Welcome/Key Contacts Greetings from UMR!

1 Welcome/Key Contacts Greetings from UMR! Welcome to the Dignity Health benefits plan guide! The purpose of this booklet is simple: To help you get the most out of your health care plan. As your benefits administrator, we'll To help you reach us, we've included this Your UMR. walk you through the plan to give list of key Contacts and information. customer service you a better understanding of what it Stick it on your refrigerator or bulletin team is ready to all means. Of course our main goal is board if you wish, or place it in your help you! to provide you and your family with wallet or purse, so it's there when you timely, accurate and caring service. need it. You can also find this same information on your UMR ID card. It starts here, but you also have a Monday through Friday, whole team of UMR customer service 8 8 CST. and benefits experts behind you whenever a need or question arises. A handy contact card for your fridge or wallet My Dignity Health Your Pharmacy Provider OptumRx, 1-877-559-2955.

2 Benefits information St. Joseph's McAuley Pharmacy UMR Customer 602-406-3970 or 1-888-294-8348. Need ID Find it online UMR Care Pre-enrollment: Post enrollment: 24-Hour NurseLine SM..1-877-950-5083. Write us UMR. PIN 197 PO box 30541 . Enroll in Maternity salt lake city , ut 84130 -0541. Benefits provided by: Member Services Working with UMR. UMR provides benefits administration services to you and your employer. Your employer has hired us to assist You now have an easier way to file in managing your benefits plan. For claims with UMR. In fact, we call it EZ. example, we help new employees Claim. We don't need any claim forms, sign up to receive health benefits. except for prescription drug claims. We also process your health claims, With EZ claim, your doctor submits making sure they are handled quickly and accurately. your bills directly for processing. Your ID card has instructions on the reverse How do I. UMR even has medical professionals side for your doctor's office.

3 Contact UMR? on staff. They help coordinate your care To file a claim, simply show your if you are in the hospital or are dealing identification (ID) card at your doctor's with a health condition. Simply call the office. If you're planning or scheduling a treatment or procedure, you can also toll-free number Filing a claim write or call us beforehand to find out if that will be located A claim is a request that your benefits it will be covered. on the back of plan pays for a health service. more . your UMR ID. Member Services You will receive an explanation of Member services benefits (EOB) form after your claim is UMR has assigned people to help you processed. It will tell you: answer benefit and claim questions. How much of your cost is covered They are trained on your specific Where checks will be sent benefit plan. What amount you are responsible If you have any questions, you for paying, if anything can reach a UMR Customer First Representative by calling the toll-free Claim appeals number on the back of your ID card.

4 You may sometimes wish to have UMR. review a claim decision. This is called an appeal. Appeals must be made within We look forward to 180 days after you receive written notice of a denied claim. To file an working with you! appeal, send us a written request to the address on your ID card to have a claim reviewed. After you have filed an appeal, UMR. will notify you in writing of the final decision within the time limit listed in your employee benefit booklet. Benefits Terminology Learn the language of health care Let's face it. Understanding health and benefits terms is like learning a foreign language for most of us. Knowing the difference between coinsurance and copayment can be confusing. And deciphering an EOB from COB shouldn't require a PhD. Fortunately, you don't need a foreign What is an out-of-pocket? language professor or CIA code-breaker Definition: The amount you pay out to understand all of these terms. That's of your pocket for particular health care because our own UMR team of language services during a particular period of experts has already defined them for you, time.

5 An out-of-pocket maximum limits along with a few others. Check it out. the amount you have to pay during a Before you know it, you'll be speaking particular period of time. benefits as a second language! What is coordination What is a deductible? of benefits (COB)? Definition: The amount you have to Definition: Many families are covered pay before your plan pays for specified by more than one health plan. The services. Deductibles are usually an annual coordination of benefits (COB) process set amount. A deductible may apply to all determines which plan pays first. It also services or just a portion of your benefits. determines if the second plan will pay any It depends on your benefits plan. remaining charges not covered by the first plan. The process makes sure your doctor doesn't get paid twice for the same service. What is a coinsurance? Definition: A set percentage of costs What is an explanation that are covered by your plan after your of benefits (EOB)?

6 Deductible has been plan pays Definition: An EOB is simply the a higher percentage. You pay a lower statement explaining your benefits percentage. activity. It includes the services percentage provided, the amount billed and the amount paid, if any. You should review What is a copayment? your EOBs carefully. Call the customer service number on your ID card or visit Definition: A small set fee. It is paid each if you have any questions time you have an office visit, outpatient about your EOB. service or prescription refill. The fee is de- termined by your health plan. Copayments don't vary with the cost of service. set fee Money Saving Tips 10 ways to control health care costs Everybody can play a role in controlling the rising cost of health care. In fact, there are many things you can do to reduce how much you spend on health care now and in the future. 1 Dignity Health 4 Get online Preferred Providers It makes sense to find out The Dignity Health plans let you see everything you can to make any doctor you want.

7 But you can save a bundle by seeing doctors informed, cost-saving health care choices. That's why we offer a Fast that are part of the Dignity Health number of Web tools to help you Preferred Network of providers. assess health care options, pharmacy You can also visit providers in the benefits and health coverage UnitedHealthcare National network. estimates using the Internet. Visit Generic drugs usually Going to in-network doctors usually our Web site at saves you 40 percent to 50 percent cost you 30 percent to or even more off your bill. 70 percent less than 5 Choose the right care brand names. There is a time and place for 2 Go generic everything. A trip to the emergency Generic drugs are the same as other room may be needed if you are medications, just without the brand seriously injured or ill. Consider name. The biggest difference is a cheaper option, like a walk-in the price. Generics usually cost you clinic or urgent care, if you have a 30 percent to 70 percent less than minor illness or issue, such as an ear brand names.

8 Infection. It may save you time as well as money. 3 Practice prevention more . Preventive care includes things like physical exams, vaccines, blood tests and cancer screenings. These services can prevent you from getting sick or detect a health issue before it gets serious. Check your health plan to see if preventive care is covered in full or at discounted rates. Money Saving Tips 6 Think long-term 9 Take care of yourself Some people go to the doctor for The harmful effects of habits, minor reasons once they meet their such as tobacco use and alcohol yearly deductible. While that may not have an instant impact on health care abuse, are well known in regard to health issues such as cancer and costs, it is a major factor in driving up heart disease. If you use tobacco everyone's overall costs of care. products, seek help to try quitting. Review your Practice moderation if you drink alcohol. Get help if stress or explanation of benefits 7 Eat right depression are an issue.

9 You will feel (EOB) statement to A balanced diet can save you money. better and also save a few dollars. make sure you are It keeps you healthier in the short- properly billed. term and lessens the chances of developing more serious and costly 10 Review your EOB. medical conditions in the future. Billing mistakes sometimes happen. Review your explanation of benefits (EOB) statement to make sure you 8 Exercise are properly billed. Contact your Just 30 minutes of walking or other doctor or other care provider if you regular exercise each day helps suspect an incorrect charge. manage weight, stress and possibly your pocketbook. Exercise helps control and prevent high blood pressure and cholesterol, two of the major risk factors for heart disease. How to read your EOB. You deserve an explanation An explanation of benefits (EOB) is not a bill. It simply tells you everything you might want to know about your claims. Among the more important things A section that shows how close you included on your EOB are: are to meeting any plan maximums The service you received There is a second page that includes How much the service cost contact numbers if you have questions.

10 How much you may owe, if anything It also tells you how to file an appeal if A notes section that explains the you want a claim decision reviewed. meaning of any special codes Page Dist Code SAMPLE Employee Member Number Joe Patient 999999999. Joe Patient Patient 01-11-12. Notice Date Customer Inc. Employer Name 7670-00-999999. PO box 30541 salt lake city , ut 84130 -0541 Employer Number 1-800-826-9781. EXPLANATION OF BENEFITS NOTICE - THIS IS NOT A BILL. Patient Account: 05050505aa Claim Control Number: 12171769999. Provider: Physician,Joe,MD Plan Amount Provider May Amount Amount See Note Less Allowable Dates of Service % Benefit Amount Paid Bill You Service Description Billed Not Payable Section Deductible Amount From: To: $ 80 $ $ $ $ $ 908 $ Emergency Care 01-01-12 01-01-12. The type of service How much How much your How much you may you received the service cost benefits plan paid owe (if anything). $ $ $ $ $ $ TOTALS. Note Section 908 Provider negotiated discount.