your health care counts specialty discussion our health plan: what do you need to know? door...
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Your Health Care Counts
Specialty DiscussionOur Health Plan: What Do You Need to Know?
Door Kewaunee Health Insurance Purchasing Cooperative – Sturgeon Bay
November , 2012
UNITEDHEALTHCAREDENTAL
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Value Add Features
Prenatal Dental Care Program• Members may receive additional cleanings or perio maintenance during that period• Covered at 100%• Deductible does not apply
Oral Cancer Screening
• One screening per benefit period
• Adult Members
UNITEDHEALTHCARE VISION
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Vision Care and Your Health
Facts:
• Vision disorders are the 2nd most prevalent
health problem1
• Eye exams may detect early warning signs
of serious health conditions2
- diabetes- hypertension- high cholesterol- vascular disease- glaucoma- cataracts
1 Employee Benefit News, April 15, 2009 2 Health News Digest, December 2008
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
In-Network Benefits At a Glance
Frequency BenefitsComprehensive Eye Exam Every 12 months $15 copay
A complete pair of eyeglass lenses* Covered selection of contact lenses (lens fitting included)* *after copay
Every 12 months $30 copay
• Frame Every 24 months $130 allowance
• Single vision, lined bi-focal, lined tri-focal or lined lenticular lenses
(Other lens options available at a discounted rate)
• Standard scratch coating
Every 12 months
Covered in full
Covered in full
Covered in full
Lens Options See benefit summary for details
Elective Contact Lenses
• Contact lenses that fall outside the covered selection.
(Copay does not apply)
Every 12 months $105 allowance
Additional Materials 20% off
UNITEDHEALTHCARECritical Illness and
Accident Protection
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What about Critical Illness?
1 Heart and Stroke Statistical Update, American Heart Association 2010 2 American Cancer Society, Cancer Facts & Figures 2010
3 Center for Studying Health System Change 2008
Facts you should know:• Every 34 seconds someone has a
heart attack1
• Men have a 44% chance of getting
cancer and women have a 38%
chance of getting cancer in a lifetime2
• Nearly 20% of insured Americans
have problems paying their medical
bills3
Critical Illness -What’s Covered?*
*Partial Benefit -- See Benefit Summary or Certificate of Coverage for specific provisions.All features may not apply. Some states have restrictions.
Cardiovascular
Heart Attack
Heart Failure
Ruptured Aneurysm
Stroke
Coronary Artery Bypass*
Critical Illness – Other
Chronic Renal Failure
Paralysis
Severe Burns
Severe Brain Damage
Coma
Major Organ Failure (except heart)
Cancer
Cancer
Carcinoma in Situ*
1
32
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Coverage Options
Employee: Increments of $1,000 from $5,000 to a maximum of $20,000
Dependents:
Spouse/Domestic Partner $10,000
Child(ren) $2,500
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Why Accident Insurance?
Facts you should know:
• Accidents are the 5th leading cause of death in the United States 1
• More than 180,000 people die from injuries each year – 1 person every 3 minutes 2
• Injuries are the leading cause of death for people ages 1-44 in the US 3
•42% of American workers say they are living paycheck to paycheck4
1 National Vital Statistics Reports, January 2012 2 National Highway Traffic Safety Administration, 2008
3 National Highway Traffic Safety Administration , 2008 4 Careerbuilders, August 2011
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Accident - What’s Covered?
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Base Plan - 24 Hour Coverage
Silver Plan
Accidental Death & Dismemberment Initial Care Hospital Care-Life
-Both hands or feet or combination-One hand or foot
-Two or more fingers or toes or combination
-One finger or toeChild benefit – 50% of
employee/spouse
$20,000$20,000
$10,000$4,000
$2,000
Ground Ambulance
$200 Hospital Admission
$800
Air Ambulance
$1,200
Hospital Inpatient Stay(per day up to 365 days)
$160
Emergency Room
Treatment
$100 Hospital Intensive Care
Unit ICU Admission
$2,500
Accidental Death Common Carrier
(while on public transportation)Child benefit – 50% of
employee/spouse
$80,000Physician Office
Urgent Care (per visit)
$40Hospital ICU Inpatient Stay
(per day up to 30 days)
$500
Waiver Premium Yes
What’s Covered? Enhanced Plan
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Enhanced Benefit Coverage (sample of benefits included) Scheduled Benefit
Follow Up Care
Major Diagnostic Exam $160
Follow Up Physician Visit $40
Medical Appliances (equipment) $140
Physical Therapy (per day up to six days} $ 30
Prosthetic•One device•Two or more devices
$500 $1,000
Rehabilitation Unit (per day up to 30 days) $ 80
Common Injuries (for complete list, see Summary of Benefits)
Abdominal/Thoracic (abdomen/chest) Surgery•Surgery to repair•Exploratory without repair
$1,000 $ 100
Blood/Plasma/Platelets $280
Burns•2nd Degree (at least 36% of body surface)•3rd Degree (9-34 sq. inches)•3rd Degree (35 or more sq. inches)Skin Graft – 25% of burn benefit
$500 $8,000
Coma $10,000
Concussion (once per 12 month period) $140
Dental EmergencyBroken teeth repaired with crown(s)Broken teeth resulting in extractions
$ 200 $80
Eye Surgery $200
Critical Illness and Accident Additional Features
Wellness Benefit - $100 per year for Employee and Spouse
• Mammogram• Colonoscopy• Pap Smear• Chest X-rays• Fasting blood glucose test• Blood test for triglycerides• PSA (blood test for prostate cancer)• Additional screenings listed in enrollment packet
Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Q & A
15Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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