There are many ways into the complex health care system...

There are many ways into the complex health care system.Get benefits that make it easier to focus

on your health, not your health care.

welcometouhc.com/

Tolleson Union High School District 2016 Benefits Guide

Health care can be hard. We're here to help you through it.

Your benefits

MEDICAL PLAN

Health Plan Information 3

Base Plan 6

High Deductible Health Plan 7

MORE BENEFITS

Prescription Benefits 9

BENEFIT EXTRAS

myuhc.com 10

Personal Support 11

Preventive Care 12

ENROLLMENT

What's Next 13

You can count on us to help protect you financially and guide you through your health care needs. We'll help make your health experience easier by giving you tools and support to help you save time, save money and find care when you need it.

Visit the website.

welcometouhc.com/

Search for network providers.

Learn more about your benefits.

Watch helpful videos and much more.

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We start by helping to make it easier to get care and stay healthy.

Preventive care is covered 100% in our network.*

Immunizations

Preventive exams and health screenings

VIEW BENEFITS on pages 4-5.

Help is a call, email or web chat away.

Contact us for help and answers.

Manage your health and your plan online and on the go.

Using the network helps you save on covered services.

Doctor office visits

Prescription drugs

Emergency services

Hospital care

Lab services

Pregnancy care services

Outpatient care services

Rehabilitative services and devices

Wellness services and more

If you’re wondering, this is not the complete list of covered services. See your official health plan documents for more details.

VIEW BENEFITS on pages 4-5.

* Certain preventive care services are provided as specified by the Patient Protection and Affordable Care Act (ACA), with no cost-sharing to you. These services are based on your age, gender and other health factors. UnitedHealthcare also covers other routine services that may require a co-pay, co-insurance or deductible. 3

What do I pay for covered services?

CO-PAYMENT OR CO-PAY

You'll pay a fixed amount of money for each covered doctor visit or prescription.

DEDUCTIBLE

This is the amount you will need to pay for covered services before your plan begins to pay.

CO-INSURANCE

This is your share of the costs of a covered service, calculated as a percent.

FIND INSURANCE TERMS CONFUSING? Visit justplainclear.com

DEDUCTIBLE PER PLAN YEAR Individual Family

WHAT YOU PAY IN THE NETWORK

$750 $2,250

WHAT YOU PAY OUT OF THE NETWORK


$1,500 $3,000

WHAT YOU PAY OUT OF THE NETWORK $10,000 $20,000


$2,600 $5,200


COVERED SERVICES Doctors and Specialists PCP Visit $35 Not covered 20% 50% 20% 50% Specialist Visit $55 Not covered 20% 50% 20% 50% PCP Visit - Tier 1 Provider $20* Not covered 20% 50% 20% 50% Specialist Visit - Tier 1 Provider $40* Not covered 20% 50% 20% 50% Preventive Care

Well-child visits $0 Not covered $0 not covered $0 not covered Mammogram $0 Not covered $0 not covered $0 not covered Screenings and Immunizations $0 Not covered $0 not covered $0 not covered Annual Physical $0 Not covered $0 not covered $0 not covered Emergency Care

Virtual Care $0 Not covered 20% not covered 20% not covered Convenience Care $35 Not covered 20% 50% 20% 50% Urgent Care $50 Not covered 20% 50% 20% 50% Emergency Care $500 same as network 20% same as network 20% same as network Hospital care

Outpatient surgery 20% Not covered 20% 50% 20% 50% Lab and X-ray 20% Not covered 20% 50% 20% 50% Hospital Stay 20% Not covered 20% 50% 20% 50%

What will it cost to see providers in and out of the network? Providers in our network have agreed to charge lower prices. If you use out-of-network providers, your costs may be higher.

What is the most I may have to pay?

OUT-OF-POCKET LIMIT You'll never pay more than your out-of-pocket limit during your plan year.

OUT-OF-POCKET LIMIT Individual Family

$3,000 $9.000

$3,425 $6,850

$30,000 $60,000

$4,500 $9,000

$30,000 $60,000

PRESCRIPTIONS

Retail (30-day) Tier 1 Tier 2 Tier 3

$0 $30 $50 Not covered

$0 $30 $50 The amount you pay after

the Combined Medical/Pharmacy

Deductible has been met.










How much will it

cost to fill a prescription? This is what you'll pay when you need a prescription. You may save by choosing prescriptions from the lower tiers and signing up for home delivery. Talk to your pharmacist or doctor to learn ways you may be able to save.







Questions to help you choose

BASE PLAN

*By using a Premium Tier 1 Designated Provider, your office copay is reduced. the program is not availeable in all specialisties and all areas. Please check myuhc.com for a Premium Tier 1 Designated Provider near you. This information does not replace your official health plan documents. Please see your official health plan documents for all coverage details, which includes limitations and exclusions.

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What do I pay for covered services?

CO-PAYMENT OR CO-PAY

You'll pay a fixed amount of money for each covered doctor visit or prescription.

DEDUCTIBLE

This is the amount you will need to pay for covered services before your plan begins to pay.

CO-INSURANCE

This is your share of the costs of a covered service, calculated as a percent.

FIND INSURANCE TERMS CONFUSING? Visit justplainclear.com

DEDUCTIBLE PER PLAN YEAR Individual Family


$750 $2,250



$1,500 $3,000



$2,600 $5,200


COVERED SERVICES Doctors and Specialists PCP Visit $35 Not covered 20% 50% 20% 50% Specialist Visit $55 Not covered 20% 50% 20% 50% PCP Visit - Tier 1 Provider $20* Not covered 20% 50% 20% 50% Specialist Visit - Tier 1 Provider $40* Not covered 20% 50% 20% 50% Preventive Care

Well-child visits $0 Not covered $0 not covered $0 not covered Mammogram $0 Not covered $0 not covered $0 not covered Screenings and Immunizations $0 Not covered $0 not covered $0 not covered Annual Physical $0 Not covered $0 not covered $0 not covered Emergency Care

Virtual Care $0 Not covered 20% not covered 20% not covered Convenience Care $35 Not covered 20% 50% 20% 50% Urgent Care $50 Not covered 20% 50% 20% 50% Emergency Care $500 same as network 20% same as network 20% same as network Hospital care

Outpatient surgery 20% Not covered 20% 50% 20% 50% Lab and X-ray 20% Not covered 20% 50% 20% 50% Hospital Stay 20% Not covered 20% 50% 20% 50%

What will it cost to see providers in and out of the network? Providers in our network have agreed to charge lower prices. If you use out-of-network providers, your costs may be higher.

What is the most I may have to pay?

OUT-OF-POCKET LIMIT You'll never pay more than your out-of-pocket limit during your plan year.

OUT-OF-POCKET LIMIT Individual Family

$3,000 $9.000

$3,425 $6,850

$30,000 $60,000

$4,500 $9,000

$30,000 $60,000

PRESCRIPTIONS

Retail (30-day) Tier 1 Tier 2 Tier 3

$0 $30 $50 Not covered













How much will it

cost to fill a prescription? This is what you'll pay when you need a prescription. You may save by choosing prescriptions from the lower tiers and signing up for home delivery. Talk to your pharmacist or doctor to learn ways you may be able to save.







HDHP 2 HDHP 1

The doctors and facilities in our network have agreed to provide you services at a discount.

Search the NETWORK at welcometouhc.com/

The network can help lower your costs.

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* You won't need to worry about these costs for preventive care if you stay in the network.

You may be required to receive approval for some services before they can be covered.

Base Plan

Use our network to save money. A network is a group of health care providers and facilities that have a contract with UnitedHealthcare. You can receive care and services from anyone in our network.

Save money by staying in our network. If you go out-of-network, you’ll have to pay for all of the costs.

There's no need to choose a primary care provider (PCP) or get referrals to see a specialist.

Consider a PCP; they can be helpful in managing your care.

Preventive care is covered 100% in our network.

DETAILED BENEFITS on pages 4-5.

Paying for network care

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Co-payment (co-pay)* You’ll pay a fixed amount of money for each covered doctor visit or prescription.

Deductible* This is the amount you’ll need to pay for covered services before your plan begins to pay.

Co-insurance* After you’ve paid your deductible, you’ll only pay a percentage of each covered service.

Out-of-pocket limit You'll never pay more than your out-of-pocket limit during the plan year. The out-of-pocket limit includes all of your co-payment, deductible and co-insurance payments.

For all of the COVERAGE DETAILS, see your official health plan documents.

National Network Coverage 780,000+ doctors and health care professionals

(clinics, labs, care centers, etc.) 5,700+ hospitals

30,000+ pharmacies

High Deductible Health Plan

Qualified expenses:

Doctor office visits

Prescriptions

Eyeglasses and contacts

Dental care and braces

Chiropractic services and more

You may be required to receive approval for some services before they can be covered.

You own the HSA. Use it to save and pay.

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Get network freedom and an HSA. You can use any doctor, clinic, hospital or health care facility. You can save money when you use a health savings account (HSA) and the network.

There’s coverage if you need to go out of the network. Choose what's best for you. Just remember, out-of-network

providers will likely charge you more.

There's no need to choose a primary care provider (PCP) or get referrals to see a specialist.

Consider a PCP; they can be helpful in managing your care.

Preventive care is covered 100% in our network.

DETAILED BENEFITS on pages 4-5. National Network Coverage

780,000+ doctors and health care professionals (clinics, labs, care centers, etc.)

5,700+ hospitals 30,000+ pharmacies

You can open a health savings account (HSA). An HSA is a personal savings account to help you save and pay for your health care.

It's your money. There's no "use it or lose it" rule. You get to keep it even if you

change plans, change employers or retire.

Set a goal - even a small one. Check with your employer to see if you can set up regular,

pretax deposits through payroll deduction.

LEARN MORE and see if you're eligible at welcometouhc.com/.

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How paying for network care works with an HSA

Your deductibleYou pay for all services, including prescriptions, until you meet your

deductible. You can use an HSA to help pay it.

Your out-of-pocket limitWhen you reach the limit, you are done

paying. The plan pays 100% of covered services.

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STEP1

STEP2

STEP3

Pay with your HSA or pay another way You are done paying

Preventive care is covered 100% when you use a network doctor.

SEE BENEFITS on pages 4-5. *This includes all deposits, including any contributions Tolleson Union High School District makes.

Your plan pays 80%

You pay 20%

Your co-insurance After you reach the deductible, you

share the costs with the plan. You can use an HSA to help pay your share.

Open an account with the preferred HSA bank of more than a million people.

VISIT optumbank.com.

Open your HSA with Optum Bank.

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Save on taxes. You don't have to pay federal, or in most instances, state income taxes on your HSA deposits, qualified expenses and interest earned. The IRS limits how much you can put into an HSA each year. The 2016 limits are:*

Individual $3,350

Family $6,750

Paying for prescriptions. You will have to pay the full cost of your covered prescriptions until you’ve paid the deductible. You can use your HSA to help pay. After the deductible, you will pay a co-payment. For more details, see your official health plan documents.

Keep more of your money.

UnitedHealthcare and OptumRx® are partners in making your health plan work better. OptumRx makes prescription medications more accessible and affordable and focuses on improving your overall health outcomes.

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Prescription Benefits Easily fill and save on your medications. You'll be covered for a wide variety of medications from UnitedHealthcare. Best of all, we've made it easy for you to get your prescriptions filled and save money.

Access thousands of retail pharmacies.

Save when you use a network pharmacy.

Get 24/7 phone support, refill reminders and more.

Get more at myuhc.com.

Find network pharmacies.

Estimate and compare costs.

How we cover prescriptions. The UnitedHealthcare Prescription Drug List (PDL) is the list of prescriptions that are covered by the plan and organized by cost tiers. Choosing medications in the lower tiers may save you money.

Tier 1Lower-cost

Medications

Tier 3Higher-costMedications

Tier 2Midrange-costMedications

Search the NETWORK and the PDL at welcometouhc.com/.

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Benefits worthy of your favorites bar

Access your benefits and get help any time, anywhere. It’s myuhc.com in your pocket. With the UnitedHealthcare Health4Me® app, you can access your virtual health plan ID card, check claim updates, find physicians and facilities, estimate costs and get answers to questions.

Estimate health care costs. You have easy-to-use tools so you can see what a treatment or procedure typically costs, estimate costs of prescriptions, and see what your share of expenses may be.

Starting healthier habits just got fun. RallySM is an experience on myuhc.com that may help you eat better, be more active and complete activities to improve your health.

Get help finding quality care. To help you make more informed choices about health care, the UnitedHealth Premium® Designation Program includes doctors who meet quality and cost-effeciency guidelines. You can find a doctor's designation on myuhc.com.

VISIT welcometouhc.com/ for more information.

Manage your benefits and health care at myuhc.com®

Track claims and expenses.

Pay health care bills.

Find network providers, care centers and pharmacies.

Find and compare medications.

Refill prescriptions.

Get help managing your asthma with the Asthma Disease Management Program. The program can help you avoid asthma triggers and it can help reduce hospital stays and missed days at work or school.

Get help to breathe easier.

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We're here to help. Whether it’s finding care or managing a complex health condition, you’ll get help whenever you need it. Here are some of the programs and services that are available as part of your health plan with no additional cost to you.

See a doctor online – at any time. When you don’t feel well or your child is sick, the last thing you want to do is leave the comfort of home to sit in a waiting room. Now, you don’t have to. A Virtual Visit lets you see and talk to a doctor from your home computer or mobile device. There is a cost for Virtual Visits. See your health plan documents for coverage details.

Help is a call away. By calling us, you’ll also be able to access Care24® services, which includes 24-hour registered nurses, an employee assistance program, financial and legal help and more.

As a member, you can call Care24 1-866-271-7340 or log in to myuhc.com.

Get help through pregnancy and delivery. Enroll in the Healthy Pregnancy Program by calling the number on your health plan ID card to access nurses, get information to help you identify health risks and more. You'll even get a gift for mom and baby.

Get important, personalized health reminders. You may receive special messages from us through myuhc.com. These messages can help to improve your health and remind you about the importance of preventive care. We call these messages HealtheNotes (pronounced “healthy notes”).

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Why is preventive care so important?

* This content is provided for informational purposes only, and does not constitute medical advice. Always consult your doctor about any decisions about medical care. The services outlined here do not necessarily reflect the services, vaccines, screenings, or tests that will be covered under your benefit plan. Always refer to your plan documents for specific benefit coverage and limitations or call the toll-free member number on your health plan ID card. Certain procedures may not be fully covered under some benefit plans.

Regular preventive care visits and health screenings help you learn your current health status and may help identify potential health issues before they become more serious. Working with your doctor can help you determine what preventive care services may be right for you.

Common preventive care office services*

Annual wellness exam

Measurements of your weight, blood pressure, glucose (blood sugar) and cholesterol

Immunization vaccines, such as flu shots

Well-baby and well-child visits

Common preventive care screening services*

Cancer screenings, such as mammography, colorectal and cervical

Osteoporosis screening

Tobacco use and sexually transmitted diseases screening

Healthy diet, physical activity and depression screening

How is preventive care covered? Certain preventive health services will be covered based on age, gender and other factors without cost sharing (100% without charging a co-payment, deductible or co-insurance), as long you receive these services from a network provider.

How do I know if a service is preventive care or not? Preventive care focuses on your current health when you are symptom-free. If you are receiving treatment due to a symptom or an existing illness, the services provided usually won’t be considered or covered as preventive care.

Do you need more help?

welcometouhc.com/

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What comes next? Choose the best plan As you consider your benefits, think about how often you go to the doctor and the total cost of your benefits, including how much you pay in monthly premiums.

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Before coverage starts While we're setting up your insurance:

2

SEARCH OUR NETWORK for providers near you at welcometouhc.com/.

Once coverage begins Your coverage starts 07/01/2016.

3

WATCH THE MAIL for your ID card (if changing plans or a new member).

START USING YOUR PLAN once your coverage starts.

GET STARTED ONLINE at myuhc.com and download the Health4Me app to manage your health and benefits.

1. Go to myuhc.com.

2. Click on Register Now. You'll need your health plan ID card, or you can use your Social Security number and date of birth to register.

3. Follow the step-by-step instructions.

Use your plan Here are some great ways to use your plan throughout the year:

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SCHEDULE AN ANNUAL EXAM, flu shot or other preventive care.

USE OUR RESOURCES to stay healthy and save money.

ESTIMATE YOUR COSTS before you get care with myuhc.com or the Health4Me app.

CALL US FOR HELP when you need us.

GET ON-THE-GO ACCESS to health and account info, tools and resources with the Health4Me app.

MANAGE YOUR PLAN AND HEALTH ONLINE at myuhc.com.

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© 2015 United HealthCare Services, Inc. UHCEW579811-000

Consumer 7/15 Tolleson Union High School District SR #

welcometouhc.com/

Health plan coverage provided by or through UnitedHealthcare of California, UnitedHealthcare of Oklahoma, Inc., UnitedHealthcare of Oregon, Inc., UnitedHealthcare Benefits of Texas, Inc., UnitedHealthcare of Washington, Inc. Administrative services provided by United HealthCare Services, Inc., OptumRx or OptumHealth Care Solutions, Inc. Behavioral health products are provided by U.S. Behavioral Health Plan, California (USBHPC) or United Behavioral Health (UBH). The UnitedHealthcare plan with Health Savings Account (HSA) is a high deductible health plan (HDHP) that is designed to comply with IRS requirements so eligible enrollees may open a Health Savings Account (HSA) with a bank of their choice or through Optum Bank, Member of FDIC. The HSA refers only and specifically to the Health Savings Account that is provided in conjunction with a particular bank, such as Optum Bank, and not to the associated HDHP. Virtual visits are not an insurance product, health care provider or a health plan. Unless otherwise required, benefi ts are available only when services are delivered through a Designated Virtual Network Provider. Virtual visits are not intended to address emergency or life-threatening medical conditions and should not be used in those circumstances. Services may not be available at all times or in all locations. Information for individuals residing in the state of Louisiana or who have policies issued in Louisiana: Health care services may be provided to you at a network health care facility by facility-based physicians who are not in your health plan. You may be responsible for payment of all or part of these fees for those non-network services, in addition to applicable amounts due for co-payments, co-insurance, deductibles, and non-covered services. Specific information about network and non-network facility-based physicians can be found at myuhc.com or by calling the toll-free Customer Care telephone number that appears on the back of your health plan ID card. All UnitedHealthcare members can access a cost estimator online tool at myuhc.com. Depending on your specific benefit plan and the ZIP code that is entered, either the myHealthcare Cost Estimator or the Treatment Cost Estimator will be available. A mobile version of myHealthcare Cost Estimator is available, and additional ZIP codes and procedures will be added soon. This tool is not intended to be a guarantee of your costs or benefits. Your actual costs and/or benefits may vary. When accessing the tool, please refer to the Terms and Conditions of Use and Why Your Costs May Vary sections for further information regarding cost estimates. Refer to your health plan coverage document for information regarding your specific benefits. For a complete description of the UnitedHealth Premium® designation program, including details on the methodology used, geographic availability, program limitations and medical specialties participating, please see myuhc.com. Rally Health provides health and well-being information and support as part of your health plan. It does not provide medical advice or other health services, and is not a substitute for your doctor’s care. If you have specific health care needs, consult an appropriate health care professional. Participation in the health survey is voluntary. Your responses will be kept confidential in accordance with the law and will only be used to provide health and wellness recommendations or conduct other plan activities. Advocate services should not be used for emergency or urgent care needs. In an emergency, call 911 or go to the nearest emergency room. The information provided through Advocate (Advocate4Me) services is for informational purposes only and provided as part of your health plan. Wellness nurses, coaches and other representatives cannot diagnose problems or recommend treatment and are not a substitute for your doctor’s care. Your health information is kept confidential in accordance with the law. Advocate services are not an insurance program and may be discontinued at any time. Wellness nurses, coaches and other representatives cannot diagnose problems or recommend treatment and are not a substitute for your doctor’s care.”, please insert the sentence: Please discuss with your doctor how the information provided is right for you The Care24® program integrates elements of traditional employee assistance and work-life programs with health information lines for a comprehensive set of resources. It is not a substitute for a doctor’s or professional’s care. Due to the potential for a conflict of interest, legal consultation will not be provided on issues that may involve legal action against UnitedHealthcare or its affiliates, or any entity through which the caller is receiving these services directly or indirectly (e.g., employer or health plan). This program and its components may not be available in all states or for all group sizes and are subject to change. Coverage exclusions and limitations may apply.

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