1. 2019 medical benefit plans
University of Nebraska

2. Sign up for your 2019 benefits
10/29/2018 – 11/16/2018
Today you’ll learn more about:
2019 Medical plan options
Enhancements to current benefits
Services available from UMR
Teladoc
Open enrollment for [PLAN YEAR] coverage is [M,D] through [M,D]. The choices you make during this time take effect when the new benefits year begins [M,D, YYYY]. 2

3. What’s new for 2019
UMR will administer current medical plans, as well as a new Qualified High Deductible Health Plan.
Preferred tier benefit with Nebraska Medical Center.
Increased preventive benefits.
Infertility treatment benefits.

4. Your medical benefits at a glance – LOW
Fill this chart in with any plan specific information
Your medical benefits at a glance – LOW
Deductible and benefit percentage
Low Option
Preferred Tier
In-network
Out-of-network
In-network and out-of-network charges are combined to satisfy the deductible and co-insurance out-of-pocket.
Deductible
Individual
Family
$1,350
$2,600
$1,550
$3,100
$1,950
$3,900
Coinsurance
Percentage applied to covered medical expenses
Plan pays 85%
Plan pays 70%
Plan pays 55%
Out-of-pocket maximum
Includes deductible
$3,650
$7,300
$4,050
$8,100
$4,850
$9,700
After satisfying the coinsurance and out-of-pocket limit, the Plan pays 100% of eligible charges.
Preventive
Regular
< age 2 – 100%
Age % to $250, then deductible & coinsurance
Preventive Enhanced
Age % to $400, then deductible & coinsurance

5. Your medical benefits at a glance – BASIC
Fill this chart in with any plan specific information
Your medical benefits at a glance – BASIC
Deductible and benefit percentage
Basic Option
Preferred Tier
In-network
Out-of-network
In-network and out-of-network charges are combined to satisfy the deductible and co-insurance out-of-pocket.
Deductible
Individual
Family
$300
$600
$450
$900
$650
$1,300
Coinsurance
Percentage applied to covered medical expenses
Plan pays 85%
Plan pays 70%
Plan pays 55%
Out-of-pocket maximum
Includes deductible
$1,750
$3,500
$2,050
$4,100
$2,650
$5,300
After satisfying the coinsurance and out-of-pocket limit, the Plan pays 100% of eligible charges.
Preventive
Regular
< age 2 – 100%
Age % to $250, then deductible & coinsurance
Preventive Enhanced
Age % to $400, then deductible & coinsurance

6. Your medical benefits at a glance - HIGH
Fill this chart in with any plan specific information
Your medical benefits at a glance - HIGH
Deductible and benefit percentage
High Option
Preferred Tier
In-network
Out-of-network
In-network and out-of-network charges are combined to satisfy the deductible and co-insurance out-of-pocket.
Deductible
Individual
Family
$200
$400
$300
$600
$450
$900
Coinsurance
Percentage applied to covered medical expenses
Plan pays 90%
Plan pays 80%
Plan pays 65%
Out-of-pocket maximum
Includes deductible
$1,500
$3,000
$1,700
$3,400
$2,150
$4,300
After satisfying the coinsurance and out-of-pocket limit, the Plan pays 100% of eligible charges.
Preventive
Regular
< age 2 – 100%
Age % to $250, then deductible & coinsurance
Preventive Enhanced
Age % to $400, then deductible & coinsurance

7. Your medical benefits at a glance - QHDHP
Fill this chart in with any plan specific information
Your medical benefits at a glance - QHDHP
Deductible and benefit percentage
Qualified High Deductible Health Plan
Preferred Tier
In-network
Out-of-network
In-network and out-of-network charges are combined to satisfy the deductible and co-insurance out-of-pocket.
Deductible
Individual
Family
$2,700
$5,400
$10,800
Coinsurance
Percentage applied to covered medical expenses
Plan pays 100%
Plan pays 80%
Plan pays 70%
Out-of-pocket maximum
Includes deductible
$3,600
$7,200
$14,400
After satisfying the coinsurance and out-of-pocket limit, the Plan pays 100% of eligible charges.
Preventive
100% Preferred Tier and In-Network
Ded & Coins Out of Network

8. HSA eligibility requirements
A health savings account (HSA) is a bank account opened and owned by you.
Use it to save money tax-free to pay for qualified expenses.
In order to contribute to an HSA:
You must be enrolled in a qualified, high deductible health care plan
You may not be covered under any other type of medical plan (such as a spouse’s plan)
You may not be enrolled in Medicare
You may not be claimed as a dependent on someone else’s tax return
You can click the “play video” button in slide show view and it will take you to the YouTube video “Ten Things You Should Know about HSAs”.
NOTE: You must have internet access and YouTube approval to view the video

9. Finding a network provider
Choose the option that’s easiest for you!
Visit umr.com/UofNE to find a provider.
Call UMR toll-free at and ask a representative for help.

12. Look up care where you live
Search by category:
People: Doctors and other health care providers
Places: Hospitals, clinics, imaging centers
Services and Treatments: Office visits, surgeries
Care by Condition: Area of the body, type of illness
Cost Estimates: For common conditions

13. Look for provider ratings for quality and cost
UnitedHealth Premium symbols look like this:
Premium Care Physician
Quality Care Physician
Quality Not Evaluated
Does Not Meet Quality
UnitedHealthcare reviews health care providers in the network for how well they deliver quality and cost-effective care.
Premium Care Physicians are those who meet program criteria for quality & cost-efficient care
Quality Care Physicians are those who meet program criteria for providing quality care
Quality Not Evaluated means the specialty is not evaluated or the evaluation is in progress
Does Not Meet Quality indicates those that do not meet program criteria for providing quality care
When you receive care from a Premium provider, you may pay less in out-of-pocket costs for your visit.

14. If your current doctor isn’t in the network
You may continue to receive care at the in- network benefit level until June 30, 2019 if you are actively receiving treatment for:
Late-term or risky pregnancy
Organ transplants
Inpatient care during transition
Behavioral health
Post-surgical care
After June 30th
Find a network provider at umr.com/UofNE
After the transition of care period ends, you will need to find an in-network provider to receive the highest plan benefit.

15. Go to Teladoc for these health issues
General health
Specialty care
Dermatology (skin conditions)
$75 per consultation
Colds or flu
Allergies
Strains and sprains
Digestive issues
Sinus problems
Pediatric care
$45 per consultation
To get a consult:
Visit Teladoc.com
or call Teladoc ( )

16. Activate your member ID card
Call the number and peel off the sticker
After you enroll, you will receive an ID card for your medical, dental and prescription drug benefits.
Your card tells you your member ID number and the number to call for customer service. It also gives health care providers information they need to file claims for services you receive.
To activate your card, call the toll-free number printed on the sticker attached to the front of your card.

17. How to read your ID card Your group health plan number
Your member ID number
Family members covered under your plan
Your pharmacy benefits information
On the front of your card, you will find:
The Member ID number assigned specifically to you to track all of your benefits and claims information.
A list of the family members covered under your plan.
Your medical provider network, also referred to as your preferred provider organization (PPO). Going to doctors, clinics and hospitals in your network will save you money.
The number assigned to identify your group health plan.
Information about your prescription drug plan. Pharmacists use this to process your claims.
Your medical provider network

18. The back of your ID card Your number to call for prior authorization
Your numbers for customer service and Teladoc
Your number to call for pharmacy questions
On the back of your card, you will find:
The UMR Care Management phone number to call when your plan requires prior authorization for certain medical services.
If you’re traveling outside your network coverage area, look to see if you have access to a regional or secondary network.
The toll-free phone number to call when you have questions about Pharmacy benefits.
The phone numbers to call for UMR customer service or the NurseLine
Information about your dental benefits.
Your secondary network

19. A digital ID card on umr.com
View your member ID information on your computer or mobile device
Have your doctor scan the on-screen bar code for your benefits information
Print a temporary replacement card
Fax a copy of your card to your doctor’s office
With umr.com, you can log in and pull up a digital copy of your member ID card on your mobile device.
You’ll find all the same information as what appears on your card.
Your doctor can scan the on-screen bar code to get instant access to your benefits information.
You can print a copy from your desktop
Or fax a copy of your card to your doctor’s office.

20. Signing up for umr.com 1 2 Helpful hints
Visit umr.com on your desktop computer or tablet device
Click Login/Register to sign up 2
Helpful hints
Have your UMR member ID card handy
Spouses and adult children must create their own online account
You must provide a valid address
Select a username and password you can remember
Here’s a few things to know to help you through the registration process:
Make sure you have your UMR member ID card handy. You will need your member ID number and group number to enroll.
Dependent spouses must create their own online account by selecting “I am the spouse or dependent” when they register.
You will need to provide a valid address.
Make sure you select a username and password you can remember for when you log in again in the future.

21. See your benefits information anytime, anywhere
With umr.com you can:
Check your benefits and see what’s covered
Look up what you owe and how much you’ve paid
Find a doctor in your network
Learn about medical conditions and your treatment options
Access tools and trusted resources to help you live a healthier life

22. Talk to someone who speaks your language
Get help in Spanish from a UMR customer first representative
Or get interpretation service assistance for more than 200 other languages
All UMR customer first representatives speak English, and many also speak Spanish.
When calling UMR, you may select the Spanish-language option to speak to a bilingual representative.
If none are available, or if you need help in a different language, UMR has a language line providing interpretation services for more than 200 languages.

23. Make sure certain services are covered in advance
Services that need prior authorization include:
Hospitalizations
Transplants and transplant- related services
Durable medical equipment
Over $500 for rental
Behavioral health stays
Over $1,500 for purchase
Home health care
Over $1,000 for prosthetics
Clinical trials (QHDHP only)
Infertility treatment
If you or a dependent plan to be admitted to the hospital or receive certain outpatient services, UMR may require prior authorization.
Your provider may be asked to provide information to confirm the service or inpatient stay is medically necessary, clinically appropriate and considered effective for treating your condition.

24. Choose the right health care setting
­Ty­­­pe of care
Wait time
Cost**
Teladoc Consults by phone or online video for routine ailments.
17 minutes
for doctor to respond
$45 per consultation
Retail clinic/convenient care clinic Clinics located in retail stores, supermarkets and pharmacies.
15 minutes
or less
$89
per service
Urgent care/ walk-in clinic Evening and weekend treatment for illnesses or injuries.
20 to 30 minutes
$156 visit cost
How much you pay and how long you wait may depend on where you go. Make sure you choose the right setting for your needs.
Use NurseLine to speak by phone with a registered nurse any time of day, seven days a week.
Call to get
- Help choosing the right health care setting for illness or injury
- Or information about common health problems or injuries
Use Teladoc to request a consultation from a board-certified doctor any time of day, seven days a week, by phone or online. Teladoc physicians can diagnose routine ailments, recommend treatments and prescribe medications.
Retail clinics, sometimes called convenient care clinics, are located in retail stores, supermarkets and pharmacies. They offer routine care for:
- Colds or Flu - Vaccinations or screenings - Sinus infections - Minor sprains, burns or rashes - Allergies - Headaches or sore throats
Urgent care centers, sometimes called walk-in clinics, are often open in the evenings and on weekends. They offer timely care for:
- Sprains and Strains - Minor broken bones or cuts - Mild asthma attacks - Minor infections or rashes - Sore throats - Earaches
Visit your doctor’s office for clinical care
Seeing your doctor is important. Your doctor knows your medical history and any ongoing health conditions.
See your doctor for:
- Preventive services and vaccinations
- Medical problems or symptoms that are not an immediate, serious threat to your health or life
Visit the ER only if you are badly hurt. If you are not seriously ill or hurt, you could wait hours and your health plan may not cover non-emergency ER visits.
Got to the ER for:
- Sudden change in vision - Heavy bleeding
- Sudden weakness or trouble talking - Spinal injuries
- Large, open wounds - Chest pain
- Difficulty breathing - Major burns
- Severe head injury - Major broken bones
Clinical care (your doctor’s office) See your primary care provider for preventive and ongoing care.
1 week
or longer for an appointment
$166 visit cost
Emergency room (ER) Visit the ER only for serious illnesses or injuries. Your health plan may not cover non-emergency ER visits.
3 to 12 hours
for non-critical cases
$570 visit cost

25. What happens after you receive care
Any time you or one of your dependents see a doctor, visit the emergency room or are admitted to the hospital, the health care provider or facility will submit a claim to UMR for processing based upon the information shown on your member ID card.
UMR then determines how the claim will be paid, based upon the rules outlined by your benefits plan.

26. Understanding your EOB
The type of service you received
How much
the service cost
How much your benefits plan paid
How much you may owe (if anything)
After UMR has processed your claim, you will receive an explanation of benefits (EOB) statement. An EOB is not a bill, but it will tell you:
How much the service cost
How much of the cost will be paid by your benefits plan
How much you may owe, if anything
What special codes mean
You will receive a copy of your EOB by mail only if you have a balance to be paid to your provider.
Your code definition
Your plan maximums and how close you are to meeting them

27. You may be asked if you’ve been in an accident
If a recent medical claim was the result of an injury. A third party may be responsible for part of the costs.
If your claim is NOT accident related. UMR will process the claim according to your benefits plan.
UMR may contact you and ask whether medical care you received was related to an accident.
This may include:
Work-related injuries
Motor vehicle accidents
Falls
Medical malpractice
Product recalls
To provide information, select the Accident details tile after you log on to umr.com, or call
Accident details

28. Expert support when care gets complex
Nurse case managers guide patients through complicated medical events.
Reviewing your treatment needs
Helping you understand your benefits options
Coordinating care among different providers
Communicating issues to your medical plan
UMR’s nurse case managers serve as advocates for patients and their caregivers during medical events involving multiple health care providers and procedures over an extended period.
UMR’s nurse case managers can support you by:
Reviewing your treatment needs with your doctor
Helping you and your family understand your benefits options from diagnosis to conclusion
Coordinating care among different providers
Communicating any complex issues to your medical plan

29. Expert help for your chronic condition
UMR nurse coaches provide one-on-one support for:
Asthma
Heart disease
Heart failure
Chronic obstructive pulmonary disease (COPD)
Diabetes
UMR Disease Management
UMR offers expert resources and one-on-one support to help those with one or more of the following conditions:
Asthma
Heart failure
Diabetes
Heart disease
Hypertension
Chronic obstructive pulmonary disease (COPD)
Depression (when occurring with one of the other listed conditions)
With health coaching, you’ll get:
Resources on your condition and the benefits of healthy lifestyle habits
One-on-one calls with a nurse coach
Motivation and support for reaching your goals
Enroll by calling: or visit umr.com

30. We love healthy babies – and healthy moms
Moms-to-be receive:
Resources promoting prenatal health and healthy lifestyle habits
One-on-one calls with a nurse throughout pregnancy
And help identifying any personal risk factors
You can click the “play video” button in slide show view and it will take you to the UMR Maternity Mgmt video.
NOTE: You must have internet access and YouTube approval to view the video
UMR Maternity Management
If you’re thinking about having a baby, are pregnant for the first time, or are adding a new little brother or sister to your family, UMR can help support you throughout your pregnancy.
The program includes:
Resources on the importance of prenatal health and healthy lifestyle habits before and during pregnancy
One-on-one calls with an OB/GYN nurse to offer guidance on the issues that are important to you
Help in identifying any personal risk factors you might have and how to recognize common signs of complications
Enroll by calling: or visit umr.com

31. Talk to a nurse and earn a reward
Your gift for completing the program:
$25 reward card for enrolling early and completing the program
Your choice from a selection of books on pregnancy, childbirth or infant care

32. Chat online with UMR customer service
We’ve made it easier for you to get the answers you need – fast
Simply log in to umr.com and click the Live Chat icon in the top navigation bar
Team members are available 24 hours a day, seven days a week (excluding major holidays)

33. Thank you! Dedicated Plan Advisors: 1-844-659-5059 Mon-Fri 7am-7pm
We look forward to the opportunity to serve you.
If you have any questions, please contact:
Dedicated Plan Advisors: Mon-Fri 7am-7pm or
umr.com/UofNE