2018 UCare Group Medicare NSPMEOA Retirees U3204 (02/18)

UCare is not a Cost contract! About UCare Serve 80,000 Medicare members in Minnesota and western Wisconsin Friendly customer service with a real person, located in Northeast Minneapolis Members rate UCare 9 out of 10 overall Nonprofit insurer with Medicare Advantage contract UCare is not a Cost contract!

Star Ratings Medicare Quality Program uses a 5-star rating system Score based on five health service categories: Keeping healthy through screenings, tests and vaccines Managing chronic conditions Satisfaction Operational performance Customer service UCare is a 4.5 Star Plan!

Who can join UCare Group Medicare? Retirees and their spouses who: Have Medicare Part A and Part B Continue to pay Part B premium Live in Minnesota or within 26 counties in Wisconsin Do not have end-stage renal disease.

UCare Group Medicare Premium Rates High: $332 Core: $164 Basic: $73 Rates are per member, per month through 12/31/18

Large Provider Network Allina Health Mayo Health System CentraCare Clinics Park Nicollet Clinics Essentia Health Ridgeview Clinics Fairview Clinics Stillwater Clinics HealthEast St. Luke’s HCMC U of M Physicians North Memorial And many more

All UCare Group Medicare plans include: Preventive Services– $0 copay Preventive Dental – 3 cleanings/year – 100% coverage Prescription Drug coverage – Medicare Part D Medical Out-of-Pocket Maximum – $3400 Worldwide Emergency coverage Coverage out of area up to 6 months – no need to notify Out of network non-emergency coverage – 80%

Primary Office Visit Choose a Primary Care Clinic Just a home base Primary Doctor Visits Choose a Primary Care Clinic Keep your doctor, your clinic Find in Primary Care Clinic Listing Change clinic anytime Just a home base Primary Office Visit $15 copay on all plans Almost every primary care clinic is in our network! Your chosen clinic is just a home base – your doctor does not have to approve, refer, or sign off on anything for you to see whoever you want. Yes, ALMOST every primary care clinic, the few primary care clinics of HealthPartners are not within our network, but the specialty and urgent care HealthPartners clinics are. For those that use the internet, it’s best to click Find a Doctor on UCVare.org to search for your doctor in the network. Choose UCare for Seniors as your plan.

Specialist Doctor Visits See any Specialist No referral needed Simply make an appointment Use Find a Doctor tool Specialist Office Visit High – $15 copay Core – $30 copay Basic – $40 copay To see a specialist, like a cardiologist, the copay is $15 for High, $30 for Core and $40 for Basic.

Covered at 100% after copay, per admission Inpatient Hospital Covered at 100% after copay, per admission High – $100 copay Core – $200 copay Basic – $300 per day copay, days 1 through 5 We coordinate with all providers, no paperwork

Outpatient Surgery and Skilled Nursing High – $200 copay Core – $250 copay Basic – $250 copay Skilled Nursing/Rehabilitation No three-day in-patient hospital stay requirement $0 for days 1 through 20 $100 per day for days 21 through 100

Worldwide Emergency Care Emergency Services Worldwide Emergency Care High – $50 copay Core – $75 copay Basic – $75 copay Ambulance Services 100% coverage after: High – $100 copay Core – $100 copay Basic – $200 copay

Vision and Hearing Benefits High and Core Plans include: Vision exam – $0 copay $150 eyewear credit each year Hearing Exam – $0 copay $500 hearing aid credit every 3 years Basic plan includes: Vision exam – $40 copay Hearing exam – $40 copay

Additional Dental Benefits Preventive Dental included in all plans 3 cleanings, 2 exams, annual bitewing x-rays Additional dental coverage for $21 per month Coverage for fillings, crowns, dentures Full mouth x-rays $50 deductible $1200 annual maximum

Prescription Drug Coverage – Part D Formulary – List of Covered Drugs Search online by name 4 tiers – Generic, Preferred Brand, Non-Preferred and Specialty Large Pharmacy network or mail order Includes Fairview Pharmacies Preferred Pharmacies – 90 day supply for 2 copays .

Initial Coverage Stage From $0 to $3,750 in annual prescription drug costs High Core Basic Annual deductible Tier 1 – Generic Tier 2 – Preferred Brand Tier 3 – Non-preferred Tier 4 – Specialty $100 $10 copay $40 copay $90 copay 30% coinsurance $150 $15 copay $45 copay $100 copay $250 25% coinsurance

Coverage Gap Stage – Donut Hole Once you have reached $3,750 in annual prescription drug costs High Core Basic Coverage in Gap Once you reach $5000 in out of pocket costs: Catastrophic Coverage 5% coinsurance or $3.35 for generics and $8.35 for brand name – whichever is greater Coverage through the gap paying co-pays. No Donut Hole Tier 1 Generics covered thru the gap with $15 copay You pay 35% of brand name drugs Smaller Donut Hole You pay 44% of Generic drugs Larger Donut Hole

UCare Group Medicare Fitness Programs SilverSneakers® Fitness Free membership to a fitness center 13,000 locations nationally ‒ use it anywhere! YMCA, LA Fitness, Snap, YWCA, Curves Health Club Savings (Lifetime and others) $20 per month toward your membership No minimum number of visits required.

How do I join UCare Group Medicare? Retirees and Spouses May enroll when Medicare-eligible (generally age 65) Each fills out an application and plan choice Enrollment Folders Includes 2 applications and 2 plan choice forms Mail forms in the green envelope provided

I joined UCare Group Medicare. Now what? Confirmation of enrollment Member ID card Customer Service UCare 24/7 Nurse Line Disease Management Programs Member Portal at UCare.org

Questions about UCare Group Medicare Contact information Phone: 612-676-6900 Toll Free: 1-877-598-6574 Email: groupsales@ucare.org Visit our offices 500 Stinson Blvd. NE, Minneapolis, MN 55414 Find us online @ ucare.org

THANK YOU Happy Retirement!