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BENEFITS DISCUSSION

BENEFITS TOPIC:

Free standing: clinic Outpatient: hospital

*after you satisfy your deductible

Deductible-amount need to satisfy before your plan will starts to pay

Regular price-amount to pay without insurance Contracted-aggreed amount to pay with the insurance form UHC Copay-

Deductible-amount you need to satisfy before your plan starts to kicks in.

After you max out the total deductibles then thats the time you will only be paying 30%.

For example:

-Well actually,the total maximum amount of deductible is not a one time payment.Lets say for example,We have regular price amounting 5oo dollars and since you are insured by United Healthcare then you are just only be paying the contracted price of 200 dollars every office visit which will be applied to your total deductibles.And whats the good thing with this,for example you max out the total amount of your deductibles then you are entitled for the 30% payment only,imagine you will only be paying $60 every office visit for your xray,amazing right?

Note: If deductible provided then be proactive on providing the remaining deductible

COPAY- *member is not be possible to get charged higher than the copay amount *to quote the copay,dont forget the dollars *

Coinsurance and Copay is an out of pocket expense and if the member can max it out then UHC will be paying 100%.

HMO- they can only visit the in network providers to enjoy the benefits(all exchange plan and offexchange is under HMO)

PPO-can visit both IN network and out of network offices and take advantage the benefits but the coverage percentages might different.

DOC360 PLAN ID-B0000085 *for emergency,you will be covered by the insurance even if you admitted to any hospital *For urgent care must be in innetwork doctor and facility but can go walk in without any referrals

*Urgent care is for injuries or illnesses that are not life-threatening, while the emergency room (ER) is for more serious, potentially life-threatening medical situations.

***PREVENTIVE VS. DIAGNOSTIC

PREVENTIVE-if member didnt feel any symptoms and its the initial check up.No abnormalities found prior to that screening.USUALLY 0 DOLLARS COST

DIAGNOSTIC-initial check up but there is symptoms already and also if the member has a diagnosis previously that they had that abnormalities

COVID-19 Testing***"***********

Do you have a provider to visit?

Member ID: 125530029 Who called: Relationship to the member:

Reason for call:

Resolution Provided: JOB AID:

Offered Schedule Commitment? Yes/No: Callback Schedule(time and date)?: Other concerns:____________ Wrap Up:

MAMMOGRAM:

IF preventive: $0 copay and deductible doesnt apply.

OUTPATIENT: You pay 50% coinsurance The annual deductible does not apply.

FREE STANDING: You pay 50% coinsurance The annual deductible does not apply.

*****************MEDICINE:

Major diagnostic You pay 50% coinsurance The annual deductible does not apply.

*****************Colonoscopy MAJOR DIAGNOSTIC: You pay 50% coinsurance The annual deductible does not apply.

*****************BARIATIC SURGERY -Not covered

*****************CATARACT -Benefits are not covered.

*****************BREAST PUMP -You pay 0% coinsurance The annual deductible does not apply.

*****************CPAP

You pay 50% coinsurance The annual deductible does not apply

2 TYPES OF VISION: STAND ALONE-included in their additional plan EMBEDDED-included in their medical plan

Note: any concern about vision plan then transfer them to the UHOne

TWO(2)Options to help member look for any surgeries that plan does not covered:

-I can connect you to the standalone representative (UHOne) -find program outside the UnitedHealthcare(using the findhelp)

*Not all Individual and Family plans offer Adult Vision benefits.

MEDICAL VS.ROUTINE

Medical-These services are typically performed by an Ophthalmologist.(special visit)

Routine-These services are typically performed by an Optometrist.(vision for adults)

Note: if they do not have embedded benefits then they cannot get glasses.

*If find in the member benefit then its embedded(transfer spectera) *If found in the plan tab then its stand alone(transfer UHOne)

DENTAL******** -members will receive dental ID card -The dental card is mailed separately than the medical ID card. -Dental claims address for providers (All states):

*UnitedHealthcare Dental PO Box 30567 Salt Lake City, UT 84130-0567

-All transfers to UHC Dental are warm transfers. -UHC Dental: 800-445-9090

Pediatric Dental Plan -Members who are 18 and under are covered.Terminates on the last day of the month

*PPO20-INO( they can choose any Out of Network Dentists as long as the provider accepts the insurance)

*Benefits apply to the medical deductible and OOPM

DENTAL COST SAVINGS 3 ways to lower the cost: -transfer to the standalone(UHOne) -Find PROGRAMS outside United healthcare(using findhelp.org) -look for local practice dental schools

CICARE:

Member, I actually have 3 options here so you can have a dental services,first I can help you connect to the UHOne standalone plan to check for available dental plan for ,second is I can directly help you find programs outside United Healthcare using my tools here and lsatly I can suggest you look for a local dental schools often offer lower cost dental services,I provided this options since I can see it here that

**********Eligibility Issues Send it to DBPSBeligibilityissues1_DL@ds.uhc.com

Body of Email: *Member's name *Member's ID *State Abbreviation (such as VA or FL) *Date of birth *Effective date *Expected Dental Plan: Built in Plan Benefits *Plan name/description and Plan ID

**********Dental Id Card

********** Specialized Denture Support Team

-If the member is inquiring about dentures,warm transfer to the Specialized Denture Support team in your Genesys/VCC

********** Standalone UHOne Dental

If an IFP member already has a UHOne Dental plan and has dental inquiries,use this contact phones: *Questions about billing: 800-657-8205. *Questions on benefits and claims, disenroll:866-877-6187. *UHOne General Questions, enroll: 844-273-5025.

********** Dental Provider Search

MEDICAL EMERGENCY

*ALERT your supervisor so they will call 911

*OBTAIN the callers informations: 1.Caller's name 2.Caller's current location: Address, city, and state 3.Caller's specific location at the site 4.Details of the emergency situation 5.If the caller is alone, are any pets loose where the caller is located, and is the caller able to open the door for Emergency Services?

*STAY on the line until the situation resolved and when Emergency service arrive

*ENGAGED in conversation

*DOCUMENT the call in Facets and include: 1.Nature of the call 2.Outcome of the call 3.Names of the additional contacts who handled the call

*ASSESS your current state of mind

*******************Behavioral Health (IFP)

REWARDS CARD -18 and older with an active plan -issues should be handled by you and should NOT be transferred to the WebTech Team.

********2024 Rewards Program

Conditions: *assign to innetwork doctor *paperless communication options *receive SMS Messaging(texts) *sign up to autopay *register their account at myuhc.com/exchange

********2025 Rewards Program -8 years and older -up to $150 reloadable UHC-branded Visa Gift Card. -NJ and NM excluded only for the $50

2 Incentives: 1.$100 for PCP visit 2.$50 for completing the 4 tasks and conditions: *all paperless *receive all sms comms. *sign up to auto pay *register their account at myuhc.com/exchange

********Reward Program Notes -For members with a $0 premium, auto-pay is automatically marked “complete” for them. -Termed members are still qualified to claim their rewards as long as they completed all the activities while their plan was active.

********Who is eligible for a Reward Visa gift card? -Any member 18+ that has an active IFP plan -All members can get the rewards -under 18 is not eligible for the incentive reward -need to create members online account.

********Actions Required to Earn Rewards AUTO PAY -member is unable to redeem rewards if their plan is delinquent -TAT 2-3 business days

ALL PAPERLESS COMMUNICATIONS -TAT within 1 hour

ALL TEXT MESSAGE ALERTS -TAT within an hour

PCP OFFICE VISIT -Only PCP office visit claim is considered eligible -members must wait for the applicable claim to be processed and paid before the task will be marked completd via portal -TAT 30 business days

REGISTER ACCOUNT ONLINE -TAT immediate

********Clinical & Risk Adjustment Incentives -will be informed via sms and email

INCENTIVES: *Breast Cancer Screening *Child and adolescent Well Care visit *Hemoglobin A1C Control for patients with diabetes *Eye Exam for Patients with Daiabetes *Kidney health Evaluation for patients with Diabetes

******** Risk Adjustment Incentive -This incentive is for seect members who have not seen their PCP this year. -will qualify $75 Visa gift card for completing a PCP visit -does not apply to NJ and NM members -filing dsputes about the eligibility,TAT within 30 days *after they click redeem then allow 5-7 business day to receive the gift card thru mail

******** Exception Overrides

-only processed in Maestro

Galileo App Gift Card Usage: -anywhere Visa is accepted -Visa Gift Card Rewards cannot be used for the purchase of alcohol, tobacco, firearms, or be used at any gambling establishment/app/website

********Virtual Plans with Galileo -Galileo is the virtual provider for the Virtual First Individual and Family Plans.(Maryland-Virtual Access) -depends on plan type -galileo has no cost deuctible does not apply -Only available in FL, GA, IL, MD, MI, OH, TX, and VA. -its under virutal first plan -Visit galileohealth.com/united and/or the application Galileo App -24/7 anytime access -Galileo app should be linked with their account so that they will not getting charge

WALKTHROUGH -provide the website : galileohealth.com/united -they need to log in first their insurance using members id number and so they will be receiving a triggered message and thats the time that they can click the link then download the app.

*********Using the Mobile App When logging into the app,the member can : *Request a medication *Consult with our experts *Request a lab test *Request a referral

-TAT for urgent care appointment requests is 2 hours or less.

*********PCP Information

GALILEO – Members will use the mobile app as their first point of contact to receive care.

*Members have 24/7 "Anytime Access" via the Galileo mobile app for urgent and comprehensive primary care needs through messaging, phone, or video conference.

*Galileo costs $0 for UHC Virtual First members and there are no copays, coinsurance, or deductibles for care in the Galileo app.

*Members are not assigned to a specific provider within the Galileo team, instead, their care is managed by a team of providers.

*Text or video chat with real, experienced providers in English or Spanish 24/7/365

*Start a chat anytime - no appointment needed *Request prescriptions, lab tests, specialist referrals, and second opinions *Retrieve past medical records for free

IN-OFFICE VISIT - Members schedule an appointment to go into an office to receive care and treatment/services in a face-to-face setting.

*Members will be required to pay a cost share for each visit. (Review the benefit summary in Maestro to advise the member of their cost share amount). *Members are restricted to office hours for receiving care. *The office may not have a Spanish speaking provider.

Can a member change their PCP from Galileo Health to an in-office PCP? -Yes. Members who update their primary care provider to a local in-network, in-office provider may be charged a higher cost share than expected when receiving care.

*Ask probing questions to determine if the member needs help understanding the plan and using the mobile app.

*If the member insists on changing their PCP from Galileo Health to an in-office PCP, go to the Provider & Referral Call Handling Index

*Advise the member that they are still able to seek care through the Galileo app even after changing to an in-office PCP. This can be helpful to the member in the evening or on weekends/holidays when their in-office PCP is closed or when they are unable to schedule an appointment in a timely manner with their in-office PCP.

*The member does not need to change their PCP back to Galileo to receive care through the app,

*********Members Under 18 -each member should have a Galileo app -children 6 and below is not included in Galileo since they should see an in-office pediatrician

*********Galileo Inbound and Outbound Calls -You should never immediately offer to transfer the caller to Galileo. Transfer if: *PCP support like needs referral *Medical Care Support *assistance accessing care *Technical Issue like registration *App set-up-tion *Getting started assistance

*********Virtual First Care Model

What is Galileo? -Galileo is a new kind of health care experience that lets you text or video chat with a curated team of board-certified providers via a convenient, 24/7 mobile app.

While other virtual options may focus on handling common issues, Galileo providers take care of almost any primary, urgent, specialty, chronic, or behavioral need in one place—building a strong relationship with you along the way.

How do I get started with Galileo? -Create your Galileo username and password (separate from your UHC account) at galileohealth.com/united. You’ll also need to enter your name, date of birth, phone number, and member ID as they appear on your UnitedHealthcare insurance card to confirm your eligibility.

How do I download the Galileo app? -After confirming your eligibility on galileohealth.com/united, you will be able to enter your phone number to receive a text message with a link to download the Galileo app (for iPhone or Android). Once downloaded, log in to the app with the user name and password you submitted while creating your account.

-Once coverage begins, you can reach Galileo providers 24/7 with health questions and concerns. Galileo's team responds quickly to provide same-day care and treatment.

What type of specialists are available through virtual visits? -Galileo does not offer visits directly with specialists, but they do consult with a number of specialists on your care, saving you time and unnecessary specialist visits. Galileo consults with leaders in sleep medicine, pulmonology, orthopedics, neurology, cardiology, and pediatrics. If you do need to get specialist care outside the app, Galileo will refer you to someone nearby and in-network.

Is there a phone # members can call to connect with Galileo/a Galileo provider? -Correspondence with Galileo/Galileo providers happens exclusively through the app. There is a support email inbox as well: support@galileo.io

What can/can't members do before their effective date on the app? -Prior to the plan becoming active, you can log in to the Galileo app, create your profile, insert your medical history and medications, and retrieve your medical records. You can also take health quizzes from the Learn tab, where you'll assess your habits, test your knowledge, and find out if you're at risk for certain diseases.

How do I change my PCP online? -Your virtual first plan includes $0 access to care through the Galileo app. Changing your PCP from Galileo will cost you more. We highly recommend you stick with Galileo as your first stop for care-It's $0.

If you change your PCP and want to change it back to Galileo, you will need to call member services.

Member Services can assist members in changing their PCP over the phone, but it is recommended, they first make sure the member understands the potential cost implications of seeing in-person primary care, vs. their primary care through the app. You must advise the member of their cost share amount for seeing an in-office provider. (Use the benefit summary in Maestro). Advise the member that they are still able to seek care through the Galileo app even after changing to an in-office PCP. This can be helpful to the member in the evening or on weekends/holidays when their in-office PCP is closed or when they are unable to schedule an appointment in a timely manner with their in-office PCP.
The member does not need to change their PCP back to Galileo to receive care through the app, Refer to the features tab within the IFP Website Index to assist members who want to update their PCP online.

What can I use Galileo for? -Under UnitedHealthcare’s Virtual First plan, Galileo is your virtual primary care provider. Use Galileo to treat many things, including conditions that would normally require a doctor’s appointment or urgent care visit: colds, headaches, prescriptions and refills, and even managing complex and chronic conditions like diabetes, high blood pressure, heart disease, and high cholesterol.

If you need to see a specialist in person, open a case with Galileo and discuss your request with your provider. If appropriate, Galileo providers can make in-network local referrals and will follow up on your progress in the app.

Help! I am trying to sign in to the Galileo app, but it is asking to charge me. ---You must first create a Galileo user name and password (separate from your UHC account) at galileohealth.com/united and confirm your eligibility by entering your name, date of birth, phone number, and member ID as they appear on your UnitedHealthcare insurance card. Then, use the user name and password you created to sign in to the Galileo app. If you are still experiencing issues, reach out to the Galileo Patient Support Associates (PSAs) by emailing support@galileohealth.com.

How much does it cost? ---While covered, any care you receive in the Galileo app costs $0. There are no copays, coinsurance, deductibles, or surprise bills for in-app care. Any costs from services outside the app, such as prescriptions, lab testing, or specialists would be subject to your benefits.

How do I contact Galileo customer service? Reach out to the Galileo Patient Support Associates (PSAs) via the in-app Patient Support chat or by emailing support@galileohealth.com.

What is the turnaround time (TAT) for appointments? ---After submitting a case (request to receive care) through the Galileo app, the typical turnaround time is just under two hours, but can be a bit longer if they are experiencing a high volume of requests. Members may see the following verbiage when accessing the app: What’s going on? or Setting Expectations about Turnaround Time

You’ve successfully submitted a case to our clinical providers, who will respond to you as soon as possible. Our team handles a number of patient cases at any given time, and follow a system to ensure that clinical needs are addressed in the order in which they are received.

We are experiencing a high volume of requests but anticipate them returning to normal soon. We appreciate your patience and look forward to caring for you

Provider Delay -Thank you for choosing Galileo. We apologize that you haven’t yet received a response to your health concern. I can confirm that your messages have been received and that one of our providers will respond with guidance as soon as possible. We’re experiencing an unprecedented amount of patient inquiries at this time, and wait times are currently longer than they would normally be.

Please let me know if there’s anything else I can assist with in the meantime. We appreciate your patience and look forward to caring for you now and in the future.

Note: It can take roughly 3-5 days to schedule a video chat. If a visit is needed sooner, the Galileo team is able to accommodate same day visits when there is a clinical need to do so.

Are translation services available? -Yes. Galileo currently uses translation services to support all patients with video encounters. They support any language through their translation services but some of the most requested languages are Spanish, Mandarin, Russian, Vietnamese, Portuguese, Creole, French, Korean, and Arabic. Amharic is also available, though not frequently requested.

Can a Galileo provider submit a prescription for a controlled substance? ---Galileo is unable to prescribe controlled substances. Note: If a member needs a refill for a controlled substance previously prescribed by another provider, the member should contact the prescribing provider's office to request a refill. In most cases, the pharmacy will proactively do this on the members behalf.

Why does my Galileo PCP show as in NY? ---Galileo PCPs are virtual providers. On our systems the Galileo PCP is registered with the Provider ID 007660664001, NPI 1619436029, and State: NEW YORK, regardless of member's state.

Virtual Urgent Care- Virtual Primary Care-

FAQ'S: 1.Are 24/7 virtual visits for virtual care available on demand? -Yes, members can wait in line for first available provider.

2.How do I access Optum Virtual Care? -Log in with their myUHC username and password at myuhc.com/virtualcare.

3.Are there 24/7 Care Support Lines available to members? -Yes, 1-800-442-4250.

4.Questions about their bill. -Call: 1-833-916-0004.

ONE PASS/GYM BENEFITS********** -One Pass is a fitness program for body and mind that is designed around the member and the member's goals. -Advantage Plus Plan

NOTE: All members who previously enrolled in One Pass and used the Physical Gym benefit in 2024 will have to enroll in One Pass Select in 2025. Members who had previous workouts and history from using the Digital Fitness benefit in 2024, will be able to continue with no interruption if they enroll in One Pass Select by 3/30/2025 as they have 90 days to re-enroll without losing their workout history.

Digital Features: Thousands of on-demand and live-streaming fitness classes and workout videos

Customizable workout builders to build workouts and provide guidance on how to perform exercises Ability to use multiple platforms at one time

Categories include: -Body Weight/No Equipment -Cardio -Cycling -Dance -Mind/Body/Yoga -Strength -Stretching -Many more!

-They can access one pass through One Pass members portal -It starts once the plan activated

AMERICAN ASSOCIATION OD RETIRED PERSONS WHAT IS AARP? -AARP is the nation’s largest nonprofit, nonpartisan organization dedicated to empowering people to choose how they live as they age. With nearly 38 million members and offices in every state, Puerto Rico and the U.S. Virgin Islands, AARP works to strengthen communities and advocate for what matters most to families—with a focus on health security, financial stability, and personal fulfillment. We also work for individuals in the marketplace by sparking new solutions and allowing carefully chosen products and services to carry the AARP Name.

Enrollees covered under an applicable UnitedHealthcare health plan are eligible for a one-year AARP membership or one-year AARP membership renewal at no additional cost. Acceptance of membership offer is voluntary. Offer is non-transferrable.

Once eligibility is confirmed it can take up to 5 weeks to receive a membership card in the mail. TAT includes 1 week for processing and up to 4 weeks for the membership card to be received.

Members can review all AARP benefits at:

Members can view AARP by downloading the AARP NOW for free.

Hours of Operation: Monday-Friday(8 am-8 pm)

Chat: AARPBOT -available 24/7 Live agent: Monday-Friday( 8 am-8pm ET) Saturday(9 am-5 pm ET) *connect online or via the AARP mobile app: https://www.aarp.org/membership/benefits/all-offers-a-z/

COORDINATION OF BENEFITS******* -IFP may coordinate with commercial group plans when permitted -IFP plans can't coordinate with other individual plans, unless the other individual plan allows coordination

*********Accident Related Requests -If a member or attorney is calling to report an accident they were involved and is trying to obtain information regarding third-party liability matters involving claims related to a personal injury (e.g., auto-accident, injury on the job, slip and fall, etc.), follow the below process to submit this information.

SEQUENCE ON PAYING RESPONSIBILITIES: Medicare>>>>>IFP>>>>>Medicaid

FINDHELP- utilize for looking financial and programs not covered by the plans and outside the UHC. Look for some help regarding subsidy.

Subsidy

out of pocket-when u max it out then insurance will carry the 100% and deductible