2017 Summary Of BENEFITS - Gnjumc
2017 Summary ofBENEFITSUnitedHealthcare Group Medicare Advantage (PPO)Group Name (Plan Sponsor): GREATER NJ ANNUAL CONF UMCGroup Number: 12369H2001-816Our service area includes the 50 United States, the District of Columbia and all USterritories.This is a summary of drug coverages and health services provided byUnitedHealthcare Group Medicare Advantage (PPO)January 1, 2017 - December 31, 2017.For more information, please contact Customer Service at:Toll-Free 1-877-714-0178, TTY 7118 a.m. - 8 p.m. local time, 7 days a weekwww.UHCRetiree.comY0066 160717 022133
Summary of BenefitsJanuary 1, 2017 - December 31, 2017We’re dedicated to providing clear and simple information about your plan so you always stay fullyinformed. The following information is a breakdown of what we cover and what you pay. This iscalled “cost-sharing” or “out-of-pocket” costs. Cost-sharing includes co-pays, co-insurance anddeductibles. This will help you control your health care costs throughout the plan year.Keep in mind that this isn’t a full list of benefits we provide, it’s just an overview. To get a completelist, visit our website at www.UHCRetiree.com to see the “Evidence of Coverage” or call customerservice with any questions.About this plan.UnitedHealthcare Group Medicare Advantage (PPO) is a Medicare Advantage PPO plan with aMedicare contract.To join UnitedHealthcare Group Medicare Advantage (PPO), you must be entitled to MedicarePart A, be enrolled in Medicare Part B, live in our service area as listed on the cover, and be aUnited States citizen or lawfully present in the United States, and meet the eligibility requirementsof your former employer, union group or trust administrator (plan sponsor).What’s inside?Plan Premiums and BenefitsSee plan costs including information about the monthly premium, deductible and maximumout-of-pocket limit.UnitedHealthcare Group Medicare Advantage (PPO) has a network of doctors, hospitals,pharmacies, and other providers. You can see any provider (in-network or out-of-network) thatparticipates in Medicare and accepts the plan at the same cost share. Your copays or coinsurancewill be the same.You can search for a network provider and pharmacy in the online directories atwww.UHCRetiree.com.Drug CoverageLook to see what drugs are covered along with any restrictions in our plan formulary (list of Part Dprescription drugs) found at www.UHCRetiree.com.
UnitedHealthcare Group Medicare Advantage (PPO)Premiums and BenefitsIn-NetworkOut-of-NetworkMonthly Plan PremiumContact your group plan benefit administrator todetermine your actual premium amount, if applicable.Maximum Out-of-Pocket Amount(does not include prescription drugs)Your plan has an annual combined in-network andout-of-network out-of-pocket maximum of 1,250 eachplan year.If you reach the limit on out-of-pocket costs, you keepgetting covered hospital and medical services and wewill pay the full cost for the rest of the year.Please note that you will still need to pay your monthlypremiums, if applicable, and cost-sharing for yourPart D prescription drugs.
UnitedHealthcare Group Medicare Advantage (PPO)BenefitsIn-NetworkOut-of-NetworkInpatient Hospital Coverage 0 co-pay per admit 0 co-pay per admitOur plan covers an unlimited number of days for aninpatient hospital stay.Doctor VisitsPreventive CarePrimary 5 co-pay 5 co-paySpecialists 10 co-pay 10 co-payMedicare-covered 0 co-pay 0 co-payRoutine physical 0 co-pay; 1 per planyear* 0 co-pay; 1 per planyear*Emergency care 0 co-pay (worldwide)If you are admitted to the hospital within 24 hours, youpay the inpatient hospital co-pay instead of theEmergency co-pay. See the “Inpatient Hospital Care”section of this booklet for other costs.Urgently needed services 0 co-pay (worldwide) 0 co-pay (worldwide)If you are admitted to thehospital within 24 hours,you pay the inpatienthospital co-pay instead ofthe Urgently NeededServices co-pay. See the“Inpatient Hospital Care”section of this booklet forother costs.If you are admitted to thehospital within 24 hours,you pay the inpatienthospital co-pay instead ofthe Urgently NeededServices co-pay. See the“Inpatient Hospital Care”section of this booklet forother costs.
BenefitsDiagnosticTests, Laband RadiologyServices,and X-RaysHearing ServicesVision y services(e.g. MRI) 0 co-pay 0 co-payLab services 0 co-pay 0 co-payDiagnostic testsand procedures 0 co-pay 0 co-payTherapeuticradiology 0 co-pay 0 co-payOutpatientx-rays 0 co-pay 0 co-payExam todiagnose andtreat hearing andbalance issues 10 co-pay 10 co-payRoutinehearing exam 0 co-pay (1 exam every12 months)* 0 co-pay (1 exam every12 months)*Hearing aidsPlan pays up to 500(every 3 years)*Plan pays up to 500(every 3 years)*Exam todiagnose andtreat diseasesand conditionsof the eye 10 co-pay 10 co-payEyewear aftercataract surgery 0 co-pay 0 co-payRoutine eyeexams 10 co-pay (1 exam every12 months)* 10 co-pay (1 exam every12 months)*Eye wearPlan pays up to 130eyewear allowance every2 years. Plan pays up to 175 contact lensallowance in lieu ofeyewear allowance every2 years.*Plan pays up to 130eyewear allowance every2 years. Plan pays up to 175 contact lensallowance in lieu ofeyewear allowance every2 years.*
BenefitsMentalHealth CareInpatient visitIn-NetworkOut-of-Network 0 co-pay per admit, upto 190 days 0 co-pay per admit, upto 190 daysOur plan covers 190 days for an inpatient hospitalstay.Outpatient grouptherapy visit 5 co-pay 5 co-payOutpatientindividual therapyvisit 10 co-pay 10 co-pay 0 co-pay per day: days1-100 0 co-pay per day: days1-100Skilled nursing facility (SNF)Our plan covers up to 100 days in a SNFRehabilitationServicesOccupationaltherapy visit 0 co-pay 0 co-payPhysical therapyand speechand languagetherapy visit 0 co-pay 0 co-payAmbulance 0 co-pay 0 co-payRoutine TransportationNot coveredFoot Care(podiatryservices)Foot examsand treatment 10 co-pay 10 co-payRoutine footcare* 10 co-pay for each visit(Up to 6 visits per planyear)* 10 co-pay for each visit(Up to 6 visits per planyear)*
BenefitsMedicalEquipment urable MedicalEquipment(e.g.,wheelchairs,oxygen) 0 co-pay 0 co-payProsthetics(e.g., braces,artificial limbs) 0 co-pay 0 co-payWigs afterChemotherapy(for hair loss thatis a result ofChemotherapy)Up to a 300 allowancefor wigs/hairpieces(cranial prosthesis) every12 months.*Up to a 300 allowancefor wigs/hairpieces(cranial prosthesis) every12 months.*Fitness programthroughSilverSneakers 0 membership fee.Monthly basic membership for SilverSneakers throughnetwork fitness centers.If you live 15 miles or more from a SilverSneakersfitness center you may participate in theSilverSneakers Steps Program and select one of fourkits that best fits your lifestyle and fitness level general fitness, strength, walking or yoga.MedicarePart B DrugsChemotherapydrugs 0 co-pay 0 co-payOther Part Bdrugs 0 co-pay 0 co-pay
Prescription DrugsIf the actual cost for a drug is less than the normal cost-sharing amount for that drug, you will paythe actual cost, not the higher cost-sharing amount.Your plan sponsor has elected to offer additional coverage on some prescription drugs that arenormally excluded from coverage on your Formulary. Please see your Additional Drug Coverage listfor more information.If you reside in a long-term care facility, you will pay the same for a 31-day supply as a 30-daysupply at a retail pharmacy.Stage 1: AnnualPrescriptionDeductibleSince you have no deductible, this payment stage doesn’t apply.Stage 2:Initial Coverage(After you payyour deductible,if applicable)Retail Cost-SharingMail Order Cost-SharingOne-month supplyThree-month supplyTier 1:Generic 10 co-pay 20 co-payTier 2:Preferred Brand20% of the cost, with a 45 co-paymaximum20% of the cost, with a 120 co-paymaximumTier 3:Non-PreferredDrugs20% of the cost, with a 90 co-paymaximum25% of the cost, with a 225 co-paymaximumTier 4:Specialty Tier20% of the cost, with a 90 co-paymaximum25% of the cost, with a 225 co-paymaximumStage 3:CoverageGap StageAfter your total drug costs reach 3,700, the plan continues to pay its shareof the cost of your drugs and you pay your share of the cost.Stage 4:CatastrophicCoverageAfter your yearly out-of-pocket drug costs (including drugs purchasedthrough your retail pharmacy and through mail order) reach 4,950, youpay the greater of 3.30 co-pay for generic (including brand drugs treatedas generic), 8.25 co-pay for all other drugs.
Additional nualmanipulationof the spineto correctsubluxation 10 co-pay 10 co-payRoutineChiropractic Care 10 co-pay (Up to 12visits per plan year)* 10 co-pay* (Up to 12visits per plan year)Diabetesmonitoringsupplies 0 co-pay 0 co-payWe only cover bloodglucose monitors andtest strips from thefollowing brands:OneTouch Ultra 2System, OneTouchUltraMini , OneTouchVerio , OneTouch Verio Sync, OneTouch Verio IQ, OneTouch Verio Flex System Kit,ACCU-CHEK NanoSmartView, andACCU-CHEK Aviva Plus.We only cover bloodglucose monitors andtest strips from thefollowing brands:OneTouch Ultra 2System, OneTouchUltraMini , OneTouchVerio , OneTouch Verio Sync, OneTouch Verio IQ, OneTouch Verio Flex System Kit,ACCU-CHEK NanoSmartView, andACCU-CHEK Aviva Plus.DiabetesSelf-managementtraining 0 co-pay 0 co-payTherapeuticshoes or inserts 0 co-pay 0 co-payHome health care 0 co-pay 0 co-payHospiceYou pay nothing for hospice care from anyMedicare-approved hospice. You may have to pay partof the costs for drugs and respite care. Hospice iscovered by Original Medicare, outside of our plan.DiabetesManagement
Additional BenefitsIn-NetworkOut-of-NetworkPrivate duty nursingNursing services provided in the home by a privateduty nurse who holds a valid, recognized nursingcertificate and is licensed according to state law in thestate where services are received.Covered services include nursing services of aregistered nurse (RN), licensed practical nurse (LPN)or licensed vocational nurse (LVN) delivered to acovered individual who is confined in the home due toa medical condition.Note: Custodial and domestic services are notcovered.If covered private duty nursing services are receivedbefore you reach the out-of-pocket maximum, you pay20% of the cost for each visit. The amounts you paydo not apply to the out-of-pocket maximum.There is a 5,000 limit per plan year for private dutynursing services. Once the plan has paid 5,000 in aplan year, you are responsible to pay all charges forthe remainder of the plan year.NurseLineSMSpeak with a registered nurse (RN) 24 hours a day,7 days a weekOutpatient surgery 0 co-pay 0 co-payOutpatient grouptherapy visit 5 co-pay 5 co-payOutpatientindividualtherapy visit 10 co-pay 10 co-payRenal Dialysis 0 co-pay 0 co-payVirtual Doctor VisitsSpeak to specific doctors using your computer ormobile device. Find participating doctors online fits are combined in and out-of-network
This information is not a complete description of benefits. Contact the plan for more information.Limitations, co-payments, and restrictions may apply.The Formulary, pharmacy network, and/or provider network may change at any time. You willreceive notice when necessary.Benefits, premium and/or co-payments/co-insurance may change on January 1 of each year.You must continue to pay your Medicare Part B premium.You are not required to use OptumRx home delivery for a 90 day supply of your maintenancemedication. If you have not used OptumRx home delivery, you must approve the first prescriptionorder sent directly from your doctor to OptumRx before it can be filled. New prescriptions fromOptumRx should arrive within ten business days from the date the completed order is received,and refill orders should arrive in about seven business days. Contact OptumRx anytime at 1-888279-1828, TTY 711. OptumRx is an affiliate of UnitedHealthcare Insurance Company.Out-of-network/non-contracted providers are under no obligation to treat Plan members, except inemergency situations. Please call our customer service number or see your Evidence of Coveragefor more information.Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies,a Medicare Advantage organization with a Medicare contract and a Medicare-approved Part Dsponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare.If you want to know more about the coverage and costs of Original Medicare, look in your current“Medicare & You” handbook. View it online at http://www.medicare.gov or get a copy by calling1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call1-877-486-2048.This document is available in other formats such as Braille and large print. This document may beavailable in a non-English language. For additional information, call us at 1-877-714-0178.
Multi-language Interpreter ServicesEnglish: We have free interpreter services to answer any questions you may have about our healthor drug plan. To get an interpreter, just call us at 1-877-714-0178. Someone who speaks English/Language can help you. This is a free serviceSpanish: Tenemos servicios de intérprete sin costo alguno para responder cualquier pregunta quepueda tener sobre nuestro plan de salud o medicamentos. Para hablar con un intérprete, por favorllame al 1-877-714-0178. Alguien que hable español le podrá ayudar. Este es un servicio gratuito.Chinese Mandarin: 㒠ⅻ㙟 忈䤓劊幠㦜 ソ 屲 ℝ ㅆ㒥嗾䓸 棸䤓 䠠 桽ᇭⰑ㨫 榏尐㷳劊幠㦜 庆咃䟄 1-877-714-0178ᇭ 㒠ⅻ䤓 㠖ぴ ⅉ ⃟ ソ ᇭ 扨㢾 欈 忈㦜 ᇭChinese Cantonese: 㒠 䤓 ㅆ㒥塴䓸 椹 厌ⷧ㦘䠠 䍉㷳㒠 㙟 彊䤓劊巾 㦜 ᇭⰑ榏劊巾㦜 嵚咃榊1-877-714-0178ᇭ㒠 嶪 㠖䤓ⅉ❰ 㲑 䍉 㙟 ヺ ᇭ抨 㢾 檔 彊㦜 ᇭTagalog: Mayroon kaming libreng serbisyo sa pagsasaling-wika upang masagot ang anumang mgakatanungan ninyo hinggil sa aming planong pangkalusugan o panggamot. Upang makakuha ngtagasaling-wika, tawagan lamang kami sa 1-877-714-0178. Maaari kayong tulungan ng isangnakakapagsalita ng Tagalog. Ito ay libreng serbisyo.French: Nous proposons des services gratuits d’interprétation pour répondre à toutes vosquestions relatives à notre régime de santé ou d’assurance-médicaments. Pour accéder au serviced’interprétation, il vous suffit de nous appeler au 1-877-714-0178. Un interlocuteur parlant Françaispourra vous aider. Ce service est gratuit.Vietnamese: &K¼QJ W¶L Fµ G FK Y WK¶QJ G FK PL୷Q SK Ó୵ WU OஏL F F F X K L Y୳ FKŲţQJ V F NK H Y FKŲţQJ WU QK WKXஃF PHQ 1ୱX TX Y F Q WK¶QJ G FK YL Q [LQ J L 1-877-714-0178 V୯ Fµ QK Q YL Q QµLWLୱQJ 9L W JL¼S Óஓ TX Y Ò \ O G FK Y PL୷Q SK German: Unser kostenloser Dolmetscherservice beantwortet Ihren Fragen zu unseremGesundheits- und Arzneimittelplan. Unsere Dolmetscher erreichen Sie unter 1-877-714-0178. Manwird Ihnen dort auf Deutsch weiterhelfen. Dieser Service ist kostenlos.Korean: 鲮ꩡ鱉 넍ꊁ ꚩ뾍 鿅鱉 꼲븽 ꚩ뾍꾅 隵뼑 덽ꓭ꾅 鲪뼩 麑ꍡ隕녅 ꓩꊁ 뭪꾢 ꟹ걙ꌱ뇑險뼍隕 넽걪鱽鲙 뭪꾢 ꟹ걙ꌱ 넩끞뼍ꇙꐩ 놹쀉1-877-714-0178 냱ꈑ ꓭ넍뼩 늱겢겑꿙 뼑霢꽩ꌱ 뼍鱉 鲩鲮녅閵 鵹꿵 麑ꍩ 阸넺鱽鲙 넩 ꟹ걙鱉 ꓩꊁꈑ 끩꾶鷞鱽鲙 Russian: ̬͒͘͏ ͚ ͉͇͘ ͉͕͎͔͏͔͚͙͑ ͉͕͖͕͗͘͢ ͕͙͔͕͘͏͙͔͕͌͒ͣ ͙͇͕͉͕͕͗͊͘͜ ͏͒͏ ͓͌͋͏͇͓͔͙͔͕͕͑͌͊ ͖͇͔͇͒ ͉͢ ͓͕͍͙͌͌ ͉͕͖͕͎͕͉͇͙͒ͣͣͦ͘͘ ͔͇͟͏͓͏ ͈͖͇͙͔͓͌͒͘͢͏ ͚͚͇͓͒͊͘͏ ͖͉͕͌͗͌͋͞͏͕͉͑ ͙͕͈͉͕͖͕͎͕͉͇͙̾͒ͣͣͦ͘͘͢ ͚͚͇͓͒͊͘͏ ͖͉͕͌͗͌͋͞͏͇͑ ͖͕͎͉͕͔͏͙͌ ͔͇͓ ͖͕ ͙͕͔͚͌͒͌͛ 1-877-714-0178 ̩͇͓͕͇͍͙͑͌ ͖͕͓͕ͣ͠ ͕͙͚͔͗͋͘͏͑ ͕͙͕͑͗͐͢ ͕͉͕͊͗͏͙ ͖͕ S͚͑͘͘͏ ̫͇͔͔͇ͦ ͚͚͇͒͊͘ ͈͖͇͙͔͇͌͒ͦ͘
Arabic:8710-417-778-1Hindi: ֛ ֧֞֒ ֚֭֚֭֗֞և֑֭ ֑֞ ֈ֗֞ շ֠ ֑֫վ֊֞ շ֧ ֧֞֒ ֧ե ը շ֧ շ֚֟֠ ֠ ֭֭֒֘֊ շ֧ վ֗֞ ֈ֧֊֧ շ֧ ֔֟ձ ֛ ֧֞֒ ֚֞ ֡ ֭ֆֈ֡ ֑֞֙֟֞ ֧֚֗֞ձդ ի ֔ ֭։ ֛֨ե ձշ ֈ֡ ֑֞֙֟֞ ֭֒֞ ֭ֆ շ֒֊֧ շ֧ ֔֟ձ ֚ ֛ ֧ե 1-877-714-0178 ֒ ֫֊ շ֧֒ե շ֫ժ ֑֭֗շ֭ֆ֟վ֫ ֛֟֊֭ֈ֠ ֫֔ֆ֞ ֛֨ ը շ֠ ֈֈ շ֒ ֚շֆ֞ ֛֨ ֑֛ ձշ ֡ ֭ֆ ֧֚֗֞ ֛֨ Italian: È disponibile un servizio di interpretariato gratuito per rispondere a eventuali domande sulnostro piano sanitario e farmaceutico. Per un interprete, contattare il numero 1-877-714-0178. Unnostro incaricato che parla Italianovi fornirà l’assistenza necessaria. È un servizio gratuito.Portugués: Dispomos de serviços de interpretação gratuitos para responder a qualquer questãoque tenha acerca do nosso plano de saúde ou de medicação. Para obter um intérprete,contacte-nos através do número 1-877-714-0178. Irá encontrar alguém que fale o idioma Portuguêspara o ajudar. Este serviço é gratuito.French Creole: Nou genyen sèvis entèprèt gratis pou reponn tout kesyon ou ta genyen konsènanplan medikal oswa dwòg nou an. Pou jwenn yon entèprèt, jis rele nou nan 1-877-714-0178. Yonmoun ki pale Kreyòl kapab ede w. Sa a se yon sèvis ki gratis.1PMJTI 6NPřMJXJBNZ CF[Q BUOF TLPS[ZTUBOJF [ VT VH U VNBD[B VTUOFHP LUØSZ QPNPřF X V[ZTLBOJVPEQPXJFE[J OB UFNBU QMBOV [ESPXPUOFHP MVC EBXLPXBOJB MFLØX "CZ TLPS[ZTUBŁ [ QPNPDZU VNBD[B [OBKŀDFHP Kň[ZL QPMTLJ OBMFřZ [BE[XPOJŁ QPE OVNFS 1-877-714-0178 5B VT VHB KFTUCF[Q BUOB Japanese: 䯍ቑ ㅆ ㅆ 椉ቋ堻 ⑵㡈堻ኴ ዐ 栱ሼቮሷ役 ር ራሼቮቂቤ �ሧቡሼᇭ抩峂ትሷ䞷 ቍቮ ቒᇬ1-877-714-0178 ር榊崀ሲቃሸሧᇭ㡴㦻崭ት崀ሼⅉ 劔 � ኰኖቊሼᇭUHEX17PP3843193 000
SilverSneakers 0 membership fee. Monthly basic membership for SilverSneakers through network fitness centers. If you live 15 miles or more from a SilverSneakers fitness center you may participate in the SilverSneakers Steps Program and select one of four kits that best fits your lifestyle and fitness level - general fitness, strength, walking .
benefits of caring for country. These benefits include: health and wellbeing benefits; cultural and socio-political benefits; economic benefits; and, environmental benefits. The discussion includes some of the barriers to achieving benefits, as well as anticipated and realised benefits of caring for country.
Health and Welfare Benefits Plan Summary Plan Description January 20192020 . This summary plan description (SPD) provides a summary of your benefits updated as of January 1, . It describes benefits provided to you by the Sony Pictures Entertainment Inc. Health and Welfare Benefits Plan (the "plan" or "SPE Benefits Plan") your plans .
834 Other long-term employee benefits are all employee benefits other than short-term employee benefits, post-employment benefits and termination benefits. Termination benefits are employee benefits provided in exchange for the termination of an employee's employment as a result of either: (a) an entity's decision to terminate an employee's employment before the normal retirement
2022 Benefits Summary & Guide Welcome to the Macalester College benefits program. The 2022 Benefits Summary & Guide will acquaint you with the benefits available to faculty and staff of Macalester College. We hope you find this guide helpful as you weigh . Employee (1) 200.00 0.00 243.50 43.50 287.00 87.00 Employee (2 ) 200.00 0 .
Blue Shield Gold 80 PPO Plan Summary of Benefits The Summary of Benefits is provided with, and is incorporated as part of, the Evidence of Coverage. It sets forth the Member’s share-of-costs for Covered Services under the benefit plan. Please read both documents carefullyFile Size: 860KBPage Count: 107Explore furtherIndividual and Family Plan PPO Plan Summary of Benefits .www.blueshieldca.com2021 Summary of Benefits - Producer Connectionwww.blueshieldca.comHow are bronze, silver and gold plans different? bcbsm.comwww.bcbsm.comMember Services - Blue Cross Blue Shield Associationwww.bcbs.comFind a Doctor - Blue Cross Blue Shield Associationwww.bcbs.comRecommended to you b
US Summary Tables Summary Benefits Data Summary Financial Data Benefits and Duration Data Summary Labor Force Data Wage and Tax Rate Data Charts Glossary of data definitions Choose another quarter The UI Data Summary is produced quarterly from state-reported data contained in the . 2016
Nov 26, 2017 · Chemtrails, HAARP and The Full Spectrum Dominance of Planet Earth – Hosted By Bye Bye Blue Sky and Conspiracy Culture Bookstore Archives November 2017 October 2017 September 2017 August 2017 July 2017 June 2017 May 2017 April 2017 March 2017 February 2017 January 2017 December 2
ACCOUNTING 0452/22 Paper 2 May/June 2019 1 hour 45 minutes Candidates answer on the Question Paper. No Additional Materials are required. READ THESE INSTRUCTIONS FIRST Write your Centre number, candidate number and name on all the work you hand in. Write in dark blue or black pen. You may use an HB pencil for any diagrams or graphs. Do not use staples, paper clips, glue or correction fluid. DO .
