Entire Enrollment Kit

106 Pages·2010·5.66 MB·English

2011 Enrollment Kit
OnE
Hospitals Doctors Rx Drugs
convenient
plan
$0 monthly plan premium
AARP® MedicareComplete Choice® Plan 2 (Regional PPO)
R5287-001
Florida
Y0004Y0066_100707_142434 CMS Approved 08202010
COVER - APPROVED VERSION
What You’ll Find in this Booklet
Cover Letter.........................................................................1
Medicare Advantage Explained............................................3
Benefits at a Glance.............................................................4
Passport Brochure...............................................................6
Ready to Enroll....................................................................8
Summary of Benefits............................................................9
Add i t i o n a l P l a n I n f o r m a t i o n .....................................31
- Appeals & Grievances............................................33
- Plan Ratings..........................................................35
- Disclaimers............................................................37
Pha r m a c y O p t i o n s ..........................................39
- Drug List................................................................41
Enrollment Materials
- Outbound Education & Verification Call Checklist
(See back of Enrollment Materials Divider)
- Scope of Appointment Form
Enrollment Form
Roadmap After Enrollment
Health Care to Fit Your Needs…
now that is peace of mind
At UnitedHealthcare we realize more than ever the importance of affordable health care
coverage. We are dedicated to helping you make the right choices by providing quality, cost-
effective health care solutions. As one of the largest and most recognized health carriers in
the United States, you can be confident we will be here
when you need us.
ONE
out of
We Make Health Care Simple…
and provide the answers you need FIVE
INSIDE THIS BOOKLET: Medicare members
use our Medicare
• Understand the basics of Advantage Programs
Medicare Advantage
• Learn how our plans can benefit you
• View plan details and how they • Start your application process
compare to your Original Medicare
• Continue on your path to good health
• Look up your medications
We’re Here For You
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1 Talk with your local sales agent. Health care is personal. Your agent will
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2 answer your questions and help you enroll.
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0 Thomas S. Paul
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3 Chief Executive Officer, UnitedHealthcare Medicare Solutions
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Cover Letter - Version 3 with revisions from 6/10/10
You may contact 1-800-MEDICARE (1-800-633-4227) and TTY users should call 1-877-486-2028,
24 hours a day, 7 days a week or visit www.medicare.gov for more information about Medicare
benefits and services including general information regarding health and Part D benefit.
The AARP® MedicareComplete® plans are SecureHorizons® plans insured or covered by an affiliate of
UnitedHealthcare Insurance Company, a Medicare Advantage organization with a Medicare
contract. AARP MedicareComplete plans carry the AARP name, and UnitedHealthcare pays a
royalty fee to AARP for use of the AARP intellectual property. Amounts paid are used for the general
purpose of AARP and its members. AARP is not the insurer. You do not need to be an AARP
member to enroll.
AARP does not recommend health related products, services, insurance or programs. You are
strongly encouraged to evaluate your needs.
This document is available in alternative formats. You must have both Medicare Part A and B, and
must reside in the service area of the plan. You must continue to pay your Medicare Part B
premium if not otherwise paid for under Medicaid or by another third party. Your ability to enroll
may be limited certain times of the year. For more information contact Customer Service at
1-800-547-5514 7 days a week, between 8:00 a.m. and 8:00 p.m. local time. TTY users can call
711 or write us at P.O. Box 29675, Hot Springs, AR 71903-9675, or go to
www.AARPMedicarePlans.com. You must use plan providers except in emergency or urgent care
situations or for out-of-area renal dialysis. If you obtain routine care from out-of-network providers
neither Medicare nor AARP MedicareComplete RX plans will be responsible for the costs. For PPO
and HMO-POS members, with the exception of emergency or urgent care or out-of-area renal
dialysis, it may cost more to get care from out-of-network providers. For PPO members,
reimbursement is provided for all covered benefits regardless of whether they are received in
network. Out of network services may cost more than in network services. You may be able to get
Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra
Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a
day/ 7 days a week; Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday
through Friday. TTY users should call 1-800-325-0778; or your State Medicaid Office. The Medicare
Prescription Drug benefit is only available to members of the Medicare Advantage with Prescription
Drug (MA-PD) plans. By enrolling in an MA-PD you will automatically be disenrolled from any
existing Medicare Prescription Drug coverage. To receive the highest level of benefit you must use
contracted network pharmacies to access your prescription drug benefit except in the case of
emergency. The pharmacy network includes retail, mail order, long-term care, home infusion and
I/T/U (Indian Health Service, Tribes, or Urban Indian) pharmacy services. You may obtain your
prescriptions from pharmacies outside the contracted network at a reduced benefit. Quantity
limitations and restrictions may apply. For more information about mail order, names and
addresses of network pharmacies or for more information call 1-800-547-5514, or TTY 711,
Monday through Friday, 8:00 a.m. to 8:00 p.m. local times. Or write us at P.O. Box 29675, Hot
Springs, AR 71903-9675, or go to www.AARPMedicarePlans.com. The AARP® MedicareComplete®
benefit packages, plan premiums, copayments/coinsurance may vary by county, and service areas
are all subject to change annually at the Medicare Advantage contract renewal time with the
Centers for Medicare & Medicaid Services (January 1). Availability of coverage beyond the end of
the current year is not guaranteed.
2
Medicare Advantage Explained
Medicare is health insurance for people 65 and older and others with certain disabilities. You have choices
about how you get your Medicare coverage. You can choose Original Medicare (Parts A and B) or a Medicare
Advantage plan.
Many people with Original Medicare find there are expenses that are not covered. To help pay for some of
these additional costs, many people choose to enroll in a Medicare Advantage plan.
Original Medicare consists of Medicare Parts A and B
• Part A helps with hospital costs • Part D (optional add-on) stand-alone prescription drug plans
• Part B helps with doctor services can be added to help with the cost of prescription drugs
and outpatient care • M ost preventive care services are not covered –
expect to pay additional costs for these services
• O riginal Medicare has unpredictable out-of-pocket expenses
Original Medicare
(Parts A and B)
A
Operated by the Federal government. = PART PBART + PDART
Medicare pays fees for your care
directly to the doctors and
hospitals you visit
Original Medicare Optional Plan
You Can Add
Medicare Advantage (Part C) Combines Your Coverage into ONE Plan
• Medicare Advantage plans • Prescription drug coverage (Part D) is included in many
0 cover at least the same services Medicare Advantage plans
1
0 as Parts A and B • Preventive care services like dental, vision, hearing and
2
9
0 foot care may be included at no extra charge
8
0 • Medicare Advantage plans have predictable out-of-pocket
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5 Parts A and B to enroll. You pay a
3
2 low or no additional monthly plan
9
1
_ premium beyond the Prescription Other Services
2
2 Medicare Part B premium Drug Coverage May Be Included
7
0
0
1
_ Medicare Advantage plans may be a lower-cost alternative to Original Medicare. Medicare
6
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]0 Advantage can offer extra preventive benefits and prescription drugs all in ONE convenient plan.
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MA EXPLAINED APPROVED LAYOUT - Legal Edits
Benefits at a Glance
This plan is a Preferred Provider Organization (PPO). PPO plans provide care through a network of doctors and
hospitals, and give you the option to receive care out-of-network for covered services, generally at a higher cost to
you. With a PPO you do not need a referral to see specialists. PPO plans may be a good fit for someone looking for
predictable cost shares and benefits above Original Medicare.
Benefit In-Network Out-of-Network
Monthly plan premium $0
Deductible None
Medical Coverage
Annual physical $0 copay $40 copay
Preventive services (Medicare-covered) $0 copay 30% coinsurance
Immunizations (pneumonia and flu) $0 copay $0 copay
Primary Care Physician (PCP) office visit $10 copay $40 copay
Specialist office visit $30 copay (No Referral Needed) $40 copay
Inpatient hospitalization $290 copay per day: days 1-5. $375 copay per day: days 1-27.
$0 thereafter. $0 thereafter.
Outpatient surgery and hospital services 20% coinsurance 30% coinsurance
Urgently needed care $30 copay $40 copay
Emergency care $50 copay $50 copay
Ambulance services $200 copay $200 copay
Home health care $0 copay 30% coinsurance
Skilled nursing facility (SNF) care $50 copay per day: days 1-20. $175 copay per day: days 1-58.
Lab services:
HIV & cardiovascular screenings $0 copay $0 - $20 copay
All other lab services $20 copay $20 copay
Diagnostic testing:
EKG & AAA screenings 0% - 20% coinsurance 30% coinsurance
All other diagnostic tests 20% coinsurance 30% coinsurance 0
1
X-rays $16 copay $21 copay 0
2
3
Annual out-of-pocket maximum $4750 $10000 combined 0
8
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Prescription Drugs d
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Prescription drug deductible $0 ov
r
Initial coverage stage 31-day retail supply 90-day mail order supply p
p
A
n Tier 1: $6 $12 S
n Tier 2: $45 $125 M
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n Tier 3: $85 $245 3
2
n Tier 4: 33% 33% 0
1
Coverage gap stage (after prescription No Coverage 4
1
costs paid reach $2840) _
2
2
Catastrophic coverage stage (after you The greater of $2.50 for generic, $6.30 for brand-name, or 5% 6
0
have paid $4550 out-of-pocket) 0
1
_
6
6
0
0
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4
0
0
0
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To verify your provider is in the plan’s network or for additional plan information
4 visit us online at www.AARPMedicarePlans.com
Also included in this plan In-Network Out-of-Network
Foot care $30 copay for 6 visits per year* $40 copay for 6 visits per year*
Vision services $0 copay for Medicare-covered $40 copay for Medicare-covered
glaucoma screening glaucoma screening
$30 copay for routine exams; 1 $40 copay for routine exams; 1
per year* per year*
Dental services $0 copay for oral exams; 1 every $40 copay for oral exams; 1
6 months* every 6 months*
$0 copay for routine cleanings; $40 copay for routine cleanings;
1 every 6 months* 1 every 6 months*
$0 copay for X-rays; 1 every $40 copay for X-rays; 1 every
year as ordered by your dentist* year as ordered by your dentist*
Hearing services $30 copay for annual hearing $40 copay for annual hearing
test* test*
SilverSneakers® Fitness Program Fitness center membership and Self-directed, pedometer-based
classes at over 10,000 physical activity and walking
participating nationwide program
locations. Access to treadmills, Available for members living 15
weights, and fitness classes and miles or more from a
a heated pool at select SilverSneakers fitness center
locations. Please visit
www.silversneakers.com for
more information
UnitedHealth Passport® Program Included in this plan. See the Passport brochure in this booklet
for more information.
NurselineSM Speak with a registered nurse (RN) 24 hours a day
* Benefit combined in and out-of-network
The benefit information provided here in is a brief summary, not a comprehensive description of benefits. For
more information contact the plan or review the Summary of Benefits provided within this booklet for more
benefit information.
Plan is insured or covered by UnitedHealthcare Insurance Company or one of its affiliates,
a Medicare Advantage Organization with a Medicare contract.
To verify your provider is in the plan’s network or for additional plan information
visit us online at www.AARPMedicarePlans.com 5
The 2011 UnitedHealth Passport® Program
The UnitedHealth Passport® Program is Included in Your Plan.
You pay no additional charge (beyond your monthly
health plan premium) for health care coverage while
you travel within the UnitedHealth Passport® service
area. Simply pay the same copay or coinsurance as
you would at home to receive non‑emergency care
benefit coverage when traveling within the service
area, including preventive care, specialist care and
hospitalizations. Emergency care is covered worldwide.
The gray states on the map to the right show the
states in which there are UnitedHealth Passport®
service areas. If you are a plan member who resides
within one of the counties in this list, you are eligible
to participate in the UnitedHealth Passport Program. If you travel to any of the counties on this list, you will be
able to use the Passport benefit to access routine and preventive care as needed.
Alabama Illinois
Autauga, Baldwin, Bibb, Blount, Chilton, Elmore, Bureau, Carroll, Cook, Henderson, Henry, Jersey, Jo
Jefferson, Lowndes, Macon, Mobile, Montgomery, Daviess, Kane, Knox, Madison, Marshall, Mercer,
Russell, Shelby, St. Clair, Walker Monroe, Peoria, Putnam, Rock Island, Stark, St. Clair,
Tazewell, Warren, Whiteside, Will, Woodford
Arizona
Cochise, Graham, Maricopa, Pima, Pinal, Santa Cruz, Indiana
Yavapai Adams, Allen, Boone, Fulton, Hamilton, Hancock,
Hendricks, Huntington, Johnson, Kosciusko, Madi‑
Arkansas
son, Marion, Noble, Posey, St. Joseph, Vanderburgh,
Benton, Carroll, Crawford, Sebastian, Washington
Warrick, Wells, Whitley
Connecticut1
Iowa
All Counties in the State of Connecticut
Appanoose, Benton, Black Hawk, Boone, Bremer,
Florida 0
Buchanan, Butler, Cedar, Chickasaw, Clarke, Clayton, 1
0
All Counties in the State of Florida 2
Clinton, Crawford, Dallas, Davis, Delaware, Des 3
0
Georgia Moines, Dubuque, Fayette, Floyd, Greene, Grundy, 8
0
Chatham, Cherokee, Clayton, Cobb, Columbia, Guthrie, Hamilton, Hardin, Henry, Iowa, Jackson, e
s
DeKalb, Forsyth, Fulton, Harris, Muscogee, Rich‑ Jasper, Jefferson, Johnson, Jones, Keokuk, Lee, Linn, U
&
mond Louisa, Lucas, Madison, Mahaska, Marion, Marshall, e
Monroe, Muscatine, Page, Polk, Pottawattamie, Fil
Hawaii 3
All Counties in the State of Hawaii Poweshiek, Scott, Shelby, Story, Tama, Van Buren, 64
Wapello, Warren, Washington, Wayne 2
2
Idaho 1
_
Ada, Canyon Kansas 6
1
Johnson, Sedgwick 7
0
0
1
_
6
6
0
0
Y
To verify your provider is in the plan’s network or for additional plan information
26 visit us online at www.AARPMedicarePlans.com
Master Template
Kentucky Rhode Island
Boone, Campbell, Kenton All Counties in the State of Rhode Island
Maine South Carolina
Cumberland, Kennebec, Sagadahoc, York Beaufort, Charleston, Greenville, York
Massachusetts Tennessee
All Counties in the State of Massachusetts Anderson, Blount, Bradley, Campbell, Carter,
Claiborne, Cocke, Davidson, DeKalb, Fayette,
Michigan
Grainger, Greene, Hamblen, Hamilton, Hancock,
Allegan, Kent, Ottawa
Hawkins, Hickman, Jefferson, Johnson, Knox,
Missouri
Loudon, McMinn, Meigs, Monroe, Morgan, Roane,
Barry, Cass, Christian, Cole, Crawford, Dade, Dallas,
Rutherford, Scott, Sevier, Shelby, Sullivan, Tipton,
Douglas, Franklin, Gasconade, Greene, Jackson,
Unicoi, Union, Washington
Jefferson, Laclede, Lafayette, Lawrence, Lincoln,
Texas
McDonald, Polk, St. Charles, St. Louis, St. Louis City,
Austin, Brazoria, El Paso, Fort Bend, Hardin, Harris,
Stone, Texas, Warren, Washington, Webster, Wright
Jefferson, Liberty, Montgomery
Nebraska
Utah
Burt, Cass, Douglas, Otoe, Sarpy, Washington
Box Elder, Cache, Davis, Morgan, Salt Lake, Summit,
New Mexico
Tooele, Utah, Wasatch, Weber
Dona Ana, Grant, Hidalgo, Luna, Sierra
Vermont
New York1
All Counties in the State of Vermont
All Counties in the State of New York
Virginia
North Carolina
Bland, Botetourt, Bristol City, Buchanan, Chester‑
Alamance, Caswell, Catawba, Chatham, Cumberland,
field, Craig, Dickenson, Floyd, Franklin, Goochland,
Davidson, Davie, Durham, Forsyth, Guilford, Haywood,
Grayson, Lee, Hanover, Henrico, Montgomery,
Henderson, Iredell, Mecklenburg, Orange, Person,
Newport News City, Norfolk City, Norton City, Ports‑
Randolph, Rockingham, Rowan, Stokes, Surry, Wake,
mouth City, Radford City, Richmond City, Roanoke,
Wilkes, Yadkin
Roanoke City, Russell, Salem City, Scott, Smyth,
Ohio Tazewell, Washington, Wise, Wythe
Butler, Clark, Clermont, Cuyahoga, Delaware, Franklin,
Washington
Greene, Hamilton, Madison, Mahoning, Montgomery,
Skagit, Spokane, Whatcom
Preble, Stark, Summit, Trumbull, Warren
Wisconsin
Oregon2
Brown, Calumet, Dodge, Fond Du Lac, Green Lake,
Clackamas, Lane, Marion, Multnomah, Washington,
Kewaunee, La Crosse, Manitowoc, Milwaukee, Monroe,
Yamhill
Oconto, Outagamie, Ozaukee, Racine, Shawano,
Pennsylvania Sheboygan, Trempeleau, Vernon, Washington,
Erie, Lancaster, Lehigh, Northampton, York Waukesha, Waupaca, Waushara, Winnebago
1 Members of HMO plans H3307 in New York as well as Point of Service plans H0752 in Connecticut and
H3107 in New Jersey may access Passport services in the state of Florida only.
2 The H3805 HMO plans in the Oregon counties of Clackamas, Lane, Marion, Multnomah and Washington do
not participate in UnitedHealth Passport. Therefore, members of these plans are not eligible to participate in
the program.
Plan is insured or covered by UnitedHealthcare Insurance Company or one of its affiliates,
a Medicare Advantage organization with a Medicare contract. 3
7
Ready to Enroll?
makE
Things to Do Before You Enroll:
an informed
Review the benefit information in this booklet.
CHOICE
You may choose to contact your doctor to confirm if he or she is in the
network or you may ask your sales agent to check for you. For a complete
list of plan providers, visit our Web site.
Check the Drug List in this booklet to see if your medications are included.
Visit our Web site for a detailed listing of prescription medications. (for MAPD plans)
Have your Original Medicare ID card ready or other proof that states you are eligible for
Medicare. This information will help you fill out the Enrollment Form.
I’m a Member…What’s Next?
Enjoy Peace of Mind with One Convenient Plan
After Medicare approves your enrollment you will receive your Welcome Letter, New Member Kit and
your Member ID card.
This is a sample card; your card may look different.
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www.myaaRPmedicare.com 2
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