pharmacy drug card services• Physician/health care professional status• ID cards• Notification status• Forms or materials

United eServices® Customer Support UnitedeServices.com 1-866-336-9369

Employer eServices® Customer Support EmployereServices.com 1-800-651-5465

myuhc.com® Customer Support myuhc.com 1-877-844-4999

Care24SM 1-888-887-4114• 24 hr access to counselors/RNs TYY/TDD• Health Info Library 1-800-8 8-1120• Financial and Legal Service Referrals

United Behavioral Health unitedbehavioralhealth.com 1-800-357-0978Mental health and substance abuse services Click on Employers,

then click Behavioral Solutions

Prescription Drug Questions myuhc.com 1-877-842-6044Pharmacy and Medco Solutions Link under Prescriptions

UnitedHealthcare – Dental Claims Address 1-877-816-3596Please mail claims to theaddress on the member’s card

UnitedHealthcare – Vision Claims Address 1-800-638-3120Please mail claims to theaddress on the member’s card

United HealthCare Insurance Company UnitedHealthcare Life 1-866-293-1794P.O. Box 30759Salt Lake City, UT 84130

U.S. Department of Labor COBRA dol.gov/ebsa 1-866-444-3272

Broker Commissions Customer Service UnitedeServices.com 1-888-641-9147

Resource Web Site/Address Phone

2

Enrollment Address

UnitedHealthcareP.O. Box 30964Salt Lake City, UT 84130

Claims Address

Please mail claims toaddress on ID card

Service Center Billing

Address

Please see invoice stub orcall Customer Support

Important Contacts

BRG_UHC pages 3/13/08 3:41 PM Page 89

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Commissions

Commission Basics

Commission payments

Commissions are paid by the schedule on the following pages. A broker must be licensed andappointed as an agent of UnitedHealthcare to solicit, negotiate and affect coverage. No brokerwill be installed on a group or paid commissions until they are licensed and appointed withUnitedHealthcare and consistent with applicable law.

Sign up for convenient electronic funds transfer (EFT)

Log in to UnitedeServices.com, click on the Forms tab, select your location, click on theDirect Deposit Authorization Form, and simply enter the required information. Allow fourweeks for the direct deposit to take effect. EFT is only available for commissions paid onUnitedHealthcare business.

Online commission statements

Visit the Compensation tab of UnitedeServices.com to view your UnitedHealthcare commissionstatements any time, anywhere. There, you can save, download, print and export your statementsand historical data.

Note: Online statements are only available if you receive your commissions statements addressed to your individual name.

Become one of the best – The United Advantage® program

Based upon your commission performance, you may be eligible for UnitedHealthcare’sUnitedAdvantage program. United Advantage is an exclusive, performance-based recognitionprogram for our top performing brokers, featuring benefits and services that will give you competitive advantage in your business. Contact your UnitedHealthcare representative or theBroker Commissions Customer Service line at 1-888-641-9147 to learn more about how tobecome a United Advantage member and start taking advantage of the great benefits today.

Commission schedules and bonus programs

Review your local Producer Performance Guide for complete commission schedules, bonusprograms and associated policies.

Broker Commissions Customer Service: 1-888-641-9147

www


Commissions

Agent of Record (AOR)

What is an Agent of Record?

The Agent of Record is the agent designated by the group as the current servicing agentand indicates the agent or agency receiving the commissions on a case. The Agent ofRecord’s name and producer ID must be specified clearly on the initial Group EnrollmentApplication completed for each new group.

How to become an Agent of Record

Agent of Record letters must be on company letterhead and signed by the president, officer, or other decision maker of the employer group and should include a fax number forconfirmation purposes. Letters of authorization that are not on company letterhead will notbe accepted. Agent of Record letters should be sent to your local UnitedHealthcare representative for processing.

Agent of Record changes

Commissions and bonuses will be paid only to the licensed and appointed Agent of Recordassigned to the case by the customer. UnitedHealthcare reserves the right to accept orreject, at our sole discretion, requests to change the Agent of Record assigned to a caseand direct commissions and bonus payments to another Agent of Record. All requests tochange Agent of Record assignments must be made in writing by the customer in a formapproved by us.

Note: Please refer to the Producer Performance Guide for complete information on base, commissions, bonuses, and policies and practices.

Commissions Schedule

Checks are mailed on the commission payment dates listed on the following pages. Pleaseallow one day for electronic funds transfer (EFT) transmission. To view check commissionsonline, visit UnitedeServices.com.

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2008 Commission Payment Schedule – BASICS

Check commissions online at UnitedeServices.comwww





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2008 Commission Payment Schedule – PRIME/UNET

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Comprehensive, Convenient Online Tools

Brokers and Consultants United eServices®

UnitedAdvantage® Agencies UnitedAdvantage.com

Benefits administration Employer eServices®

Employers and employees OnlinEnroll®

Consumer health information myuhc.com®

Note: United Advantage® status is based on annual qualification. Contact your UnitedHealthcare representative for details

United eServices®

United eServices is designed specifically for brokers and consultants to help you meet thedemands of your business. It’s all part of our commitment to help you grow your business andprovide the best health care experience. If you’ve not yet joined the thousands of our brokersand consultants already accessing this invaluable resource, you’re missing out on the efficiency others are now enjoying. Register with United eServices online. Visit UnitedeServices.com

and click on the Register button. Below are a few of the United eServices resources that canhelp you meet the demands of your business.

Product, programs and services information

Our extensive products, programs and services can meet all of your customers’ health benefitneeds. The product section on United eServices features:

• Specialty Products – life, dental and vision coverage• Programs and Services – detailed information on wellness programs, pharmacy

programs and more

Products using the Plan Wizard

For groups with over 50 employees, we offer a Preferred Portfolio of products that are a broadcollection of consistent, streamlined benefit plans that are efficient and easy to administer. TheUnitedHealthcare Preferred Portfolio Plan Wizard is web tool designed for you to obtain information on these streamlined benefit plans. The Plan Wizard will help you to select fromthe many product, deductible, copayment and coinsurance options available to you in thePreferred Portfolio, so that you can meet your clients' specific needs. For detailed informationregarding the Preferred Portfolio Plan Wizard please view the Frequently Asked Questionsonline by going to the Product tab and then clicking Plan Wizard in the menu bar.

Network information

The Network tab on United eServices is your source for information on UnitedHealthcare’snational network of physicians, hospitals and other health care professionals.

Network fact sheets: Find key local network information including the number of coveredindividuals, accreditation status, reimbursement methods and much more.


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Network maps: Access Network Accessibility Area Maps that indicate areas withUnitedHealthcare’s products and service.

Network changes: Learn about network changes such as additions or terminations of ahospital, physician or other health care professional.

Physician directory: Search the online directories for network physicians, dentists, hospitals,facilities, and other health care professionals.

Online training and demos

The Training and Demos tab grants you access to online demonstrations and site overviewsfor our many innovative web portals and other services.

• United eServices • OnlinEnroll• United Advantage • myuhc.com• Employer eServices • myuhcdental.com

Forms

These are just some of some of the broker, employer and employee forms that can be foundon United eServices.

• Case submission checklist • Life participation form• Employee participation form • Broker eServices brochure and application

Benefits administration

To access online benefit administration, click on the Benefits Administration tab which will direct youto the Employer eServices web site. Through EmployereServices.com, you can manage virtuallyevery aspect of your benefits administration online and in real time, increasing efficiency and savingtime and money. Based on your agreement/contract with UnitedHealthcare, you can update enrolleeinformation, check claim status, request an ID card, access and pay monthly invoices and view benefitplan cost and utilization reports. If you have an Employer eServices ID and password, you mayalso take advantage of a single-sign-on option. To do this, simply select My Account, UpdateEmployer eServices Information and submit your Employer eServices ID and password. Thisinformation will be encrypted and saved so that you may select the Employer eServices linkfrom the Benefits Administration page, and go directly to Employer eServices without an addi-tional login.

And more…

For group sizes up to 50 in upstate New York, Pennsylvania and states outside the Oxfordservice area, United eServices also offers online quoting, case tracking, and product andrenewal information. With a click of a button, you can create quotes and generate proposals.Our case tracking feature allows you to easily check the status of case submissions online inreal-time. Online renewal support sends an e-mail alert to inform you when renewals are postedon United eServices. With the product and renewals features you can also view renewal policies, benefits summaries, product grids, and generate alternate renewal quotes. All of thismeans less time on paperwork and more time focusing on your business.


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Employer eServices®

Set up and manage your web site access

Your client has been automatically registered on the Employer eServices web site and a ClientMaster Administrator (CMA) has been designated from the company. The CMA sets up, manages and controls in real-time who in your company has access to the various informationand tools within Employer eServices. The CMA can:

• Create or deactivate users• View a list of current users• Assign or change data access levels and privileges • Reset users’ passwords

Your CMA should have received two e-mails from us that contain their user ID and password.They can simply go to EmployereServices.com, use their new ID and password to loginand begin setting up company users’ access. If your CMA has not received or cannot locatetheir ID and password, please call the dedicated Employer eServices Customer Support Staffat 1-800-651-5465. If your CMA has questions, there’s an easy-to-follow online tutorial onthe Web site.

Brokers acting on behalf of a benefits administrator

If you’re not already registered, please contact your local UnitedHealthcare representative toobtain more information regarding user login IDs and market availability. If you need assistancein finding your UnitedHealthcare representative, contact our United eServices support staff at 1-866-336-9369.

Online training resources to help you get started

Once your CMA has set up any employees with access to Employer eServices as appropriate,users can learn how to accomplish online benefit transactions through multiple online trainingresources:

• Online tutorials: General overview and self-starter introduction with step-by-step instructionsfor specific online transactions

• Online help: Online resource for obtaining answers to specific questions

• Instructor led webcasts: Live, instructor led webcasts offered to help guide you throughthe site

• Automated webcasts: An innovative self-service training tool that allows you to attend awebcast without pre-registering or trying to fit in a pre-determined time and day during yourbusy schedule. You decide when you have time to access these webcasts – anytime, anyday, from anywhere.

• Quick reference guides: Reference cards that may be downloaded and printed for easyaccess to information


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If users still have questions after trying the self-service online training resources, they can callthe dedicated Employer eServices Customer Support Staff at 1-800-651-5465. The EmployereServices support staff are a user’s best resource for help as UnitedHealthcare representativesdo not have access to the Web site due to security and privacy issues.

Additional resources and tools

Employer eServices offers a full range of resources that make plan administration easier. Weencourage you to explore them and learn more about how they can be tailored for your needs.

Network information

Search the online directories of health care professionals, learn about network changes, andfind key local network information.

Programs and services

We’re always looking for ways to enhance the value of your benefits plan. Check online frequently to learn more about new programs and services available to you.

Forms on the Employer eServices Web site

Here is a sampling of some of the forms that can be found on the Web site:

• Dental Claim Form• Health Insurance Claim Form• HIPAA Authorization for the Disclosure of Information• Medicare Status Change Form for Enrollees and Dependents• Prescription Drug Reimbursement Form

Communication resource center

When your clients need help educating their employees about their UnitedHealthcare benefits,the Communication Resource Center on Employer eServices is your one stop online resource.Click on the Communication Resource Center link and you’ll find tools to help you communicatethe value of UnitedHealthcare benefits to employees, helping them make better health caredecisions.

• Build a custom newsletter in seconds, complete with logo, a message, and pre-writtenarticles that you select. Your professionally formatted newsletter is available immediately inPDF format, which you can then distribute to employees via e-mail, hard copy or on anintranet site.

• View and download posters, brochures, flyers and a collection of electronic articles that youcan e-mail, print or use in company newsletters.

• Access health and wellness articles on a wide variety of important health topics, and leveragethe planning tools to effectively promote workplace wellness.

www


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The Communication Resource Center is filled with employee education materials that are easyto access, flexible to use, and completely free to you and your clients. To get there, simply login to EmployereServices.com and click the Communication Resource Center link.

Reporting options for employer groups

Our online customer reporting solutions through Employer eServices provides access to information that helps you identify trends, evaluate your company’s health care experience,and make more informed choices about your medical benefits programs.

Access standard reports for free, or generate customized reports on demand. Online reportingallows you to download information into a spreadsheet and print right from your desktop. Inaddition, interactive training tools are at your fingertips on the Web site.

With Web-based flexible reporting options, you can choose from three levels of reports tomeet your business needs:

• Standard: Obtain regularly reported basic financial, utilization and membership information.

• Select: In addition to the standard reports, customize report parameters to deliver moredetailed data and membership/utilization information.

• Expanded: Choose from a variety of report templates and levels of information to facilitateutilization analysis. Obtain detailed performance information on plans, network, medical man-agement and managed pharmacy programs.

Note: Reporting options availability based on group size and funding arrangement.


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OnlinEnrollSM

For open enrollment, we offer OnlinEnroll, our online enrollment tool that collects and managesyour client’s employee benefit enrollment data regardless of how many carriers the companyoffers. Enrolling online makes benefits administration easier for employees and faster and moreefficient for you with easy data collection and management of all your carriers in one spot.

The group’s employees simply make their benefit selections through our secure and easy-to-usesite at unitedhealthcare.com/ole. OnlinEnroll provides everything employees and their fami-lies need to make the best choices for their health care needs, including:

• Summary of coverage by family member• Plan description pages• Comparison of plans• Online links to physician directories and detailed plan pages• Summary of annual and per-pay-period cost for selected benefits

The benefits administrator can access online reports and monitor the enrollment process allfrom his or her own computer, saving valuable time.

If your client used OnlinEnroll for open enrollment, you can continue to use this tool for ongoing eligibility updates, regardless of how many carriers the company offers.

If your clients are interested in using OnlinEnroll for their next enrollment period, contact yourUnitedHealthcare representative. It’s simple to sign up.

Note: Online links to physician directories and plan pages are available where sponsoring carrier provides online plandetail pages.

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myuhc.com®

Health care benefits can seem complex and confusing. Fortunately, myuhc.com,UnitedHealthcare’s consumer Web site offers easy-to-use online tools and information soemployees clearly understand their health care choices. With myuhc.com, employees will real-ize their options don’t end at open enrollment. They can access trusted, reliable informationabout their personal account and health topics of interest, developing an engaged, informedand self-reliant workforce capable of making cost-effective decisions with confidence. Thistool helps to reduce the number of benefit related questions your group’s Human Resourcesdepartment personnel have to answer – freeing them up so they can spend more time oncore business. Check out the practical and personalized tools and information that enrolleescan access on myuhc.com.

• Faster than phone or mail • Available 7 days a week• Private, secure• Credible, current information on diseases, treatment options and costs

• Provides individual coverage, eligibility and claim information• Offers interactive health information through Live Nurse Chat• Q&A with clinical professionals• Customizable tools allow employees to view results based on their

specific situations and personal information

• Registering at myuhc.com helps your employees maximize their benefits• Members can quickly and easily find many health care answers online,

saving them – and you – valuable time• Members click Register Now at myuhc.com and in a few minutes,

they’re ready to use the site

Members can:• Check claims status and history • Review eligibility/benefit information• Change/select a primary physician (if required by benefit plan)• Compare costs in and out-of-network• Print a temporary member ID card or request a replacement member ID card• Review Flexible Spending Account, Health Reimbursement Account

and Health Savings Account information, balances, rollover, and deposithistories (if in coverage)

• Use Pharmacy Online to access copayments and coverage information,drug side effects and interactions, locate pharmacies, and order prescriptions by mail (if in coverage)

Practical

Personal

Registration

All about

benefits


Encourage enrollees to register – it’s easy.

To help promote myuhc.com to your clients’ employees, look for flyers, posters, e-mail arti-cles and other materials on the Communication Resource Center on Employer eServices.

Once registered on myuhc.com, there may be a 72 hour delay to access personalized information, but your employees are able to log in and immediately utilize the site to print atemporary ID card, search for a physician or view current and reliable health informationincluding the latest information on health topics and treatments.

Members can:• Review hospital services by cost and quality-of-care ratings

using the Hospital Comparison Tool• Explore various treatment costs with the Treatment Cost

Estimator• Estimate the costs of different plan options using the Plan

Cost Estimator• Communicate one-on-one with a nurse using Live Nurse Chat• Use the Personal Health Record to organize health data and

receive condition-specific information to better manage theirhealth

• Get a personalized Health Assessment and participate inHealth Coaching Programs that help set goals and achievehealth objectives

• Ready-to-use materials: posters, flyers or payroll inserts. VisitEmployereServices.com and go to the CommunicationResource Center

• You also may create a hot button for linking your Intranetdirectly to myuhc.com

Better information/

better health

Reources for you

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UnitedHealthcare Products

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AZ

WA

OH

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KY

IN

IA

MN

NCOK

TX

UTCO

LA

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ID

AL

CA

FL

GA

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MS

MTND

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NM

OR

PA

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TN

WI

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RICTNJ

NH

VT

IL

MI

MD

DE

VA

AR

MOWV

ME

MA

• Urban2 professionals in 8 miles1 hospital in 10 miles

• Suburban2 professionals in 15 miles1 hospital in 15 miles

• Rural1 professional in 30 miles1 hospital in 30 miles

Service Area Map

560,000 doctors and 4,800 hospitals

Provider Accessibility Standards



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Consumer-Driven Products

UnitedHealthcare’s Definity Health Savings Account (HSA) and Health ReimbursementAccount (HRA) are the nation’s premier consumer-driven health products. As the industryleader, over one million members are enrolled in UnitedHealth Group’s consumer-driven products.These plan designs are attractive to employers who are looking to give their employees asense of ownership in their health plan benefits and to maximize the value they receive fortheir health care dollar.

What happens when employees have more control over their health care?

With our consumer-driven products, results show:

• 5-10% lower utilization of non-preventive care services• Over 10% decrease in emergency room utilization• Quality measures above HEDIS benchmarks• 14% fewer hospital admissions compared to industry• 94.7% generic substitution rate• Employer renewal rates below national trends• Single-digit trend over four years

Source: Definity Health Data

Definity Health Savings Account (HSA)

A Health Savings Account (HSA) is a tax-advantaged account that participants can use to payfor qualified health expenses they incur while covered under a high deductible medical plan,including deductible and copayments. HSA dollars contributed by the employer, employee orothers accumulate over time with interest and are portable after employment.

The Definity HSA helps employees get more involved in health decisions that can improve

greatest incentive for tax-deferred contributions and tax-free growth compared to other tax-advantaged accounts.

Features of the Definity HSA:

• Tax-advantaged savings accounts – individuals put away money on a tax deductiblebasis that grows tax-free

• Contributions, interest earnings and withdrawals for qualified medical expenses are alltax-advantaged

• High deductible health plan provides coverage to help employees stay healthy; deliversaccess to significant cost savings offered by UnitedHealthcare’s Choice Plus network

• Roll-over account balance, even if employees change employers

• Flexible medical benefit plan designs and preventive care coverage


their health and well-being, the results benefit the bottom line. The Definity HSA offers the


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• Discounts on covered and non-covered expenses

• HSA account administered by OptumHealth Bank (a UnitedHealth Group affiliate)

• Innovative consumer web site with easy-to-understand claims summaries, personalized messaging and decision tools

• Health advocacy programs that proactively identify health risks and provide individualhealth support and wellness information

• Range of plan designs with different deductible levels, coinsurance and out-of-pocket amounts

Employees save for the future while your client saves now. The security of health benefits withthe advantages of a 401k and the easy access of a bank account.

Definity Health Reimbursement Account (HRA)

An HRA combines the flexibility of a medical benefit with an employer-funded account. The resultis security, choice and control over health care finances. The Definity HRA is a combination of amedical benefit plan with an HRA funded by the employer. The funds in the Definity HRA helppay for deductibles, coinsurance and other eligible expenses. Give employees a sense of owner-ship in their health plan benefits and maximize the value of their health care dollar.

Features of the Definity HRA:

• Comprehensive medical coverage and the ability to choose both network and non-network physicians

• Access to UnitedHealthcare’s Choice Plus nationwide network of more than 560,000health care professionals and more than 4,800 hospitals

• Funded by the employer only (employees are not permitted to contribute to the HRA)

• Benefit dollars in the HRA are used first to assist employees in satisfying theirdeductible

• Automatic payment from the HRA account to the physician

• Can be used to pay for qualified medical expenses like office visits

• Unspent funds may roll over from year to year

• Network coverage for preventive care is covered at 100% (the employer decideswhether preventive services are eligible for reimbursement from the HRA)

Note: Choice and Choice Plus network data as of 2/2008.



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Choice Plus and Choice Products

Choice Plus

Your health, your choice. UnitedHealthcare Choice Plus gives you the freedom to see any doctorin the Choice Plus network of over 560,000 physicians, including specialists, without a referral orpreauthorization. Employees can also visit non-participating physicians, subject to higherdeductibles and coinsurance. With our Choice Plus plan, the majority of health care needs arecovered with less expense to employees when they visit a network physician or facility.

Benefits of the Choice Plus plan:

• Members visit any participating physician or facility (including specialists) without a referralor preauthorization

• Members can visit any non-participating physician and still enjoy benefits with somewhathigher deductibles and coinsurance

• When members visit participating physicians and hospitals, there aren’t any claim forms orbills to worry about

• Lower out-of-pocket costs for network care

• Range of plan designs with different deductible levels, copayments, coinsurance, andout-of-pocket amounts

Choice

Similar to the Choice Plus plan, except Choice offers access to physicians within the networkonly. Choice offers your employees a large network of 560,000 physicians and 4,800 hospitalsnationwide. Affordable, while giving employees a choice of hundreds of thousands of physicians.

Benefits of the Choice plan:

• Members visit any participating physician or facility (including specialists) without areferral or preauthorization

• When members visit participating physicians and hospitals, there aren’t any claim formsor bills to worry about

Golden Rule®

UnitedHealthcare is affiliated with Golden Rule Insurance Company. Golden Rule offers a variety of affordable health insurance plans for individuals and families. Golden Rule is availablein Connecticut but is not available in New York or New Jersey. For more information, callGolden Rule at 1-888-457-4672 or contact your UnitedHealthcare representative.

Funding options with UnitedHealthcare

Large groups have the choice to be fully insured or self-funded (ASO).



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What You Get with All UnitedHealthcare Plans

• Emergencies are covered anywhere in the world• Visit any specialist in our network without referral or preauthorization• 100% preventive care at no charge

• Care CoordinationSM – Services that help minimize the gaps caused by the complexity oftoday's health care system

• myuhc.com® – UnitedHealthcare’s Web site provides information at employees’ fingertips anywhere, anytime. Members can find personalized information on benefit eligibility, coverage,account history and claims status, or look up a physician

• EmployereServices.com – For groups to manage virtually every aspect of benefitsadministration online and in real-time, increasing efficiency and saving time and money.Benefits administrators can enroll new employees, verify or change eligibility, check claimsstatus (self-funded), and request member ID cards

• UnitedHealth Wellness® – Resources and tools to help employees stay healthy, including acomprehensive portfolio of on-site (workplace) and online wellness programs and services

• UnitedHealth AlliesSM – Health discount program that can help employees save 10% to50% on many health and wellness purchases not included in standard health benefit plans.From myuhc.com click on the Health & Wellness tab and scroll down to Exclusive HealthDiscounts to access discounts below:

• Dental care – Cosmetic procedures such as teeth whitening• Vision care – Laser eye surgery• Alternative care – Acupuncture, chiropractic care, massage therapy, and natural medicine• Health supplies – Family, household, diabetic and medical supplies; beauty and skin

care; vitamins and supplements• Long-term care – Skilled nursing facilities, assisted living, respite programs and

durable medical equipment• Hearing devices

SimplyAccountableSM

SimplyAccountable is a financial commitment from UnitedHealthcare to reduce employerclaim costs by up to 30% with no benefit plan design changes – guaranteed. This commitmentis a major advancement in health and well-being built on a foundation of network savings,care management, consumer activation, and expertise.

• Available to self-funded customers with 300+ eligible employees• At least two of the following must be selected:

• Maximum Non-Network Reimbursement Program (MNRP)• United Behavioral Health and/or • UnitedHealth Pharmaceutical Solutions

• If expected claims projections are missed, up to 35% of administrative fees can be refundedto the employer

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Proactive Health Solutions

Employees have a full suite of personal health solutions designed to help them manage theirhealth and well-being. Individuals who have access to information and easy-to-use servicesmay be more apt to be healthy and productive employees. They can get healthy and stayhealthy with our many wellness and care management programs available.

UnitedHealth Wellness

A comprehensive portfolio of wellness programs and services are available online and offline.Employees can access the following resources and tools to stay healthy:

• Gauge current health status by taking one of our online health assessments• Choose from a menu of online health improvement programs to follow at their own pace• Save money on thousands of wellness products and services• Discounts on certain non-covered health care services• Track progress with personal journaling and other wellness tools• Test health trivia and knowledge with our wellness quizzes and games• Read up on health topics in our vast health and wellness library• Reminder mailings to get recommended preventive screenings

Care24®

More than a telephonic health information line, Care24 is a comprehensive service that givesemployees access to a wide range of resources that go far beyond the ordinary. Employeescan call 1-888-887-4114 or the toll-free number on their ID card 24-hours a day, seven daysa week to access:

• Master’s-level counselors• Registered nurses• Legal and financial professionals• The Health Information Library

Employees can choose to speak with a nurse, a counselor or both, on issues such as:

• Minor illnesses or injuries • Chronic conditions and medication information• Wellness and nutrition• Emotional distress and loss • Relationships, marriage and family concerns• Child and elder care referrals• Financial and personal legal concerns

Note: Because of the potential for conflict of interest, legal consultation will not be provided on issues that mayinvolve legal action against UnitedHealthcare or its affiliates, or an entity through which the caller is receiving Care24 services, directly or indirectly (e.g., employer or health plan).


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Management consultations and employee trainings

Care24 not only helps individuals with the challenges of daily life, but also provides managersand supervisors with tools and trainings that can help keep their work group stay on track. Forexample, Care24 offers management consultations, critical incident stress management andCare24 employee trainings. A list of trainings is available in the Care24 training guide on theCommunication Resource Center on EmployereServices.com. Click the Health andWellness section and then Training Programs. For additional information from nurses or counselors call 1-888-887-4114.

United Behavioral Health (UBH)

Depression and other behavioral health conditions affect millions of Americans and their families.The health and productivity costs associated with simultaneous medical and behavioral healthproblems are substantial and growing. Our goal is to help employers manage these costs byhelping people improve their total health and productivity. We do this through behavioral healthbenefits delivered by our affiliate UBH.

United Behavioral Health is there to help employees with:

• Depression, stress and anxiety• Parenting and family problems• Childcare and elder care stress• Relationship difficulties• Substance abuse and recovery• Dealing with domestic violence• Eating disorders• Balancing work and life issues, and more…

Comprehensive support and resources

When employees call UBH for assistance, they speak directly to a master’s level UBH specialist who can answer questions related to their behavioral health benefits. The specialistcan find the best clinicians (or treatment resources) in their network who are qualified toassist with the caller’s specific needs.

United Behavioral Health’s nationwide professional network includes over 80,000 licensedand certified practitioners – counselors, therapists, psychologists, psychiatrists and socialworkers – who specialize in mental health or substance abuse problems.

The UBH network also provides a range of treatment services at over 3,600 inpatient andoutpatient facilities. Out-of-network benefits are included in some benefit plans. There is no chargefor referrals or seeing a participating provider. Additional service may require pre-authorization anda copayment.

Employees can reach UBH counselors by calling the Mental Health or Customer Care toll-freephone number on their medical ID card. Visit unitedbehavioralhealth.com for additionalresources and information.

Note: United Behavioral Health network data as of 4/2007.


UnitedHealth Pharmaceutical Solutions

Prescription medicine is crucial to the health and wellness needs of employees and their families. By integrating medical and pharmacy benefits, you can dramatically simplify theadministration of your client’s plan, and also help them get the best value for each dollar. Weoffer a comprehensive and quality pharmacy benefits, and always strive to introduce innovativeprograms to help make health care more affordable. The pharmacy plan is integrated automaticallywith all fully insured medical plans and offered separately to self-funded customers.

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Flexible benefit

designs

Broad, discounted

and integrated retail

and mail service

Clinical programs

Prescription Drug List

(PDL) management

Our benefit plans are designed to anticipate and manage trendsin the pharmaceutical industry, keeping costs down and providingthe best, most economical health and pharmacy benefits foremployers and their employees and families.

Prescriptions can be processed in person at our large network ofpharmacies (more than 60,000 nationwide) or by telephone, mail,physician faxes, and online.

We use technology to integrate medical and pharmacy informationto proactively identify and address gaps in care. For example, weprovide physicians with information that helps to provide effectivehealth care based on the patient’s history.

A three-tier Prescription Drug List is part of the standard benefitdesign for all customers. This means the health benefit design allowsbroad access to generic and brand name medications with copay-ments at three different levels based on total health care value.

Best-in-Class Pharmacy Value

Note: UnitedHealth Pharmaceutical Solutions network data as of 7/2007.


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How we make a difference for our customers:

Total health care approach. We make pharmacy decisions based on an understanding ofhow our decisions impact total health care. We do this by integrating pharmacy with medicalmanagement, using a database of pharmacy, medical and lab data, and applying pharma-coeconomic information to our pharmacy decisions and programs. We uniquely have access toreal world insights on how drugs perform and impact overall health care.

Evidence-based care. It’s our goal to lower overall healthcare costs, while providing mem-bers with medication choices at an affordable cost. Therefore, we review economic, clinicaland pharmacoeconomic evidence when developing our prescription drug list and clinical pro-grams. This evidence helps us determine a medication’s overall value relative to other medica-tions in its class.

Member engagement. Our personalized member engagement strategies are designed tomake health care work better for members. When provided with helpful and consistentresources, members are empowered to make educated decisions about his or her utilization,such as choosing high-value medications that save money.

Employees can find pharmacy information on myuhc.com or they can call the CustomerCare toll-free phone number on their member ID card for more information.

Healthy Pregnancy Program

Once we are notified that a woman is pregnant, UnitedHealthcare supports mothers throughall stages of pregnancy and delivery. In addition, we have an aggressive case managementprogram to help high-risk maternity patients have healthier babies with less reliance on costlyneonatal intensive care services.

If an enrollee would like to participate in this program, they should call 1-800-411-7984

between 9 AM and midnight, Eastern Standard Time, Monday through Friday.

Care Management

For individuals with more serious health issues, our care management process takes a deliberateapproach, mobilizing the appropriate care resources on behalf of the enrollee. This process mayidentify gaps in care – such as missing medications or misunderstanding of care instructions.

Individuals enter the care management system through notification from a physician or hospital orthrough predictive model technology that reveals a care need. Education and prevention programsinclude preadmission counseling, inpatient care advocacy and readmission prevention.


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Disease Management

Our care management approach is an intense focused approach for members with chronicconditions, such as asthma, diabetes and coronary artery disease. We identify individualsthrough calls to Care24, notification from a physician, retrospective review of claims information,or through the individual’s health assessment survey. Members benefit from a tailoredapproach that includes education and coaching from a registered nurse.

By identifying chronic diseases and high-risk cases early, it helps individuals achieve a greaterquality of life and productivity, and minimizes the progression of chronic disease. The longitudinalapproach focuses on the whole person, not just one disease.

Specialized Solutions for Managing Complex Medical Conditions

For complex medical conditions including cancer, congenital heart disease, transplants, kidney,reproductive, and neonatal services, members have access to premier medical centersrenowned for providing quality treatment while managing treatment costs and maximizingemployee benefits. Provided through our affiliate company, United Resource Networks, thisresource can help members make informed choices about where to get care, coordinate carewith their treatment team, schedule appointments, find accommodations, and direct membersto appropriate support programs. Members simply call the toll-free phone number on theirmember ID card to access these services.


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Online Administration

For open enrollment, we offer OnlinEnrollSM, our online enrollment tool that collects and manages a group’s employee benefit enrollment data regardless of how many carriers yourclient offers their employees. The employees simply make their benefit selections through oursecure and easy-to-use site at unitedhealthcare.com/ole. Employers can continue to usethis tool for ongoing eligibility updates. Refer to the Web section of this guide for moreOnlinEnrollSM information.

Real-time web-based eligibility

On the Employer eServices site click on the Enrollment tab. There, you can add, terminate,reinstate, inquire or change your employees’ eligibility information immediately. This optionworks well if you’re adding an employee or managing a few changes at a time.

Electronic eligibility management system

This option eliminates double data entry by offering the ability to export eligibility informationdirectly from the group’s Human Resource system to our system with same-day processingspeed. The designated group contact will receive an e-mail notification that your file isprocessed and statistics are available online for viewing. The reports can be sorted by employeeID, error codes or date and downloaded into spreadsheets.

COBRA enrollment

During the eligible period of COBRA/continuation, we will not terminate an insured individualuntil we are notified to do so. When you are notified by an insured individual or an event thatterminated continuation of coverage, please complete the COBRA enrollment online atEmployer eServices.

Offline Administration

In the event that you or your clients temporarily lose access to the Internet, please follow thesteps outlined below to help us administer your benefits. Refer to the Customer Service sectionfor addresses and phone numbers.

Enrolling employees

• Employee completes, signs and dates the Employee Enrollment Form within 31 days(see eligibility requirements in your group contract) from when the eligible person firstbecomes eligible to enroll.

• Employer completes the Employer section of the Employee Enrollment Form, reviewingthe form for accuracy and completeness. Refer to the Customer Service section for mailingaddresses and phone numbers. Keep completed forms in files.

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Reporting enrollee changes

• Call us immediately with any employee or dependent name, address or telephone number changes. Please have the group number and the employee’s or dependent’sidentification number on their member ID card ready before you call.

Terminating members

• Call us immediately to report a termination of employment. If you do not call, you willcontinue to be charged for that employee’s coverage.

• Please have available the group number, and the employee’s name and identificationnumber on their member ID card.

• Collect the member ID card from the terminated employee and their dependents.

• Staple the ID to the terminated employee’s enrollment form and keep them in thegroup’s file.

Note: We will continue to charge for a terminated employee’s coverage if you do not process the termination onlineor call. If a covered customer uses services after the termination of employment and before we are notified, a premi-um must be paid up to and through the time in which services were used.

Reporting continuance of coverage/COBRA information

• Complete and submit an Employee Enrollment Form to disenroll the employeeand/or dependent.

• Notify the employee in a timely manner of the right to elect continuation coverage.

• Complete and submit an Employee Enrollment Form, if the employee (and/or dependent,if COBRA applied) elects continuation of benefits.

• Call us to obtain the continuation rates for your plan.

• Collect premium payments from employees and eligible dependents (checks should bemade payable to your company) and remit total billed amount with your monthly payment.

• Call us to disenroll employees and eligible dependents once they reach the end oftheir COBRA coverage.

Upon receipt of the Employee Enrollment Form, all COBRA beneficiaries will be enrolledwith a continuation status code so you can easily identify them on the bill.


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Eligibility requirements

All newly hired eligible employees should be given the opportunity to apply for coverage within31 days of date of hire or the waiting period. Please reference the group contract for exacteligibility requirements. Please follow your clients’ eligibility policies for rehire and leave ofabsence situations.

Effective date

New hires are effective on the date of hire, the first day of the month following the date ofhire, or the first day following the completion of any designated waiting period. The waitingperiod is defined in your group contract. Changes on waiting periods can be made for futureeffective dates and only upon renewal.

If the employee is on leave and covered under the Family Medical Leave Act, the coveragebegins on the date the group policy becomes effective even if he/she was on leave at that time.

Retroactive eligibility adjustments

All requests for additions, changes and terminations of eligibility must be submitted immediately or within 31 days of the effective date. The 31-day limit is used unless prohibitedby state law, COBRA or by UnitedHealthcare contract. If COBRA coverage is part of a newenrollment or if terminating coverage for a COBRA participant, notification must be receivedwithin 60 days of the effective date. There are no limitations for retroactive COBRA reinstate-ments that have no lapse in coverage.

Identification (ID) Card

Members will receive two ID cards. Each card includes basic benefit information, importanttelephone number(s), employee and dependent name(s) and identification number(s). Theback of the ID card lists Web sites and telephone numbers for customer information.

If a member has lost their ID card, they can go to myuhc.com and print a temporary cardand also order a new replacement ID card. Employers can also request a new ID card on themember’s behalf on EmployereServices.com.

Transition of Care

If new members are concerned about transitioning their care from a non-participatingphysician to a participating physician, they may request and qualify for our Transition of Careprogram for certain health conditions. Members should call the toll-free phone number ontheir ID card for more information.


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118

Enrollment

Claims Estimator

For employees prior to a procedure that their physician has suggested, the physician canprocess an online, real-time pre-determination of benefits to check if the procedure will be covered and at what amount, all within 10 seconds or less. Physicians can access the ClaimsEstimator tool on UnitedHealthcareOnline.com.

Continuation of coverage/COBRA

Continuation of coverage allows an employee to continue on the company’s health care coverage for a period of time under certain circumstances, such as termination of employment.Federal and some state governments have mandated employers to provide certain continuationrights to employees and eligible dependents. Continuation of coverage under COBRA is availableonly to employees of enrolling groups that are subject to the terms of COBRA.

Any continuation rights are described in the Certificate of Coverage. It is the employer’sresponsibility to determine which legislation is applicable. UnitedHealthcare and its affiliatedcompanies will not assume the obligations of an Employee Retirement Income Security Act(ERISA) Plan Administrator.

Qualifying events and termination of continuation provisions are listed in the Certificate of Coverage.

Connecticut employees may want to consider using our affiliate company, Golden Rule® InsuranceCompany, for their insurance needs after their employment ends. Golden Rule InsuranceCompany offers health insurance plans for families and individuals under age 64 throughoutmuch of the United States. For more information, call Golden Rule at 1-800-413-4420. New Yorkand New Jersey employees may want to consider our suite of Oxford products as outlined in theOxford section of this guide. For more information call the Oxford Sales and Information lineat 1-800-216-0778.


Employees may have dependents covered on their medical plan who are over age 18 but areconsidered full-time students. If so, verification of student status may be needed when a claimis received.

UnitedHealthcare has a process for verifying student status and requires the affected employee’s immediate attention in order for the claim to be processed:

• If a dependent is over the age limit and UnitedHealthcare does not have any studentstatus information, the claim will be automatically denied indicating “no coverage.”

• If the dependent is currently listed as a student, but the date of service is after the studentstatus date has expired, the claim will automatically close and a letter will be sent to theemployee associated with the student, asking for updated student status date information.

• The letter from UnitedHealthcare Service Center asks the employee to provide therequired student information via mail or telephone. Instructions are provided in the letter.



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Employer eServices Online Billing

Because electronic transactions are delivering faster access to benefits for members, andreducing billing and claims errors for customers and physicians, online billing and payment isour standard method of operation. Online billing offers fast service, simplified invoices, downloadable data, and real-time calculations and payments.

• A reminder e-mail is sent to the group contact every month when the group’s invoice is readyfor review and payment on Employer eServices.

The benefits administrator (BA) or broker acting on behalf of the BA should:

• Click on the Billing tab to view, sort or download current activity, view account balance andpast due aging payment history, as well as submit payments.

• Easily make eligibility adjustments on the group’s invoice if needed. The eligibility section of thesite will guide you in making this adjustment. After you’ve made the adjustment in the eligibilityarea, simply go back to the billing section of the site and request a new adjusted invoice.

• Elect to submit your payments online or through Scheduled Direct Debit. Scheduled DirectDebit allows payment electronically through an automatic monthly debit from a designatedchecking account on the due date of the invoice. To set up Scheduled Direct Debit orestablish an online payment method, go to the Billing section of EmployereServices.com

and selecting Edit Payment Method in the menu bar. If you don’t have access to the onlinebilling tool, call Customer Care at 1-888-842-4571 to pay by phone or see the Paying PaperInvoices section below.

Note: Availability of online bill payment is based on your agreement with UnitedHealthcare and all services may notbe available to all customers.

Paying Paper Invoices

If a group receives a paper invoice, they should pay the amount billed and not adjust theinvoice. If we do not receive an Employee Enrollment form in time to be reflected on thegroup’s current invoice, additions or terminations will be reflected on the group’s next invoice.Any refund, credits and back charges will appear as an adjustment on the group’s nextmonth’s invoice.

The bottom portion of the invoice is the return payment stub. To ensure that we apply payment correctly, the group should return only the payment stub and check to the address onthe payment stub.

Note: Written changes with a payment stub will not be processed. Do not send any other correspondence or materi-

als with your payment.

Payment Due Date

Payment is due and should be received by the payment due date each month to ensure uninterrupted coverage. If a group’s premium payment is not received in full by the end of themonth when payment is due, their policy is subject to termination (see the group’s mastergroup contract).

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Small Group Renewals

Prior to the group’s policy anniversary, employer groups of up to 50 employees on the Oxfordplatform and their brokers or consultant will receive a letter to remind the group of theirrenewal date. You can also review your groups that are within 60 days of their annual renewalusing the Oxford Idea Management SystemSM. For more information about renewing on theOxford platform, please refer to the Oxford Renewals section of this guide.

For groups in upstate New York, Pennsylvania, Delaware, and any other state where smallgroup products (2-50) are available on the UnitedHealthcare platform, you can view renewalsonline at UnitedeServices.com. This service includes an e-mail alert to inform you whenrenewals are posted on United eServices. You can then obtain a list of your renewal policiesand corresponding renewal packages online and generate an alternate renewal quote as well.Plus, your renewals are stored and organized for you, neatly and conveniently, and available atyour fingertips. Renewal packages are available for review approximately three months prior tothe policy renewal date and they remain online for six months.

Large Group Renewals

A letter will be sent to the group at least 60 days prior to the renewal date notifying them ofrenewal. If you would like to evaluate alternative options for renewal and additional lines ofcoverage with UnitedHealthcare please contact your UnitedHealthcare representative.

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123

Claim Submission

Claim explanation

• Medical claim expenses may be submitted to UnitedHealthcare by the covered individual, orthe physician or other health care professional.

• Physicians and/or other health care professionals in our network submit claims toUnitedHealthcare online, and payments are made directly to the provider of the service.

• A member may submit claims directly to UnitedHealthcare for out-of-network claims or in othercircumstances where the physician did not submit their claims. Standard medical claim formsare available online at myuhc.com. Each page of the invoice should at a minimum include themember’s name and the subscriber’s ID number and policy number located on their ID card.

• Missing or incorrect information may result in a delay in processing the claim.

• Send medical claims to the claim office address on the member’s ID card.

• Questions regarding claims submission and payment may be directed to the number listedon the member’s ID card.

The member can check the claims status on myuhc.com.

Real-time adjudication

Real-time adjudication (RTA) refers to the near instant claims processing available at all physi-cian offices. Physicians and other health care professionals using our RTA technology cansubmit a claim through UnitedHealthcareOnline.com and get a fully adjudicated responsein real-time (10 seconds or less). Patients know precisely what they’re responsible for withouthaving to wait for a bill in the mail. Also, the doctor can request payment of the patient’sresponsibility from the patient before they leave the office. If applicable, members can usetheir OptumHealth Bank consumer accounts card and immediately fund qualifying expensesdirectly from their HRA, FSA or HSA accounts.

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Coordination of Benefits (COB)

COB occurs when more than one insurance company or health plan covers the employee ordependent. To determine if this coverage is primary or secondary for an employee, pleasereview the Certificate of Coverage.

When coverage under this plan is secondary

• Submit the claim to the primary coverage company• After their payment and Explanation of Benefits (EOB) are received, send a copy of the primary

coverage company’s EOB and an original invoice to the UnitedHealthcare claim office

When coverage under this plan is secondary to Medicare

• Submit the claim to the primary coverage company• After their payment and Medicare EOB are received, send a copy of the Medicare EOB and

an original invoice to the UnitedHealthcare claim office

Information regarding other coverage is updated every 12 months. The member can updatetheir COB information online at myuhc.com. The member may receive a letter requestingthis information, and should return it to the claim office in a timely manner. Refer to theCertificate of Coverage for more information.

Medicare supplemental coverage with automatic claim filing

We offer Medicare supplemental coverage to customers who provide group health coverageto their Medicare eligible employees and retirees. Through automatic claim filing, unpaidMedicare deductibles and coinsurance are electronically submitted to UnitedHealthcare forprocessing. Members enjoy added convenience because there is no paperwork and claimsprocessing is expedited.

Claims appeal process

If members disagree with a benefit determination, they have the right to appeal the claim decision. Members should refer to their Certificate of Coverage for details about how toappeal a claim decision.

To expedite members’ questions or concerns regarding claims, coverage or appeals, there’s aMember Service Request Form with instructions about how to submit information to us so wecan resolve their issue. The form is located on myuhc.com under the Claim Center link.


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Claim Information

For any services that are not billed directly, members may submit claims to UnitedHealthcare. Weaccept all standard medical claim forms used by medical physicians and health care professionals.

• Medical, HRA and FSA claims are available online at myuhc.com and generally include the following information, which helps to process claims in a timely manner:

• Member’s name and address• Member’s date of birth• Member’s subscriber number as indicated on the member’s ID card

Itemized billing information

• Physician’s diagnosis of illness or injury

• Date of service

• Place of service

• Procedure(s) performed, including Current Procedural Terminology (CPT) codes or adescription of each charge

• Name, address and Tax Identification Number (TIN) of the physician or health care professional

• A statement indicating whether or not the employee is enrolled in any other healthinsurance plan or program

• Information on when, where and how an injury occurred for services related to accidental injuries

Note: Each page of the bill should include the member’s name and subscriber’s ID number, as indicated on their ID card.

• Missing or incorrect information may delay claim processing

• Prescription, dental, vision, and mental health claim forms are also accessible throughmyuhc.com

• Send medical claims to the claims office address listed on the member’s ID card

• Questions about claims submission and payment may be directed to the Customer Caretelephone number on the member’s ID card


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UnitedHealthcare Specialty BenefitsSM

As health care costs continue to rise, the pressure is growing on employers to limit their financialexposure while still providing access to cost effective health care for their employees. The TotalAffordability ManagementSM strategy by UnitedHealthcare is aimed at using data and resourcesto raise the quality bar – enhancing service delivery and efficiency across the entire network.

When you work with UnitedHealthcare, you receive one of the broadest product portfolios inthe industry. Our portfolio features group medical, dental, vision, life, short-term disability, andlong-term disability. Our products can be employer-paid, voluntary, sold as stand-alones, orpackaged together. And because our benefits come from our extended family of companiesyou’ll see terrific advantages:

• Simplified administration from one carrier• One account team• Plan designs that fit your needs• Online employer tools via Employer eServices®

• Packaged Savings® Program

Along with our comprehensive product portfolio, we also offer superior customer service,state-of-the-art technology and streamlined administration. So make sure to review and consider our specialty products along with our UnitedHealthcare medical products.

Did you know we insure more than …

• 75,000 employers for dental, vision, life, and disability• Six million members for dental and have over 77,000 dentist access points• Eighteen million members for vision and have over 27,000 contracted vision providers• 42,000 customers and one million plan participants for life and disability

Note: Network data as of 8/2007.

Packaged Savings Program®

UnitedHealthcare gives you one-stop shopping for quality, comprehensive health care benefits.You can combine our innovative, affordable medical plans with comprehensive specialty products – dental, life, disability, and vision. The savings you realize through Packaged Savingsare based upon medical enrollment and the number of active lines of specialty coverage you have with UnitedHealthcare. The more you bundle, the more you save.

Packaged Savings means:

• Bundled UnitedHealthcare medical and specialty products for administrative credit• Savings based on medical enrollment and coverages chosen• One account team for all of your benefits needs• Streamlined administration• State-of-the-art online employer tools


This program is available from UnitedHealthcare in New Jersey and Connecticut to groupswith 50 or more lives and public sector business written on a UnitedHealthcare license, and inNew York to self-funded (ASO) business written on a UnitedHealthcare license. Contact yourUnitedHealthcare representative for more information about Packaged Savings®.

Note: Packaged Savings is not available in conjunction with any Oxford licensed products.

UnitedHealthcare Dental®

Provided by UnitedHealthcare Dental® (Dental Benefit Providers, Inc.)

Regular dental care is now recognized as an important part of total health and well-beingprogram. Just ask the Surgeon General. The UnitedHealthcare dental program offers dentalplans designed to deliver flexibility, convenience and choices – at an affordable price. Founded in1984 as Dental Benefit Providers, Inc., below are some of the many benefits of our dental plans.

• Large national network – More than 85,000 dentists and dentist specialists in thenational PPO networkNote: Network data as of 2/2008.

• Streamlined administration – Consolidated billing, eligibility and enrollment for medicaland dental benefits

• Quality management – We support standards recommended by the National Associationof Dental Plans for measuring, maintaining and improving dental health care

• Leading-edge technology – Built-in auditing and highly automated claims adjudicationfor accurate and timely payment

• Broad product portfolio – We offer innovative and customizable solutions for allemployer populations, including: Indemnity, PPO, DHMO, voluntary, preventive, and networkaccess plan designs.

• Prenatal dental care – To encourage pregnant women in their second or third trimester,UnitedHealthcare waives the deductible, coinsurance, annual maximum, and frequency limitations to reduce the risks of periodontal disease and pre-term delivery

Delivering excellence and efficiency through UnitedHealthcare Dental

UnitedHealthcare Dental delivers operational excellence, accuracy and efficiency to providersand members:

• Deep network discounts – 37% national average PPO network discount• High first call resolution rate – 93% first call resolution rate• Fast claims service – 92% of claims paid within 10 days; 97% within 15• 99.5% accurate – 99% financial and clerical accuracy• 65% auto-adjudication rate – 65% of claims are automatically adjudicated

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Dental Products

UnitedHealthcare Dental plans provide comprehensive dental benefits and the flexibility, convenienceand choices to satisfy employers and employees alike. Many plans require no payments forpreventive and diagnostic procedures, such as cleanings and routine examinations.

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Dental Options

Preferred Provider

Organization (PPO)

Traditional Dental

Health Maintenance

Organization (HMO)

Direct Compensation

(DC)

Voluntary Dental

Dental In-Network

Only (INO)

Dental Indemnity

• Extensive national network• Substantial employee cost savings when visiting a network dentist• Option to see non-participating dentists for higher out-of pocket costs• No claims forms for network coverage

• No deductible, annual maximum, or waiting periods• Members select providers from a closed panel network• Specialty referral

• No deductible, annual maximum, or waiting periods• Members select providers from a closed panel network• Specialty referral

• Low employer costs (administration only)• Convenient payroll deductions (pretax) if employees participate

in flexible spending account or cafeteria plan• Coverage for routine and other dental services

• Access to extensive national PPO network of dentists• Coinsurance flexibility• Designed for single – or multi-site employers• Available on both a contributory and voluntary basis

• Comprehensive dental benefits• Allows employees to see dentist of their choice• No referrals needed for specialists

Product Features

UnitedHealthcare Dental Growth (2002-2006)

2002 $219 million

2004 $393 million

2006 $866 million

UnitedHealthcare Dental (cont.)


UnitedHealthcare Dental (cont.)

Customer service

We provide a toll-free customer service line, 1-877-816-3596, and a Web site, myuhcdental.com, to give members immediate access to claims and eligibility information.Plus, our interactive voice response (IVR) phone system is available any time of the day.

UnitedHealthcare Vision®

UnitedHealthcare makes vision coverage simple with affordable, easy to administer visionplans for all employer groups. Routine vision exams are important even for employees whodon’t wear glasses or contact lenses because they may help uncover other medical problems.Now you can provide a well-rounded package of benefits, including a vision benefit that offersconvenience and cost-savings for your clients and their employees.

Formerly Spectera, Inc., UnitedHealthcare’s Vision products from UnitedHealthcare Specialty BenefitsSM

serves over 9,000 clients; and administers vision benefits to more than 18 million participantsnationwide. The network has more than 25,000 providers including private practice and retailchains. Clients include national and regional employers, multi-employer trust funds, HMOs, insurancecarriers, third-party administrators, associations, unions and state and local governments.

UnitedHealthcare Vision provides the following services and benefits:

• Paperwork-free vision benefit – No claim forms or ID cards in order to access care

• Interactive voice response system – Interactive phone line for members and providers

• Covered-in-full contact lens benefit – Fitting/evaluation, contacts from covered selec-tion and up to two follow-up visits covered in-full. An allowance is provided for contacts out-side of the cover-in-full selection

• Standard scratch-resistant coating – Coating covered-in-full with every pair of glassesreceived at network providers

• Frame benefit – Members receive a $50 frame allowance applied to the wholesale cost ofany frame of their choice at private practice provider, or a $130 frame allowance applied tothe retail price at retail chain providers

• Diversified network – A balanced national network, including both private practice andretail chain locations

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Vision Products

The UnitedHealthcare standard vision rider is included in most medical plans. Or, ourUnitedHealthcare VisionSM plan offers a comprehensive vision care benefit with plan designsand contribution levels that are right for any employer group.

Note: The following services and materials are excluded from coverage under the Policy: post cataract lenses; non-prescription items; medical or surgical treatment for eye disease, which requires the services of a physician; Worker’sCompensation services or materials; services or materials that the patient, without cost, obtains from any governmen-tal organization or program; services or materials that are not specifically covered by the Policy; replacement or repairof lenses and/or frame that have been lost or broken; and cosmetic extras.

• Included with most fully insured medical plans;available to self funded plans

• Employees only pay their regular office visitcopay for routine vision exams

• Dedicated provider network in the routinevision network

• Vision exam covered-in-full after office visit copay

• Preferred pricing and discounts on frames, lenses, contacts and other ophthalmic materials

• Collection of selection frames, including manypopular brands

• Discount on contact lens fitting, follow-up and materials

• Stand alone coverage options for allgroup sizes

• Flexible plan designs and low copayoptions for exams and materials

• Large national vision care provider network

• Industry-leading benefits

• Easy administration

• Outstanding covered-in-full frame and contact lenses benefit

• Access to discounts on laser eye surgery

UnitedHealthcare Standard Vision Rider UnitedHealthcare Vision Plan

UnitedHealthcare Vision Growth (2002-2006)

2002 $178 million

2004 $252 million

2006 $349 million


Specialty Products

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Life and Disability

Formerly called Unimerica® Workplace Benefits, UnitedHealthcare Specialty BenefitsSM offersfully integrated life and disability insurance policies for your clients. Our products are availableon a stand-alone basis, or packaged with our medical plans. We are one of the fastest-growinggroup life/disability insurance carriers in the industry with more than 42,000 customers andone million plan participants nationwide. Life and disability products provide employees withsecurity and flexibility while providing you with simplified, hassle-free administration.

Life coverage

Life coverage can be based on a flat coverage amount or a multiple of the employee’s salary.For groups of 10 or more, supplemental life plans can be designed to give employees theoption to “buy up” to higher levels of coverage beyond the basic plan.

Disability coverage

Our disability coverage offers group disability benefits, including short-term disability, long-term disability and voluntary disability. Optional enhancements, such as specific disease andkey employee benefit riders, are also available for certain group sizes.

Advantages of our products

Our life and disability products offer a competitive advantage through various flexible optionsand value-added services:

• Financial strength – A+ rating by Standard and Poor's (United HealthCare Insurance Company)

• Flexible funding options – Most benefit plans can be fully insured, employer-paid oremployee-pay-all.

• Special features – Most products include flexible plan designs and a variety of optionalbenefit riders. Life insurance products include special support services for beneficiaries.

• Value-added services – Employee access to 24/7 travel assistance for domestic and foreign travelers with emergency travel needs, as well as online self-service will preparationinformation and tools (offered at no cost to the employer).


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Life and Disability (cont.)

• Claims management – Our disability claims staff has, on average, 15 years of experienceworking with claimants, with an emphasis on a timely and appropriate work return. Ourclaims management strategy assures disabled employees income replacement during lostwork time, appropriate medical treatment and a physical and vocational rehabilitation plan.

• Integrated medical and disability management – True integration of disability andmedical case management can lead to consolidated information across medical and disabilityhistory available to case managers, and the ability to direct customer care for the best out-comes and access across a wide range of UnitedHealthcare resources. Integration of dis-ability and medical coverage reduces recovery time, getting employees back to productivework quicker.

Life insurance is vital to the financial security of consumers and their families, and we recognizethis fundamental requirement by offering a variety of flexible life insurance plans. In addition, weoffer a portfolio of disability products that emphasize healthy lifestyles, independent living anda robust return-to-work philosophy.

Note: Specialty products network and financial data as of 2/2008.


Note: Limitations for AD&D include: disease, bodily or mental infirmity, suicide or intentionally self-inflicted injury,commission of an assault or felony, war, use of any drug unless prescribed by a physician, driving while intoxicated,engaging in any hazardous activities, or travel in private aircraft. Non-occupational coverage only is also available.Coverage exclusions and limitations may apply.

Life Insurance

Policies

Accidental

Death and

Dismemberment

(AD&D) Policy

Disability

• Basic: Choose life coverage based on flat amounts, job level, ora multiple of the employee’s salary.

• Basic and dependent: Add dependent life coverage to thebasic plan for spouses and children.

• Basic and supplemental: Employees can buy up to higher levelsof coverage beyond the basic plan. Guaranteed Issue amounts areavailable for Life insurance and Accidental Death andDismemberment insurance, based on participation and group size.

• Basic, dependent and supplemental: Offer employees both dependent and supplemental insurance in addition to basiccoverage.

Additional insurance coverage for loss of life or injuries sustainedon or off the job and within 90 days from the date of an accident.AD&D insurance can only be purchased with one of the basic lifeinsurance policies. Please see the Underwriting Guidelines andRequirements for more details.

We offer a wide selection of group disability standard benefits,including Short-Term Disability, Long-Term Disability and VoluntaryDisability. Optional enhancements, such as specific disease and keyemployee benefit riders, are also available for certain group sizes.

A Comprehensive Portfolio

134

Specialty Products

UnitedHealthcare Life and Disability Growth (2002-2006)

2002 $35 million

2004 $83 million

2006 $202 million

Life and Disability Products


Miscellaneous Items

135


We take our responsibility to protect the privacy of individually identifiable health informationof members very seriously. UnitedHealthcare is compliant with HIPAA to protect the confiden-tiality of individuals’ protected health information and we require that our business associatesappropriately safeguard protected health information.

For specific questions, concerns or advice regarding HIPAA, please consult your legal counsel.

Medical extension of benefits

If for some reason your group contract is terminated and your plan covers medical extensionof benefits, coverage for – a covered person who is totally disabled at the time of the termination – will not end automatically. See your group contract for details.

Important notice regarding ERISA

In 1974, a federal law known as the Employee Retirement Income Security Act (ERISA) wasenacted. This is an employer law and has certain requirements that must be met. Mostemployers and their employee benefit plans are subject to ERISA. If you have questions aboutERISA, please consult your legal counsel.

Qualified medical child support order

A Qualified Medical Child Support Order is a court order requiring either the employer or theemployee to provide medical coverage for the employee’s child. Federal law requires that youkeep a written procedure for determining whether a medical child support order is qualified. Ifyou receive a qualified order, visit EmployereServices.com for the form to enroll the child.

Waiving coverage

If an employee chooses to decline health care coverage, have the employee complete thewaiver portion of the Employee Enrollment Form. Review the form to be sure all necessaryparts are completed and keep a copy for your records.

Note: If an employee or dependent who waived coverage due to the existence of other health coverage later wishes toenroll in the plan, the waiver form that was originally signed due to other coverage must be sent to the enrollmentaddress at the point of eligibility. If the form is not received, the employee or dependent will be treated as a late enrollee.


136

UnitedHealthcare ID Card

The UnitedHealthcare member ID card is just one example of our innovation – merging cutting-edge health care technology with that of the financial services industry. This card efficiently joins the user, physician and UnitedHealthcare in a secure electronic exchange ofinformation using technology similar to a retail payment transaction. Key features of theUnitedHealthcare member ID card include:

Electronic technology: The magnetic stripe on the back of the ID card enables communi-cations between the member’s physician and UnitedHealthcare at the time of service, throughthe physician’s office credit card terminal.

Security safeguards: The ID card provides protection for handling and processing confidentialhealth information with the use of an alternate identification number, instead of using themember’s Social Security number.

Member convenience: The ID card conveniently lists the member’s name as well as anycovered dependents on the same card. This means they won’t have to carry separate cards foreach dependent. Members selecting family coverage will receive two ID cards per family, andthose with single coverage will receive one ID card.

Copayment information: If applicable, members can determine copayment amounts just by looking at the front of their card. If this information is not listed, members may request verification of the copayment amount when the health care professional swipes their card orby visiting myuhc.com.

Customer service toll-free number: Anytime of the day or night, members can call ourtoll-free customer service number.

Claims address: To send in claims information or seek additional claims information, members can use this mailing address.

Miscellaneous Items


Insurance coverage provided by or through: United HealthCare Insurance Company, UnitedHealthCare Insurance Company of New York, or their affiliates. Oxford HMO products areunderwritten by Oxford Health Plans (NY), Inc., Oxford Health Plans (NJ), Inc. and Oxford HealthPlans (CT), Inc. and Oxford insurance products are underwritten by Oxford Health Insurance, Inc.and Investors Guaranty Life Insurance Company.

Administrative services to self-funded plans provided by United HealthCare InsuranceCompany or United HealthCare Service LLC.

UnitedHealthcare Dental® plans are provided by United HealthCare Insurance Company orits affiliates.

UnitedHealthcare VisionSM benefits and adminstrative services provided by or throughSpectera, Inc., United HealthCare Insurance Company, or their affiliates.

UnitedHealthcare Life and Disability products are provided by or through Unimerica InsuranceCompany, United HealthCare Insurance Company or its affiliates.

Specialty products may not be available in all states or for all group sizes. Packaged Savingsprogram may not be available in all states. Certain restrictions apply.

© 2008 United HealthCare Services, Inc.

© 2008 Oxford, LLC. Comp Health Insurance, Inc. and Investors Guaranty Life Insurance Company.

Miscellaneous Items

137


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