Unitedhealthcare HRA Medical Plan Benefits
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2014 – 2015 Unitedhealthcare HRA Medical Plan Benefits An overview of the UnitedHealthcare HRA Medical Plan benefits offered to you as a Centura Health associate This plan does not apply to Centura Health Associates who work at St. Catherine’s or St. Rose in Kansas. Details about the Medical Plan for these associates can be found on My Virtual Workplace. Click on Associates, then Human Resources and select Medical Benefits.
Table of Contents
UnitedHealthcare HRA Plan
Tiered Network Benefits . . . . . . . . . . . . . . . . . 1
This guide is intended to provide you with a general overview
Use your Primary Care Provider (PCP) . . . . . . 1 of your medical plan benefits. While this guide should answer
Pick your specialist . . . . . . . . . . . . . . . . . . . . . 1
Choose your treatment . . . . . . . . . . . . . . . . . . 1 most of your questions, it does not provide all the details of
Stay well . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 the plan. For plan details please refer to the Summary Plan
Use any Centura Health hospital or
Children’s Hospital . . . . . . . . . . . . . . . . . . . . 2 Description. Any information in this guide may be subject to
Out-of-area dependents . . . . . . . . . . . . . . . . 2
change. Contact the Centura Health Benefits
Administrative Information
Plan year . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Service Center at 1-888-622-1111 if
Plan administrator & sponsor . . . . . . . . . . . . 2
When coverage begins . . . . . . . . . . . . . . . . . 2 you have questions about the benefits
Acquisitions and mergers . . . . . . . . . . . . . . . 2 described in this guide.
When coverage ends . . . . . . . . . . . . . . . . . . 2
Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Care coordination—notification . . . . . . . . . . . 3
Filing a claim . . . . . . . . . . . . . . . . . . . . . . . . . 3
Your benefits . . . . . . . . . . . . . . . . . . . . . . . . 3
What makes up your UnitedHealthcare HRA
plan? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
2014 – 2015
How does the UnitedHealthcare HRA work?
UnitedHealthcare HRA for the 2014–15 plan
year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
5
UnitedHealthcare
Terms you need to know . . . . . . . . . . . . . . . .
Prescription benefits . . . . . . . . . . . . . . . . . . . .
UnitedHealthcare HRA plan is easy to use . .
5
6
6
HRA Medical Plan
Health Risk Assessment . . . . . . . . . . . . . . . . 7 The Centura UnitedHealthcare HRA plan
How to find a health care provider . . . . . . . . 7 is all about you
Got a question? . . . . . . . . . . . . . . . . . . . . . . 7
Finding fast answers on myuhc.com . . . . . . . 7 The UnitedHealthcare HRA (Health Reimbursement Account) plan gives you
Centura UnitedHealthcare HRA plan summary unprecedented control over your health care choices. It gives you access
HRA medical plan fundamentals . . . . . . . . . . 8 to health care dollars you can spend before you dip into your own wallet.
Preventive care benefit . . . . . . . . . . . . . . . . . 8
Prescription benefit . . . . . . . . . . . . . . . . . . . . 8
It gives you more control and more responsibility for managing your health
Medical services . . . . . . . . . . . . . . . . . . . . 8–9 care costs.
Mental health and substance abuse service . . 9
Offered through UnitedHealthcare, the UnitedHealthcare HRA plan is
UnitedHealthcare HRA plan examples . 10–11
General plan limitations
a medical plan that consists of a Centura-funded HRA account to pay
Alternative treatments . . . . . . . . . . . . . . . . . 12 for covered medical expenses first. If you deplete your HRA, you are
Comfort or convenience . . . . . . . . . . . . . . . 12 responsible for any other qualified medical expenses you incur, excluding
Dental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
preventive care, as well as mental health services and substance abuse
Experimental / unproven services . . . . . . . . 12
Foot care . . . . . . . . . . . . . . . . . . . . . . . . . . 12
treatment, until your deductible is met. After the deductible is met, Centura
Medical supplies and appliances . . . . . . . . 13 will pay the covered expenses based upon the benefit tier level and you will
Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 pay any remaining coinsurance. If you meet the plan-year out-of-pocket
Physical appearance . . . . . . . . . . . . . . . . . . 13 maximum, Centura pays 100 percent of covered expenses for the remainder
Providers . . . . . . . . . . . . . . . . . . . . . . . . . . 13
of the plan year.
Reproduction . . . . . . . . . . . . . . . . . . . . . . . 13
Services provided under another plan . . . . . 14 The UnitedHealthcare HRA plan encourages you to be more actively
Transplants . . . . . . . . . . . . . . . . . . . . . . . . . 14
involved in your health and wellness and gives you more financial
Travel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Vision and hearing . . . . . . . . . . . . . . . . . . . 14 accountability for your health care choices. As always, you work with your
All other exclusions . . . . . . . . . . . . . . . . 14–15 physician to make health care decisions that are best for you.
Claims and appeals . . . . . . . . . . . . . . . . . . . . 16
This guide provides a quick overview of this benefit option, along with many
Coordination of benefits . . . . . . . . . . . . . . . . 16
Agent for legal processes . . . . . . . . . . . . . . 17 practical tips for taking advantage of everything the UnitedHealthcare HRA
Your rights as a plan participant . . . . . . . . . 18 plan has to offer, so you can take control of your health and well-being.
Privacy practices . . . . . . . . . . . . . . . . . . . . . . 18
UnitedHealthcare HRA Medical Plan Benefits | Centura Health
Tiered Network Benefits For the following non-physician-based services, you must
use a Centura Health network provider or joint venture.
Under the UnitedHealthcare HRA medical plan you have Centura will pay 80 percent of covered expenses and you
access to a two-tier level benefits structure. The tiers are will pay the 20 percent coinsurance after the deductible has
defined as Preferred Providers and Non-Preferred Providers. been met:
Both tier levels require you to cover the coinsurance costs
· Hospitalization
for provider visits, and the applicable deductible. Regardless
of the tier level, you must access care from an in-network · Outpatient surgery*
provider. There are no out-of-network benefits under the plan. · Outpatient facility services*
Preferred Providers: This network is comprised of Primary · MRIs, CT scans, PET scans*
Care Preferred Provider network and a Preferred Specialty · Diagnostic Testing
Provider network. · Physical and Occupational Therapy
The Primary Care Preferred Provider network is now · Durable Medical Equipment
composed of those providers who are in the Centura · Sleep study services*
Health Physician Group and those who are affiliated with
* If these services are provided at a non-Centura facility
Colorado Health Neighborhoods. Also, all pediatricians in
that is contracted with UnitedHealthcare there will be a
UnitedHealthcare’s network are included in the Primary Care
40 percent coinsurance after your deductible is met.
Provider network.
Under the Primary Care Preferred Provider network, Centura Use your Primary Care Provider (PCP)
pays 80 percent of covered expenses and you pay the
Regardless of if your PCP is a Preferred or Non-Preferred
remaining 20 percent coinsurance. When accessing care
Provider, Centura recognizes the value of having a primary
from a Primary Care Preferred Provider, your deductible
care physician, and encourages you to find a PCP that you
will be waived and you are responsible for the 20 percent
coinsurance. can partner with to focus on your health.
The Preferred Specialty Provider network in composed By accessing care from a PCP, they can be your champion
of specialists who are in the Centura Health Physician for health and will assist you in making decisions when
Group, Colorado Health Neighborhoods and designated accessing care.
UnitedHealthcare providers. If you receive services from a PCP from the Preferred
If you need to access care from a specialist and choose a Provider network you are only responsible for your 20
specialty physician within the Preferred Provider network, percent coinsurance, and your deductible is waived.
Centura will pay 80 percent of covered expenses and you If you receive services from a Non-Preferred Provider PCP
will pay the remaining 20 percent after your deductible is your coinsurance is still 40 percent, and you must meet your
met. All other covered services under the Preferred Provider deductible first.
network require that you meet the deductible (with the
exception of mental health and substance abuse services) You do not need to elect a PCP under the UnitedHealthcare
before paying coinsurance. HRA plan.
Non-Preferred Providers: The Non-Preferred Provider Pick your specialist
network contains the remaining UnitedHealthcare Select
Under the UnitedHealthcare HRA plan, you can see any
providers that are not included in the Primary Care Preferred
doctor or specialist without needing a referral from a
Provider network or the Preferred Specialty Provider
primary care doctor. You have access to specialists in both
network. When utilizing services from a primary care provider
the Preferred Provider and the Non-Preferred Provider
(PCP) in the Non-Preferred Provider network you will be
network. When accessing services from a specialist within
subject to the deductible and Centura will pay 60 percent of
covered expenses and you will pay the remaining 40 percent the Preferred Provider network you will be responsible for a
coinsurance. If you need to access care from a specialist and lower amount of coinsurance after your deductible has been
choose a specialty provider from the Non-Preferred Provider met. When accessing care from a Non-Preferred Provider
network you will be required to meet your deductible and provider you will be responsible for a slightly higher amount
Centura will pay 60 percent of covered expenses and you of coinsurance after your deductible is met.
will pay the remaining 40 percent coinsurance.
1 UnitedHealthcare HRA Medical Plan Benefits | Centura Health
Choose your treatment Use any Centura Health hospital or
In most cases, your doctor does not need to notify or get Joint Venture
approval from UnitedHealthcare before providing treatment You have your choice of Centura Health hospitals or joint
or services that are covered under your plan. However, ventures for hospital care. There is no out-of network
certain prescription medications and procedures do require coverage except for emergent or urgent care.
advance notification from UnitedHealthcare. Online lists of
medications and procedures requiring advance notification Pediatric Care
are available on myuhc.com or by calling UnitedHealthcare at
Centura Health has formed an affiliation with Rocky Mountain
1-866-234-8908.
Hospital for Children to leverage their long-standing expertise
Stay well in pediatrics with our own pediatric resources to increase
the strengths and services that we bring to our communities.
Take advantage of your preventive care benefits. The
UnitedHealthcare HRA plan pays routine preventive care Based upon this affiliation, your dependents can now access
coverage from day one. There is no deductible applied pediatric services at Rocky Mountain Hospital for Children.
and there is no out-of-pocket cost to you. Here are some In order to receive the highest level of benefits for pediatric
examples of preventive care: services, please contact UnitedHealthcare at 1-866-234-
• routine physicals 8908 prior to services.
• mammograms
• annual adult health checkups Peace of mind for your out-of-area
• child immunizations dependents
Out-of-area dependent coverage is available. Contact the
• well-child checkups
Centura Health Benefits Service Center if you have an out-of
It makes sense. The better your health, the lower your
area dependent you wish to cover under the medical plan.
health care costs.
Administrative information
Plan year Acquisitions and mergers
The plan year for the Centura Health Plan is July 1 through Coverage begins on the first day of
June 30. employment for individuals who become Centura Health
associates by means of an acquisition or merger.
Plan administrator & sponsor
Centura Health When coverage ends
Associate Benefits Your coverage under the Centura Health Plan will end on the
188 Inverness Drive West, Suite 500 last day of the month in which your employment terminates.
Englewood, Colorado 80112
Coverage under this plan will continue for up to six months
When coverage begins after an associate begins an active military leave.
If you enroll in the Centura Health Plan, your coverage
begins on the first day of the month after 30 days of active
employment.
2 UnitedHealthcare HRA Medical Plan Benefits | Centura Health
Eligibility •O
utpatient Surgery, Diagnostic and Therapeutic
Full-time and part-time associates scheduled to work at least Services
40 hours per pay period, and non-benefit eligible PRN and •R
econstructive Procedures
part-time associates who have worked an average of 30 • Rehabilitation Services — Outpatient Therapy
hours per week between April 1, 2013 - March 31, 2014 are •S
killed Nursing Facility / Inpatient Rehabilitation Facility
eligible to participate in the medical plan. You may enroll your Services
eligible dependents if you are also covered under the plan.
• Transplantation Services
Eligible dependents include: •M
RI, PET & CAT Scan Centura has Opted In to the
• Your spouse, including your common-law spouse UnitedHealthcare provider radiology notification program.
• Your civil union partner as recognized under Colorado Providers must contact UnitedHealthcare to notify
law. UnitedHealthcare of a radiology service.
• Your child from birth, stepchild or legally adopted child Filing a claim
(from moment of placement in the home), or child of
In-network care
whom you have legal custody, until, in each case, the
end of the month in which the child turns age 26 You do not need to file a claim when you receive care
through a UnitedHealthcare participating provider. Your
• Your child over age 26 who is:
participating provider will do this for you.
•M
entally or physically disabled and unable to earn
his or her own living and is dependent on you for Out-of-network care
a majority of support. Proof of incapacity must be Out-of-network care is only considered if you receive
provided to UnitedHealthcare within 31 days of the emergency or urgent care outside of the Centura service
date the child’s coverage would have ended due to area. You may have to file a claim before any benefits will be
age. The child must be covered under the plan on paid. Follow these steps in the event that the out-of-network
the date prior to the day coverage would have ended provider does not file a claim for you:
due to age except during an open enrollment period.
• Request a claim form from UnitedHealthcare as soon as
possible following the visit by calling 1-866-234-8908.
Care coordination—notification
• You can also download a UnitedHealthcare claim form
Notification ensures that you receive medical care in the
on www.myuhc.com
most cost-effective and appropriate way possible.
• Complete and sign the form. Return the completed form
UnitedHealthcare works with you and your participating
and original bills to UnitedHealthcare within 90 days
provider to evaluate the medical necessity of health care
after the charges are made.
services and some prescription drugs, to make sure it is
• Receive payment. UnitedHealthcare will send payment
appropriate.
to the appropriate parties (you and/or the provider.)
The following services listed require you to call the Care
Coordination staff for notification. Call: UHC 1-866-234- Your benefits
8908, Notification Option. The following pages will summarize key Centura Health Plan
provisions. This is only a general overview of the medical
• Acupuncture Services
insurance. For more detailed information regarding your
• Dental Services – Accident only benefit plans, please review the Summary Plan Description
• Durable Medical Equipment ($1,000 or more) located on My Virtual Workplace, Human Resources site.
• Emergency Health Services Should there be an inconsistency with any communications
• Home Health Care regarding these plans, the actual Summary Plan Description
will govern.
• Hospice Care
• Hospital — Inpatient Stay Any information contained herein may be subject to change.
• Maternity Services
3 UnitedHealthcare HRA Medical Plan Benefits | Centura Health
What makes up your UnitedHealthcare HRA plan?
HEALTH
COMPREHENSIVE SAVINGS ON PREVENTIVE
REIMBURSEMENT MEDICAL
ACCOUNT + COVERAGE + HEALTH CARE + HEALTH CARE + CARE
RESOURCES COSTS COVERAGE
(HRA)
Centura-funded Coverage for Answers to More control Centura helps you
account that can eligible expenses many health care over how your pay for services
help pay out-of- after you reach questions. You get health care dollars designed to keep
pocket expenses. your deductible. the help you need, are spent by you well, including
Catastrophic when you need it, taking advantage of physicals, well-child
coverage once and delivered how UnitedHealthcare’s care, cancer
you’ve fulfilled your you want it — on the purchasing power = screenings and
deductible and phone or Web. potential savings for immunizations.
reached your you.
out-of-pocket
maximum.
UnitedHealthcare gives you access to a large, high-quality network of physicians and health care professionals. And you have open access
to specialists with no need for a referral.
How does the UnitedHealthcare
HRA work?
Centura Health funds your Health Reimbursement Account. copays. Preventive care is 100%
When you receive covered health care services (including Centura paid and does not come
mental health and substance abuse services), the provider out of your HRA.
sends the bill to UnitedHealthcare for discounts and
If you don’t use all of the money in your HRA, and you
payment. The claim is paid directly to the provider with funds
decide to stay with UnitedHealthcare HRA plan for another
from your HRA account. You will receive a statement in the
year, your remaining balance will carry forward to next year.
mail so that you can keep track of your HRA balance.
That means more money in your HRA next year and even
If you spend your entire HRA, you’ll pay 100 percent of all less that you might have to pay from your own pocket. The
medical services until you’ve reached your deductible. maximum balance allowed in your HRA is equal to two times
Once you reach your deductible, the plan pays 80 percent your annual contribution.
of your qualified medical expenses and you pay the
remaining 20 percent for Preferred Provider services, up to
your out-of-pocket maximum. If you reach the out-of-pocket
maximum, Centura pays 100 percent of all other allowable
charges incurred during the plan year, including prescription
4 UnitedHealthcare HRA Medical Plan Benefits | Centura Health
UnitedHealthcare HRA details for the 2014–15 plan year
Coverage HRA funds Total deductible Out-of-pocket max Most you’ll pay
Single $1,000* $1,500 $3,500 $2,500
Two-Party $1,500* $3,000** $7,000*** $5,500
Family $2,000* $4,500** $10,500*** $8,500
*Your HRA contributes to the total deductible. **$1,500 per person maximum. *** $3,500 per person out-of-pocket maximum
A picture is worth COINSURANCE Counts toward your
a thousand words (Your share of cost if deductible is met) Out-of-pocket Maximum
YOUR CONTRIBUTION TO REACH DEDUCTIBLE
(If HRA is depleted)
Counts toward your
Deductible
HEALTH REIMBURSEMENT ACCOUNT Responsibility
(Funded by Centura)
You
Centura
PREVENTIVE CARE COVERAGE
Your medical benefit
Terms you need to know Out-of-pocket maximum
This is the maximum amount out-of-pocket you pay, including
The structure of UnitedHealthcare HRA plan creates some slight
your deductible, coinsurance and prescription copays.
variations in the meanings of some traditional insurance terms.
Regardless of the tier that your provider is covered under,
Please read the definitions below to become familiar with what
no person will ever pay more than $3,500. The maximum
these words mean for the Centura UnitedHealthcare HRA plan.
for two-party coverage is $7,000 and the family maximum is
Deductible $10,500. If you reach the out-of-pocket maximum, Centura
Health pays 100 percent of all other allowable charges incurred
This is a fixed amount of health care expenses that you must
during the plan year, including prescriptions.
pay before health benefits begin.
Under Centura’s medical plan, preventive care, pharmacy Meeting your deductible
expenses, mental health care and substance abuse benefits and The plan will pay 80 percent of covered Preferred Provider
Preferred Provider PCP services, are not subject to and do not benefits and Non-Preferred Provider PCP expenses, and 60
contribute to the deductible. percent of covered Non-Preferred speciality provider expenses
after you have met your deductible. For two-party coverage, the
Coinsurance
deductible operates as though each person has single coverage.
This is the percentage of the covered medical expenses that
For families of three or more people, no individual will be
you pay once the deductible has been met. Under the Preferred
required to pay more than $1,500 toward the deductible. Once
Provider network, Centura pays 80 percent of the allowable
an individual family member has reached the $1,500 deductible,
charges and the associate pays the remaining 20 percent. Under
the plan will pay 80 percent of allowable charges under the
the Non-Preferred Provider network, Centura pays 60 percent of
Preferred Provider network and 60 percent of allowable
the allowable charges and the associate pays the remaining 40
Non-Preferred Primary Care and speciality provider charges
percent for speciality services. Please note that mental health and
under the Non-Preferred Provider network for that person.
substance abuse services are subject to the coinsurance, without
Once three or more family members together incur $4,500
meeting your deductible.
of allowable medical expenses, the plan pays 80 percent of
For ancillary services, such as outpatient surgery, outpatient covered Preferred Provider expenses and 60 percent of covered
facility services, MRIs, CT scans, PET scans, and sleep study Non-Preferred Primary Care Provider and speciality provider
services, you must use a Centura Health network provider or joint expenses for the entire family.
venture. If these services are provided at a non-Centura facility
If you have questions about how the deductible works, please
that is contracted with UnitedHealthcare there will be a 40 percent
contact the Benefits Service Center by calling 1-888-622-1111.
coinsurance after your deductible is met.
5 UnitedHealthcare HRA Medical Plan Benefits | Centura Health
Prescription benefits
UnitedHealthcare/OptumRx administers your prescription Use Centura’s retail pharmacies or
drug coverage. Most prescriptions can be filled at a UnitedHealthcare’s mail order for
retail outlet. However, maintenance medications can be maintenance drugs
purchased more economically through a Centura retail You will receive a 90-day supply for two copays, instead of
pharmacy or via mail order. In both cases, you can purchase three copays. Many of the hospital campuses have Centura
a 90-day supply for two copays, instead of three. There are a retail pharmacies on site. The participating pharmacies are
limited number of drugs that require advance approval from listed here:
UnitedHealthcare. A list of drugs requiring approval can be
found on www.myuhc.com. • ApotheCare Porter Pharmacy
Call 1-866-234-8908 to speak with a UnitedHealthcare • Medical Arts Pharmacy — St. Mary Corwin
representative for advance approval or mail-order drug service. Medical Center
Drug copayments are as follows: • Penrose Professional Pharmacy
• St. Anthony Hospital Pharmacy
Retail outlets, 30-day Mail order, 90-day
supply, (1 copay) supply,(2 copays)
Tier 1 $15 $30
Tier 2 $30 $60
Tier 3 $60 $120
UnitedHealthcare HRA plan is easy to use —
the rest is up to you!
Take advantage of your preventive care See your primary care doctor before going
coverage to a specialist
No matter what tier your provider is covered under, Centura Your PCP may be able to resolve the issue at a much lower
covers 100% of preventive care coverage. You and your cost to you. In addition, if you access care from a primary
family can stay healthy or detect problems early with routine care doctor under the Preferred Provider benefit network,
physicals, regular screenings and immunizations. Centura will waive your deductible and you only pay the
applicable coinsurance.
Be prepared when you make, and arrive for,
medical appointments Try to work toward the healthiest lifestyle
Have your UnitedHealthcare medical ID card handy. Your possible
doctor’s staff may ask for your plan information, subscriber Change can take time, but the rewards can be wonderful
and group numbers when you call and copy your card when There are dozens of small things that can add up to
you arrive for your appointment. You also may want to bring significant changes that can improve your health and your
a few prepared questions for your doctor to get the most ability to enjoy life. Set small goals and work with your health
from your visit. care providers, family and friends to accomplish them.
Buy generic drugs whenever possible Use Walgreens Clinics
When you need a prescription, ask your doctor if a generic The Healthcare Clinic at select Walgreens provides 100%
equivalent is available. A generic medication has the same coverage for preventive services and the Preferred
active ingredients as a brand name drug and, in most cases, Provider benefit level for all other offered services. Visit
you’ll pay less. www.Walgreens.com/Clinic for a list of services and locations
and hours.
6 UnitedHealthcare HRA Medical Plan Benefits | Centura Health
Free Health and Disease
Management Programs
Numerous programs are available to you and your family to
give you the support and tools you need to maintain good
health, have a healthy pregnancy, or manage a chronic
health condition.
To find out more about what’s available, call
UnitedHealthcare at 1-866-234-8908, or if you work for
Penrose-St. Francis Health Services, St. Mary-Corwin or
St. Thomas More, call 1-855-385-5943 or 719-776-7983.
You may also visit My Virtual Workplace, select the 2020
tab at the top of the page, select Code You from the drop
down menu and select well-being benefits.
How to find a health care provider
Use the links in the My Virtual Workplace, Associates
Services, Human Resources site Take advantage of everything
• Call UnitedHealthcare toll-free: 1-866-234-8908. myuhc.com® has to offer
This includes advice, claims history, account information
and tools to help you manage your health care dollars.
Got a question? Myuhc.com gives you easy access to health and
If you need an answer or want more information about medical information, as well as personalized benefit
your benefits, help is on the way: claims and account information. You’ll also find great
tools to help you make informed, economical and
•C
all the Benefits Service Center toll-free at healthful decisions.
1-888-622-1111 or in Denver at 303-770-4750.
•E
-mail the Benefits Service Center at Finding fast answers on myuhc.com
benefits@centura.org. You can:
•R
eview the Summary Plan Descriptions on My • Verify eligibility, deductible or copayments
Virtual Workplace, Human Resources site for more • Confirm that a claim is in process or was paid
detailed information.
• Verify what is covered by your benefits
• Order a replacement ID card
• Find a network physician in your area
• Order prescriptions and refills
• Research the cost of a medical treatment
• Learn more about your coverage
• Find which treatments the experts recommend
7 UnitedHealthcare HRA Medical Plan Benefits | Centura Health
Centura UnitedHealthcare HRA Plan Summary
UnitedHealthcare HRA medical plan fundamentals
Deductible HRA funds
Associate Only $1,500 $1,000
Associate + One $3,000 ($1,500 per person) $1,500
Associate + Two or More $4,500 ($1,500 max. per person) $2,000
Out-of-pocket maximum (includes deductibles, coinsurance and prescription copays)
Associate Only $3,500
Associate + One $7,000 ($3,500 per person)
Associate + Two or More $10,500 ($3,500 max. per person)
Preferred Provider Coinsurance after deductible 20%
Non-Preferred Provider Coinsurance after deductible 40%
Covered outpatient services at a non-Centura facility 40%
Life-time maximum None
Pre-existing conditions None
Preventive care benefit: UnitedHealthcare HRA
Preventive medical care
Example: Routine man and woman well-exam, 100% covered per participant
baby/well-child, routine mammogram
Prescription benefit: UnitedHealthcare / OptumRx
Outpatient prescription drugs
Tier 1: $15
Tier 2: $30
Tier 3: $60
Mail order Rx & Centura retail pharmacies 2 copays for a 90-day supply
Medical services: UnitedHealthcare HRA You pay
Office visit Services
Preferred Provider Primary Care Physician (PCP) office visits 20% Coinsurance, deductible waived
Non-Preferred Provider Primary Care Physician (PCP) office visits 40% Coinsurance after deductible
Preferred Provider Specialist office visits 20% Coinsurance after deductible
Non-Preferred Provider Specialist office visits 40% Coinsurance after deductible
Hospital and emergency services
Inpatient (Centura facilities only) 20% Coinsurance after deductible
Emergency care 20% Coinsurance after deductible
Ambulance (Ground and air) 20% Coinsurance after deductible
Urgent care 20% Coinsurance after deductible
Outpatient surgery* (Centura facilities and Joint ventures only) 20% Coinsurance after deductible*
* Covered services provided at a non-Centura facility that is contracted with UnitedHealthcare have a 40 % coinsurance after your deductible is met.
Home health care 20% Coinsurance after deductible
Hospice care 20% Coinsurance after deductible
8 UnitedHealthcare HRA Medical Plan Benefits | Centura HealthMedical services: UnitedHealthcare HRA You pay
Therapies (Centura facilities only)
Physical, occupational or speech 20% Coinsurance after deductible, up to 60 visits per plan year combined
Cardiac rehabilitation 20% C
oinsurance after deductible, up to 20 visits per plan year
Pulmonary rehabilitation 20% C
oinsurance after deductible, up to 20 visits per plan year
Durable medical equipment or prosthetics 20% Coinsurance after deductible
Maternity
Initial visit - Preferred Provider 20% Coinsurance after deductible
After initial visit - Preferred Provider 20% Coinsurance of global fee after deductible
Initial visit - Non-Preferred Provider 40% Coinsurance after deductible
After initial visit - Non-Preferred Provider 40% Coinsurance of global fee after deductible
Nutritional services (certain conditions apply) 100% covered
Other health care services
Acupuncture (pain management for approved diagnosis) 20% Coinsurance after deductible, up to 20 visits per plan year
Chiropractic services 20% Coinsurance after deductible, up to 20 visits per plan year
Hearing exam (diagnostic injury or illness) 20% Coinsurance after deductible
Lab and X-Ray (MRI,* PET* and CT* scans must 20% Coinsurance after deductible*
be performed at a Centura Health facility,
joint venture, or Denver MRI)
* Covered services provided at a non-Centura facility that is contracted with UnitedHealthcare have a 40 % coinsurance after your deductible is met.
Mammography testing 20% Coinsurance after deductible
Skilled nursing/Inpatient rehabilitation 20% Coinsurance after deductible, 60-day max per plan year, combined
(Centura facilities only) with inpatient rehabilitation*
Reconstructive procedures
Medically necessary 20% Coinsurance after deductible
Transplantation services
Specific Centura facilities must be utilized 20% Coinsurance after deductible
Bone marrow/Stem cell search $25,000 maximum benefit
Transportation, meal and lodging $50 for one person / $100 for two people, up to $10,000 Lifetime
Roux-en-Y, Lap band and Sleeve gastrectomy
bariatric surgery 20% Coinsurance after deductible
Penrose-St. Francis Hospital, Parker Adventist Hospital, and
St. Thomas More Hospital only
Mental health and substance abuse services: United Behavioral Health*
*All inpatient mental health and substance abuse services must be pre-authorized, call 1-877-384-2266.
Mental health services
Inpatient 20% Coinsurance, no deductible
Partial hospitalization 20% Coinsurance, no deductible
Outpatient visit 20% Coinsurance, no deductible
Substance abuse
Inpatient 20% Coinsurance, no deductible
Inpatient detoxification 20% C
oinsurance, no deductible
Partial hospitalization 20% Coinsurance, no deductible
Outpatient detoxification 20% Coinsurance, no deductible
Intensive outpatient program 20% Coinsurance, no deductible
9 UnitedHealthcare HRA Medical Plan Benefits | Centura HealthUnitedHealthcare HRA Medical Plan examples1
Services Deductible Coinsurance
$1,500 Per Person Preferred Provider: 20% Non-Preferred Provider: 40% 1
or illustrative
F
$4,500 Family Up to $2,000 Per Person, $6,000 Family purposes, it
Routine Physical – Preferred Provider or is assumed
None None
Non-Preferred Provider that claims are
PCP Office Visit – Preferred Provider Waived 20% No Deductible processed by
PCP Office Visit – Non-Preferred Provider Yes 40% After Deductible UnitedHealthcare
in the order in
Specialist Office Visit – Preferred Provider Yes 20% After Deductible
which services
Specialist Office Visit – Non-Preferred Provider Yes 40% After Deductible are listed.
Cast & Minor Surgery Yes 20% After Deductible
Single Example Services Cost Amount you Coinsurance Paid from UnitedHealthcare HRA
pay to meet you pay HRA HRA plan benefit balance
Dedcutible: $1,500 deductible
HRA: $1,000 Associate
Coinsurance: Routine Physical – $230 $0 $0 $0 $230 $1,000
Preferred Provider – 20% Preferred Provider
Non-Preferred Provider – 40% or Non-Preferred
Provider
Out-of-pocket maximum:
PCP Office Visit – $120 $0 $24 $24 $96 $976
$3,500
Preferred Provider
Total cost of medical Specialist Office $140 $140 $0 $140 $0 $836
services: $2,630 Visit – (paid by HRA)
Total amount the Preferred Provider
HRA paid: $1,000 Cast & Minor $2,000 $1360 $128 $836 $512 $0
Surgery ($836 paid
UnitedHealthcare HRA by HRA)
plan paid: $922 Specialist Office $140 $0 $56 $0 $84 $0
Total amount you paid: Visit -
$708 Non-Preferred
Provider
Totals $2,630 $1,500 $208 $1,000 $922 $0
Two Party Example Services Cost Amount you Coinsurance Paid from UnitedHealthcare HRA
pay to meet you pay HRA HRA plan benefit balance
Dedcutible: $3,000 deductible
($1,500 per person max)
Associate
HRA: $1,500 Routine Physical – $210 $0 $0 $0 $210 $1,500
Coinsurance: Preferred Preferred Provider or
Provider – 20% Non-Preferred Non-Preferred Provider
Provider – 40% PCP Office Visit – $120 $0 $24 $24 $96 $1,476
Preferred Provider
Out-of-pocket maximum:
$7,000 Specialist Office Visit – $140 $140 $0 $140 $0 $1,336
($3,500 per person max) Preferred Provider (paid by HRA)
Total cost of medical Dependent
services: $2,380 Routine Physical – $250 $0 $0 $0 $250 $1,336
Preferred Provider or
Total amount the HRA paid:
Non-Preferred Provider
$1,500
PCP Office Visit – $120 $0 $0 $120 $0 $1,216
UnitedHealthcare HRA plan Non-Preferred Provider
paid: $640
Outpatient Surgery $1,400 $1,380 $20 $0 $0 $0
Total amount you paid: $264 ($1,216 paid
by HRA)
Total cost of medical
Specialist Office Visit – $140 $0 $56 $0 $84 $0
services: $2,380
Non-Preferred Provider
Totals $2,380 $1,640 $100 $284 $640 $0
10 UnitedHealthcare HRA Medical Plan Benefits | Centura HealthUnitedHealthcare HRA Medical Plan examples1
Family Example Services Cost Amount you Coinsurance Paid UnitedHealthcare HRA balance
pay to meet you pay from HRA plan benefit
Dedcutible: $4,500 deductible HRA
($1,500 per person
Associate
max)
Routine Physical – $250 $0 $0 $0 $250 $2,000
HRA: $2,000 Preferred Provider or
Coinsurance: Non-Preferred Provider
Preferred Provider Specialist In-Office $500 $500 $0 $500 $0 $1,500
– 20% Procedure – (paid by HRA)
Preferred Provider
Non-Preferred Provider
– 40% Spouse
Routine Physical – $250 $0 $0 $0 $250 $1,500
Out-of-pocket
Preferred Provider or
maximum: $10,500
Non-Preferred Provider
($3,500 per person
max) PCP Office Visit – $120 $120 $0 $120 $0 $1,380
Non-Preferred Provider (paid by HRA)
Total cost of medical
services: $29,995 Outpatient Surgery $1,600 $1,380 $44 $1,380 $176 $0
(paid by HRA)
Total amount the
HRA paid: $2,000 Specialist Office Visit – $150 $0 $45 $0 $90 $0
Non-Preferred Provider
UnitedHealthcare Dependent
HRA plan paid:
$23,316 Well-Child Check-Up – $175 $0 $0 $0 $175 $0
Preferred Provider or
Total amount you Non-Preferred Provider
paid: $4,604
Specialist Office Visit – $140 $140 $0 $0 $0 $0
Total cost of medical Non-Preferred Provider
services: $29,995 Dependent
Total amount the Well-Child Check-Up – $175 $0 $0 $0 $175 $0
HRA paid: $2,000 Preferred Provider or
Non-Preferred Provider
PCP Office Visit – $120 $120 $0 $0 $0 $0
Preferred Provider
Outpatient Surgery $1,200 $1,200 $0 $0 $0 $0
Dependent
Well-Child Check-Up – $175 $0 $0 $0 $175 $0
Preferred Provider or
Non-Preferred Provider
Specialist Office Visit – $140 $140 $0 $0 $0 $0
Non-Preferred Provider
Inpatient Surgery $25,000 $900 $2,000 $0 $22,100 $0
Totals $29,995 $4,500 $2,089 $2,000 $23,316
11 UnitedHealthcare HRA Medical Plan Benefits | Centura HealthGeneral plan limitations
We will not pay benefits for any of the services, treatments, 2. Preventive care, diagnosis, treatment of or related to
items, or supplies described in this section, even if either of the teeth, jawbones or gums. Examples include all of the
the following is true: following:
• It is recommended or prescribed by a Physician. • Extraction, restoration, and replacement of teeth.
• It is the only available treatment for your condition. • Medical or surgical treatments of dental conditions.
Alternative treatments • Services to improve dental clinical outcomes.
1. Acupressure. 3. Dental implants.
2. Aroma therapy. 4. Dental braces.
3. Hypnotism. 5. Dental x-rays, supplies, and appliances and all
associated expenses, including hospitalization and
4. Massage Therapy.
anesthesia. The only exceptions to this are for any of the
5. Rolfing. following:
6. Other forms of alternative treatment as defined by the • Transplant preparation.
Office of Alternative Medicine of the National Institutes of
• Initiation of immunosuppressives.
Health.
• The direct treatment of acute traumatic injury, cancer
Comfort or convenience or cleft palate.
1. Television. 6. Treatment of congenitally missing, malpositioned,
2. Telephone. or super numerary teeth, even if part of a congenital
anomaly.
3. Beauty/Barber service.
4. Guest service. xperimental or investigational services or
E
unproven services
5. Supplies, equipment, and similar incidental services and
Experimental or investigational services and unproven services
supplies for personal comfort. Examples include:
are excluded. The fact that an experimental or investigational
• Air conditioner. service or an unproven service, treatment, device or
• Air purifiers and filters. pharmacological regimen is the only available treatment for a
particular condition will not result in benefits if the procedure is
• Batteries. considered to be experimental or investigational or unproven
• Battery chargers. in the treatment of that particular condition.
• Dehumidifier. Foot care
• Humidifiers. 1. Except when needed for severe systemic disease:
Routine foot care (including the cutting or removal of
6. Devices and computers to assist in communication and
corns and calluses.) Nail trimming, cutting, or debriding.
speech.
2. Hygienic and preventive maintenance foot care. Examples
7. Home remodeling to accommodate a health need (such
include the following:
as, but not limited to, ramps and swimming pools.)
• Cleaning and soaking the feet.
Dental • Applying skin creams in order to maintain skin tone.
1. Dental care except as described in the SPD, (Section
• Other services that are performed when there is not
1: What’s Covered – Benefits) under the heading Dental
a localized illness, injury or symptom involving the
Services — Accident Only.
foot.
12 UnitedHealthcare HRA Medical Plan Benefits | Centura Health3. Treatment of flat feet. •S
kin abrasion procedures performed as a treatment
4. Treatment of subluxation of the foot. for acne.
5. Shoe orthotics. 2. Replacement of an existing breast implant if the earlier
breast implant was performed as a cosmetic procedure.
Medical supplies and appliances Note: Replacement of an existing breast implant is
1. Devices used specifically as safety items or to affect considered reconstructive if the initial breast implant
performance in sports-related activities. followed mastectomy.
2. Prescribed or non-prescribed medical supplies and 3. Physical conditioning programs such as athletic training,
disposable supplies. Examples include: body-building, exercise, fitness, flexibility, and diversion
• Elastic stockings (Job stockings are not excluded.) or general motivation.
• Ace bandages. 4. Weight loss programs whether or not they are under
medical supervision. Weight loss programs for medical
• Gauze and dressings. reasons are also excluded.
• Syringes. 5. Wigs regardless of the reason for the hair loss.
• Diabetic test strips.
Providers
3. Orthotic appliances that straighten or re-shape a body
1. Services performed by a provider who is a family
part (including some types of braces.)
member by birth or marriage, including spouse, brother,
4. Tubing, nasal cannulas, connectors and masks are sister, parent or child. This includes any service the
not covered except when used with Durable Medical provider may perform on himself or herself.
Equipment (see Summary Plan Description.)
2. Services performed by a provider with your same legal
residence.
Nutrition
1. Megavitamin and nutrition based therapy. 3. Services provided at a free-standing or hospital-based
diagnostic facility without an order written by a physician
2. Except as described in the SPD (Section 1: What’s
or other provider. Services that are self-directed to a free-
Covered — Benefits) under Nutritional Counseling,
standing or hospitalbased diagnostic facility. Services
nutritional counseling for either individuals or groups,
ordered by a physician or other provider who is an
including weight loss programs, health clubs, and spa
associate or representative of a free-standing or hospital-
programs.
based diagnostic facility, when that physician or other
3. Enteral feedings and other nutritional and electrolyte provider:
supplements, including infant formula, donor breast milk, •H
as not been actively involved in your medical care
nutritional supplements, dietary supplements, electrolyte prior to ordering the service, or
supplements, diets for weight control or treatment of
obesity (including liquid diets or food), food of any kind • Is not actively involved in your medical care after the
(diabetic, low fat, cholesterol), oral vitamins, and oral service is received.
minerals except when sole source of nutrition. This exclusion does not apply to mammography testing.
Physical appearance Reproduction
1. Cosmetic Procedures. See the definition in the SPD 1. Surrogate parenting.
(Section 10: Glossary of Defined Terms.) Examples include: 2. The reversal of voluntary sterilization.
• Pharmacological regimens, nutritional procedures, or 3. Fees or direct payment to a donor for sperm or ovum
treatments. donations.
• Scar or tattoo removal or revision procedures (such 4. Monthly fees for maintenance and/ or storage of frozen
as salabrasion, chemosurgery and other such skin embryos.
abrasion procedures.) 5. Health services and associated expenses for abortion.
13 UnitedHealthcare HRA Medical Plan Benefits | Centura Health6. Fetal reduction surgery.
7. Health services associated with the use of non-surgical
or drug-induced pregnancy termination.
Services provided under another plan
1. Health services for which other coverage is required by
federal, state or local law to be purchased or provided
through other arrangements. This includes, but is not
limited to, coverage required by workers’ compensation,
no-fault auto insurance, or similar legislation. If coverage
under workers’ compensation or similar legislation is
optional for you because you could elect it, or could have
it elected for you, benefits will not be paid for any injury,
Vision and hearing
sickness or mental illness that would have been covered
1. Purchase cost of eye glasses or contact lenses, (charges
under workers’ compensation or similar legislation had
are covered for eyeglasses that are a result of cataract
that coverage been elected.
surgery.)
2. Health services for treatment of military service-related
2. Fitting charge for eye glasses or contact lenses.
disabilities, when you are legally entitled to other
coverage and facilities are reasonably available to you. 3. Eye exercise therapy.
3. Health services while on active military duty. 4. Surgery that is intended to allow you to see better
without glasses or other vision correction including radial
Transplants keratotomy, laser, and other refractive eye surgery.
1. Health services for organ and tissue transplants, except
those described in the Summary Plan Description. All other exclusions
1. Health services and supplies that do not meet the
2. Health services connected with the removal of an organ
definition of a Covered Health Service (see the definition in
or tissue from you for purposes of a transplant to another
the SPD Section 10: Glossary of Defined Terms.)
person. (Donor costs for removal are payable for a
transplant through the organ recipient’s benefits under 2. Physical, psychiatric or psychological exam, testing,
the plan.) vaccinations, immunizations, or treatments that are
otherwise covered under the Plan when:
3. Health services for transplants involving mechanical or
animal organs. •R
equired solely for purposes of career, education,
sports or camp, travel, employment, insurance,
4. Any multiple organ transplant not listed as a covered marriage or adoption.
health service under the heading Transplantation Health
Services in the Summary Plan Description. •R
elated to judicial or administrative proceedings or
order.
Travel •C
onducted for purposes of medical research.
1. Health services provided in a foreign country, unless
•R
equired to obtain or maintain a license of any type.
required as Emergency Health Services.
3. Health services received as a result of war or any act of
2. Travel or transportation expenses, even though
war, whether declared or undeclared or caused during
prescribed by a physician. Some travel expenses
service in the armed forces of any country.
related to covered services rendered at United Resource
Networks participating programs or Designated Facilities 4. Health services received after the date your coverage
may be reimbursed at our discretion. under the Plan ends, including health services for
medical conditions arising before the date your coverage
under the Plan ends.
14 UnitedHealthcare HRA Medical Plan Benefits | Centura Health5. Health services for which you have no legal responsibility 24. Any charges higher than the actual charge. The actual
to pay, or for which a charge would not ordinarily be charge is defined as the provider’s lowest routine charge
made in the absence of coverage under the Plan. for the service, supply or equipment.
6. Charges in excess of eligible expenses or in excess of any 25. Any charge for services, supplies or equipment advertised
specified limitation. by the provider as free.
7. Services for the evaluation and treatment of 26. Any charges by a provider sanctioned under a
temporomandibular joint syndrome (TMJ), when the federal program for reason of fraud, abuse or medical
services are considered to be medical or dental in nature, competency.
including oral appliances.
27. Any charges prohibited by federal anti-kickback or self-
8. Upper and lower jawbone surgery except as required for referral statutes.
direct treatment of acute traumatic Injury or cancer. Jaw
28. Any additional charges submitted after payment has been
alignment and treatment for the temporomandibular joint,
made and your account balance is zero.
except as a treatment of obstructive sleep apnea.
Orthognathic jawbone surgery is a covered service. 29. Any outpatient facility charge in excess of payable
amounts under Medicare.
9. Speech therapy except as required for treatment of a
speech impediment or speech dysfunction that results 30. Any charges by a resident in a teaching Hospital where a
from injury, stroke, or a congenital anomaly. faculty Physician did not supervise services.
10. Non-surgical treatment of obesity, including morbid 31. Outpatient rehabilitation services, spinal treatment or
obesity. supplies including, but not limited to spinal manipulations
by a chiropractor or other doctor, for the treatment of a
11. Surgical treatment of obesity, except Roux-en-Y, Lap
condition which ceases to be therapeutic treatment and
band and Sleeve gastrectomy bariatric surgery at
is instead administered to maintain a level of functioning
Penrose-St. Francis Hospital or Parker Adventist Hospital.
or to prevent a medical problem from occurring or
12. Sex transformation operations. reoccurring.
13. Custodial Care. 32. Spinal treatment, including chiropractic and osteopathic
manipulative treatment, to treat an illness, such as asthma
14. Domiciliary care.
or allergies.
15. Private duty nursing.
33. Speech therapy to treat stuttering, stammering, or other
16. Respite care. articulation disorders.
17. Rest cures. 34. Liposuction.
18. Psychosurgery. 35. Chelation therapy, except to treat heavy metal positioning
19. Treatment of benign gynecomastia (abnormal breast 36. Cosmetic or reconstructive surgery (except as specified
enlargement in males). above.)
20. Medical and surgical treatment of excessive sweating 37. Personal trainer.
(hyperhidrosis).
38. Naturalist.
21. Medical and surgical treatment for snoring, except when
39. Holistic or
provided as a part of treatment for documented obstructive
homeopathic care.
sleep apnea.
40. Pulmonary
22. Appliances for snoring.
rehabilitation
23. Any charges for missed appointments, room or facility therapy.
reservations, completion of claim forms or record
processing.
15 UnitedHealthcare HRA Medical Plan Benefits | Centura HealthClaims and appeals
If any claim for benefits is denied, you will be given the For more information about the claims and appeals process,
reason for denial in writing usually within 30 days after call UnitedHealthcare directly at 1-866-234-8908.
the receipt of the claim by UnitedHealthcare. The Claims
Claims submittal:
Administrator will notify you within this 30 day period if
additional information is needed to process the claim. You UnitedHealthcare Insurance Company
may request a one time extension within 15 days and pend P.O. Box 30555
your claim until all information is received. Salt Lake City, Utah 84130-0555
Once notified of the extension you then have 45 days to Requests for review of denied claims & notice of
provide this information. If you don’t provide the needed complaints:
information within the 45 day period, your claim will be UnitedHealthcare Insurance Company
denied. If you provide the information within the 45 day P.O. Box 30432
extension, a decision will be made within 15 days after the Salt Lake City, Utah 84130-0432
information is received.
Coordination of benefits
If you and your dependents have coverage under another
medical plan (such as your spouse’s employer’s plan),
Example
benefits are coordinated between the two plans. The primary
Suppose your spouse incurs $1,000 in medical
plan pays your benefits first. Then the secondary plan pays
expenses and his or her plan pays $500. If the Centura
any additional benefits that may be due. Health Plan would have paid $650 as the primary, it
will consider paying up to $150 ($650 – $500 = $150),
For you subject to plan provisions, toward your spouse’s
The Centura Health Plan is always considered primary for expenses.
you, the associate. If you are also covered as a dependent If your spouse’s plan pays $750, more than the Centura
on your spouse’s plan, that plan will be secondary. If the Health Plan would have paid as the primary, then no
other plan does not have a coordination of benefits provision, benefit would be paid by the Centura Health Plan.
that plan will always pay first.
For your spouse
If your spouse is covered under his or her employer’s plan, For your children
that plan will be considered primary for your spouse, and the If your dependent children are covered by your plan and your
Centura Health Plan will be secondary. The Centura Health spouse’s plan, the primary payer will be determined by the
Plan will pay expenses not paid by the primary plan, up to “birthday rule.” Under this rule, the plan of the parent whose
the amount that would have been payable under the terms birthday falls first during the calendar year (regardless of year
of the Centura Health Plan had it been the primary plan. of birth) will pay primary (If birthdays of both parents are the
If the other plan does not have a coordination of benefits same, the plan that has covered either of the parents longer
provision, that plan will always pay first. If none of the is primary.) This rule does not apply in the case of separation
circumstances already described apply, the plan that has or divorce. Instead, determination may be based on which
covered your spouse for a longer period of time will pay first. parent has legal custody of the child. If a court decree has
16 UnitedHealthcare HRA Medical Plan Benefits | Centura Healthbeen issued, the primary plan is determined by which parent individuals who are covered by the Centura Health Plan
the court decree obligates to cover the health care expenses due to “current employment status” and who are covered
of the child. Otherwise, if the parents are not married or are by Medicare due to age or disability. The Centura Health
separated or divorced, the order of benefit payment for the Plan is primary payer for the first 30 months that a covered
child is: individual is entitled to Medicare because of end-stage renal
disease (ESRD.)
• The plan of the custodial parent
• The plan of the spouse of the custodial parent Right of recovery
• The plan of the non-custodial parent Centura Health is entitled to receive reimbursement from
• The plan of the spouse of the non-custodial parent. participants who receive compensation from any third party,
If the other plan does not have a coordination of benefits other than family members, for expenses that have been
provision, that plan will always pay first. If none of the paid for by the plan.
circumstances already described apply, the plan that has In some situations, a third party, such as another person
covered your dependents for a longer period of time will pay or insurance company can be legally responsible for your
first. medical expenses. A car accident is an example of such
a situation. In these cases, the Health Plan is entitled to
Filing coordination claims repayment for all medical expenses paid. When you accept
If you are covered under two plans, it is important that you payment from UnitedHealthcare, you agree to provide any
file full and complete claims with both claim administrators. documents that would help the company recover payments
You should file your claim with the primary plan first. Then, it makes on your behalf. The legal term for the company’s
when you receive the explanation of benefits, you should right of recovery is subrogation.
forward it along with your claim to the secondary plan.
If you do receive payment from a third party and do
If you have any questions about which plan is primary not promptly refund the company the full amount,
or secondary, please contact UnitedHealthcare at UnitedHealthcare has the right to reduce future benefits
1-866- 234-8908. that are payable under the Centura Health Plan. The
reductions will equal the amount of the required refund.
Medicare secondary payer UnitedHealthcare may have other rights in addition to the
The Centura Health Plan pays primary to Medicare for right to reduce future benefits.
Agent for legal processes
Plan Administrator
Centura Health
188 Inverness Drive West, Suite 500
Englewood, Colorado 80112
17 UnitedHealthcare HRA Medical Plan Benefits | Centura HealthYou can also read
