Not all doctors charge the same Shop your options on umr.com
Medical costs can vary a lot from one doctor to another – So it pays to shop around. Your online services on umr.com include a free health cost estimator. With this feature, you can: • Search for the type of service you need
HOW TO GET STARTED Log in to your account on umr.com. If you haven’t registered, select Login/ Register and follow the steps
• Compare the true costs of care using real data from real doctors • Check which providers earned our UnitedHealth Premium rating for cost and quality • See the total charge for your treatment, and know what to expect from beginning to end With UMR’s online health cost estimator you can get a personalized estimate based on your specific medical plan and the ZIP code where you want to look for health care providers. See back for instructions »
to sign up. Make sure you have your ID card handy. Once you’ve signed in, select the shopping cart tile on your personal home page. Health cost estimator
How to create a “final estimate” using the health cost estimator:
Search for a service Find the treatment or service that applies to you by entering a search term and reviewing a list of options.
Choose from a list of providers in your area Look for a doctor based on quality and cost information and see how the cost different providers charge compares to the local average.
Select “View full estimate” to see the total cost of care You will now have an estimate based on your location, provider and remaining out-of-pocket cost.
Disclaimer: This content is provided for information only and is not to be considered medical advice. All decisions about medical care should be made by the doctor and patient. Always refer to the plan document for specific benefit coverage or call the toll-free member phone number on the back of your health plan ID card. © 2019 United HealthCare Services, Inc. UMXXXX-TFT 1019 No part of this document may be reproduced without permission.
Earn cash back when you save on health care
Introducing CareSearch Reward$ The costs for health care services can vary a lot, depending on where you go for care. The CareSearch Reward$ program rewards you and your spouse or domestic partner for
HOW TO GET STARTED Log in to your account on umr.com. If you’re a new user, select Login/Register and follow the steps to sign up for online services. Make sure you have your ID card handy.
choosing high-quality health care providers and lower cost
Once you’ve signed in, select
options where you live.
the shopping cart tile on your personal home page.
And when you choose to go to
Premium Care Physicians
or cost-effective facilities for certain qualifying procedures, you’ll receive money on a UMR prepaid reward card. Your participation is completely voluntary, and all resources are available at no cost to you. The program is open Jan. 1 – Dec. 31, 2020.
Health cost estimator
Cal
How it works Health cost estimator
CareSearch Reward$ is open to employees and spouses enrolled in the Task Force Tips, Inc. health care plan. Rewards are available for saving on common, qualifying procedures. These “shoppable” health care services are non-emergency, low-risk procedures that can be planned in advance: ► Colonoscopy: $125
►
►
►
►
►
►
(Unlimited) Mammogram: $50 (Unlimited) Stress Test: $125 (Unlimited) Sleep Apnea: $150 (Unlimited) Endoscopy: $100 (Unlimited) Sleep Study: $75 (Unlimited) MRI: $75 (Unlimited)
► Echocardiogram: $75
► ►
►
►
►
►
►
►
(Unlimited) C T Scan: $50 (Unlimited) Ultrasound: $25 (Unlimited) Knee Replacement Outpatient: $300 (Unlimited) Knee Arthroscopy with ACL Outpatient: $300 (Unlimited) Knee Arthroscopy with Meniscus Outpatient: $300 (Unlimited) Knee Arthroscopy with Medial & Lateral Meniscus Outpatient: $300 (Unlimited) Ankle Arthroscopy Outpatient: $300 (Unlimited) Shoulder Arthroscopy with Labrum Repair Outpatient: $300 (Unlimited)
► Shoulder Arthroscopy
►
►
►
►
►
with Claviculectomy Outpatient: $3000 (Unlimited) Hip Replacement Outpatient: $400 (Unlimited) Knee Replacement Inpatient: $400 (Unlimited) Knee Replacement Revision: $400 (Unlimited) Hip Replacement Inpatient: $400 (Unlimited) Hip Replacement Revision Inpatient: $400 (Unlimited)
When your doctor recommends an eligible medical procedure or test, log in to umr.com and select the Health cost estimator tile to get started. Then, confirm your ZIP code, search for the procedure and begin shopping for care.
Find a detailed list of qualifying procedures within your information packet.
How to find cost savings and be eligible for rewards: Look for a provider listed as a Premium Care Physician with two blue hearts below their name
– Or, look for health care facilities that show cost in green (below average)
– View your full estimate, then schedule an appointment and receive your eligible procedure through one of these qualifying providers or facilities.
UMR will automatically track your activity in the health cost estimator tool and match it to the eligible procedure you received. We’ll compare the claims for your medical care with your selections in the health cost estimator tool to determine your reward amount. Then watch your mail for your UMR Prepaid Reward Card. You can use your card at any store or restaurant that accepts MasterCard®, so how you choose to spend your reward is up to you.* If you have questions or are not able to find a Premium Care Physician or “green” (below average cost) facility for your qualifying procedure, please call the toll-free member services number listed on the back of your UMR ID card.
* Merchant categories are restricted for the purchase of alcohol, tobacco or gaming. The value of the card could be considered taxable income. UMR prepaid reward cards come with a toll-free customer service number and cardholder website, where you can activate your card, check your current balance and see previous transactions.
© 2019 United HealthCare Services, Inc. UM1364-TFT 1019 No part of this document may be reproduced without permission.
UMR Call UMR Customer Customer Service Service usingusing the toll-free the toll-free phonephone number number listedlisted on theonback the back of your of member your member ID card. ID card. Questions Questions aboutabout CareSearch CareSearch Reward$ Reward$
CareSearch Reward$ Program
Member Frequently Asked Questions and Terms What is CareSearch Reward$? CareSearch Reward$ is a free program for employees and spouses/domestic partners registered in Task Force Tips, Inc. Health Plan that rewards you for calling Plan Advisor OR searching the Health Cost Estimator tool on UMR.com and utilizing premium care physicians and/or green, i.e., cost-effective facilities, when you seek care. When you use premium care physicians and cost-effective facilities for qualifying procedures, you lower the total cost of claim and, most important, you are rewarded for those savings with a single-use UMR Prepaid Reward Card.
What is the Health Cost Estimator tool and how does it work? The Health Cost Estimator tool on UMR.com is a next-generation health cost estimation tool that allows you to create cost estimates using provider fee schedules for providers in the UnitedHealthcare networks. Provider fee schedules represent network-specific contracted rates or allowed amounts that the provider is allowed to use for the final billing process. This helps you generate personalized and more cost-effective estimates in the tool. It also allows you to see the breadth of options available in terms of both cost and quality when it comes to provider selection. The Health Cost Estimator tool helps you quickly and easily find personalized information before seeing a doctor. You have access to robust information that provides personalized procedure cost. Care path estimates are based on your specific health plan benefits, to help you make more informed health care decisions. The Health Cost Estimator not only provides cost information, but is also integrated with your benefit plan design and accumulator (spend to date for the year) status, and provides line of sight into how much is covered by your health plan, which expenses will affect deductibles and out-of-pocket (OOP) costs. The tool also helps you see quality information and ranking for providers based on different quality metrics in the tool.
What cost information is available? The Health Cost Estimator tool includes physician and facility costs based on contracted rates and allowed amounts. The tool is built on care paths (episodes of care for a particular procedure), which help you understand and evaluate the different episodes of care and the total costs associated. The tool additionally integrates: • Your geographic location • Y our specific plan benefits: deductible, out-of-pocket max, spend to date (accumulators), remaining deductible • Y our plan-specific service level benefits: copay and coinsurance amounts not just at plan level, but also for service levels. Example: MRI, radiology, labs, chiropractic, and several others
Does the Health Cost Estimator display an exact price? Yes. To produce an estimate for a given physician or facility performing a particular service, we look at provider fee schedules/contracted rates for that provider. We also take into account your benefit plan details and accumulator status. The final OOP estimate is the result of all these factors. The market average cost is also displayed for your reference. The only time the tool doesn’t display fee schedule pricing for the provider is when we don’t have that information from the provider, or if we don’t have sufficient claims information.
What do the different colored providers mean? Color-coded costs denote cost rankings for providers to help easily identify where a provider falls. “Below Average Cost” (in green in the Health Cost Estimator) - means the provider’s estimate is in the lowest 25 percent for the local area. “Meets Average Cost” (in gray in the Health Cost Estimator) - means the provider’s estimate is in the middle 50 percent for the local area. “Above Average Cost” (in red in the Health Cost Estimator) - means the provider’s estimate is in the highest 25 percent for the local area. Choose a green provider to be eligible for rewards.
What are care paths and why does the Health Cost Estimator use them? Costs are estimated as a “care path” or episode level to help you understand the services you should expect to receive. Estimated totals include medical professional and facility estimated costs, as well as typical services that make up a treatment episode. These services could include costs for the initial office visit, specific procedures involved, associated follow-up care, etc. The tool displays the total estimated costs for the services in the care path, as well as a more detailed breakdown of category of service in the treatment episode (i.e., facility and professional).
How often is cost information updated for providers? Cost information is updated on a quarterly basis.
Are there quality rankings for outpatient facilities? Sufficient data does not exist for outpatient facilities to create quality rankings. The tool does indicate cost efficiency. Make a green choice!
Why do some searches not include any green providers or facilities in my area? In smaller or remote cities, there may not be a green provider in your immediate area due to the fact there are very few providers in that area. In this case, you may need to expand your search and travel further to find green providers. Click on Refine Search to expand your selection or call Plan Advisor at 800-207-3172.
Does the Health Cost Estimator include information on quality as well as price? Yes. The Health Cost Estimator tool offers the UnitedHealth Premium Designation program through UnitedHealthcare. In this program, physicians are analyzed on a quality-first basis. Physicians must first meet quality criteria before they are reviewed for cost efficiency. The 2 blue hearts symbol identifies healthcare providers who have been recognized for providing value. These providers have received the Premium designation for: • Quality & Cost Efficiency OR • Cost Efficiency & Not Enough Data to Assess Quality
Does cheaper price mean poor quality? No. Many times providers that have a lower cost actually have a higher quality due to specializing in certain types of procedures. With the Health Cost Estimator, it’s easy to see which facilities offer the best quality at the lowest cost.
Do the Health Cost Estimator Premium Care Program rankings guarantee that I will have a positive outcome? The quality rankings highlight which physicians have historically demonstrated better patient outcomes.
Is this an ongoing program? Yes! This is an ongoing program available to you from January 1st, 2020. You must call Plan Advisor or use the Health Cost Estimator tool on umr.com for qualifying care paths to be eligible for a reward. You will need to visit the provider within 2 months of your call/search. We will track claims for 4 months after your provider visit. For instance, if you called Plan Advisor or used the tool in February 2020, you would need to visit the provider(s) by April 2020, and we would track your claims data until the end of June 2020. Please continue to call Plan Advisor or use the Health Cost Estimator tool on umr.com for plan savings regardless of the CareSearch Reward$ program.
How does CareSearch Reward$ work? CareSearch Reward$ is a program focused on rewarding you for searching in the Health Cost Estimator tool on UMR.com and using the providers below: Premium Care Physicians: physicians marked with 2 blue hearts. The Premium Care Program ensures quality and cost efficiency. Look for the 2 blue hearts, like the example below:
Green facilities: cost effective clinics, hospitals and other facilities. Look for results in the Health Cost Estimator tool that are banded green, like the example below.
CareSearch Reward$ is perfect for you! It helps you save money by helping you make optimal healthcare choices – and receive a reward when you do! The UMR Prepaid Reward Card is a single use prepaid Mastercard that can be used at any Mastercard-approved retailer (exceptions include gaming, tobacco and alcohol). Specific procedures are eligible to earn rewards. CareSearch Reward$ will automatically determine if a reward is met based on your claims data. You can earn these rewards when you search and visit a premium care physician and/or green facility. We make it easy for you. You don’t have to provide any documentation or submit forms for tool usage or provider usage. We are able to track your tool usage and claims data, and automatically send you a UMR Prepaid Reward Card if you qualify. After visiting a Premium Care Physician and/or a “green” facility, CareSearch Reward$ verifies that the location, provider and visit qualify for a reward. Once the visit is approved, you will receive your reward card in the mail.
Here’s a quick walkthrough of what you need to do: • Your doctor recommends a medical procedure or test. Call Plan Advisor to determine your options of providers and facilities or log into umr.com and click on the Health Cost Estimator tile to access the tool. • R eview the Care Search Reward$ program guide along with the list of eligible procedures and procedure codes to ensure you qualify. • I f you call Plan Advisor, a dedicated representative will help you with determining which providers and/or facilities you could visit. • O nce you log in to the Health Cost Estimator tool and search in the Health Cost Estimator tool for your qualifying procedure, select a Premium Care Physician (2 blue hearts), or a green cost-effective facility or both. • C all your doctor to schedule the service at the facility that you selected during your call with Plan Advisor or that you chose in the Health Estimator tool. If you have questions, contact Plan Advisor at 800-207-3172. Now, rest easy … CareSearch Reward$ takes away your burden of tracking EOBs and submitting them. We will track your claims data. You don’t need to send in forms or EOBs. If you qualify for the reward, you will receive a single-use UMR Prepaid Reward Card for the appropriate reward amount by mail.
Why am I getting rewarded? Your employer provides you with the CareSearch Rewards$ program to help save you money on healthcare services. This program was designed to encourage positive healthcare behavior by rewarding participants when they make a cost-effective, high-quality provider choice. You will receive a single-use UMR Prepaid Reward Card if you or your spouse/domestic partner recently received care from a Premium Care physician or green facility for a care path that was identified as reward-eligible.
Below are the procedures for which you may be rewarded and the number of times you may be eligible for the specific procedures: > Colonoscopy: $125 (Unlimited) > Mammogram: $50 (Unlimited) > Stress Test: $125 (Unlimited) > Sleep Apnea: $150 (Unlimited) > Endoscopy: $100 (Unlimited) > Sleep Study: $75 (Unlimited) > MRI: $75 (Unlimited) > Echocardiogram: $75 (Unlimited) > CT Scan: $50 (Unlimited) > Ultrasound: $25 (Unlimited) > Knee Replacement Outpatient: $300 (Unlimited) > Knee Arthroscopy with ACL Outpatient: $300 (Unlimited) > Knee Arthroscopy with Meniscus Outpatient: $300 (Unlimited) > Knee Arthroscopy with Medial & Lateral Meniscus Outpatient: $300 (Unlimited) > Ankle Arthroscopy Outpatient: $300 (Unlimited) > Shoulder Arthroscopy with Labrum Repair Outpatient: $300 (Unlimited) > Shoulder Arthroscopy with Claviculectomy Outpatient: $3000 (Unlimited) > Hip Replacement Outpatient: $400 (Unlimited) > Knee Replacement Inpatient: $400 (Unlimited) > Knee Replacement Revision: $400 (Unlimited) > Hip Replacement Inpatient: $400 (Unlimited) > Hip Replacement Revision Inpatient: $400 (Unlimited)
How do I qualify for a reward? First, if your doctor prescribes a medical service or test from the list of services, review the procedure listed in the information packet or call Plan Advisor to make sure it is one and the same. You will have cost-effective options in your area that may qualify for a reward – Plan Advisor can help you or use the Health Cost Estimator tool on umr.com to search for high-quality and cost-effective providers. Only employees and their spouses/domestic partners enrolled in the Task Force Tips, Inc. Health Plan qualify for rewards.
How do I get rewarded? The program is able to automatically qualify you for rewards. You will be mailed your single-use UMR Prepaid Reward Card at your mailing address. Single-use UMR prepaid reward cards are easy to use at any Mastercard-approved retailer (except for gaming, tobacco and alcohol). The UMR Prepaid Reward Card Program offers a dedicated customer service number and a full-service web portal, allowing you to activate your card, check your current balances and see your transaction history. For questions about activation or to report your card lost/stolen, please call the dedicated customer service phone number at 866-655-3692 or visit the full-service web portal at www.myincentivecard.com.
How will rewards be paid? If you qualify, we’ll mail your single-use UMR Prepaid Reward Card to your home within 60-90 days of receiving your claim. You don’t need to do anything. We track your claims on the back end and are able to automatically qualify you for a reward. UMR single-use Prepaid Reward Cards are processed every month. Be aware that rewards are considered taxable by the IRS. You’ll receive the appropriate tax information from Task Force Tips, Inc. at the end of the year.
What does CareSearch Reward$ program cost? Nothing! It is free, easy to use and completely voluntary.
Am I eligible, and how do I sign up? All active employees and their spouses/domestic partners enrolled in the Task Force Tips, Inc. Health Plan are eligible for the program. There is no need to sign up. CareSearch Reward$ is not available to members who reside or seek care in the following states. If members residing in the following states receive care in other states, they will not be considered for a reward. Alaska (AK); California (CA); Georgia (GA); Hawaii (HI); Kentucky (KY); The greater St. Louis, Missouri/ Illinois area; Maine (ME) - (all areas other than Cumberland, Sagahahoc and York counties are not eligible); Montana (MT); New Hampshire (NH); New York (NY); Upper Peninsula area of Michigan (MI) (the rest of Michigan is eligible); Utah (UT); Vermont (VT); Wisconsin (WI); Wyoming (WY) CareSearch Reward$ is available to members who reside and seek care in the following states. If members residing in the following states receive care in other states not listed below, they will not be considered for a reward. Alabama (AL); Arizona (AZ); Arkansas (AR); Colorado (CO); Connecticut (CT); Delaware (DE); Florida (FL); Idaho (ID); Illinois (IL) - excluding the greater St. Louis area; Indiana (IN); Iowa (IA); Kansas (KS); Louisiana (LA); Maine (only in Cumberland, Sagadahoc and York counties); Maryland (MD); Michigan (MI)excluding the Upper Peninsula of Michigan is not eligible; Minnesota (MN); Mississippi (MS); Missouri (MO) - excluding the greater St. Louis area; Nebraska (NE); New Jersey (NJ); Nevada (NV); New Mexico (NM); North Carolina (NC); North Dakota (ND); Ohio (OH); Oklahoma (OK); Oregon (OR); Pennsylvania (PA); Rhode Island (RI); South Carolina (SC); South Dakota (SD); Tennessee (TN); Texas (TX); Virginia (VA); Washington (WA; West Virginia (WV)
How many rewards can I earn? You may receive multiple rewards for procedures that occur on the same day. For example, you may need two knee MRIs (left and right). In this case, you would receive a separate reward for using a green provider for both services. You may receive a reward for any qualifying procedure. Please see the list of procedures and eligible number of procedures per year above. You have to have called Plan Advisor or used the Health Cost Estimator tool for qualifying care paths to be eligible for a reward. You will need to visit the provider within 2 months of your call/search. We will track claims for 2 months after your provider visit. For instance, if you called Plan Advisor or used the tool in February 2020, you would need to visit the provider(s) by April 2020 and we would track your claims data until the end of June 2020.
Are rewards taxable? Yes. Rewards are taxable. You’ll receive the appropriate tax information from Task Force Tips, Inc. at the end of the year.
Are there tax implications associated with the reward cards? UMR can provide general guidance on tax treatment but is not able to provide tax or legal advice to our customers or members. UMR recommends that any reward dollars offered as part of this program be considered a taxable event. This means that the employer has responsibility to report the value of the card as income to the member, and the member has responsibility to report it as income as well. Does being a reward card relieve the employer of its non-cash payment tax liabilities? Not necessarily. It is UMR’s guidance that any funds made available to the member are considered a taxable event and should be included as part of their taxable income. This has been the case with our previous programs and remains the same in the new program.
Who is responsible for filing the W-9 for this income? It is the employer’s responsibility to include any value provided on the reward card as taxable income to the member. This has been the case with our previous programs and remains the same in the new program. UMR can provide reporting back to the employer, which details the member name and card value provided in the past year. They can include this in the employee’s W-2, which is new with this program. We did not have the ability to do this previously. Members will also see a good-faith reminder on the card carrier that the value of the card could be considered taxable income and to consult with a tax advisor with questions.
What if I lose my reloadable UMR Prepaid Reward Card or how do I replace it? Will I be charged something? There will be no charge if your reloadable UMR Prepaid Reward Card is lost or stolen. Simply contact the UMR Prepaid Reward Card Program dedicated service phone number at 866-655-3692 or visit the fullservice UMR Prepaid Reward Card Program web portal (www.myincentivecard.com) to report your card lost or stolen.
What is my UMR Prepaid Reward Card validity? Your UMR Prepaid Reward Card is a reloadable reward card and is valid for 36 months (3 years) from the date of issuance. Make sure you keep your card since the card will be automatically reloaded if you receive rewards for multiple qualifying procedures.
Am I rewarded for all different procedures within a care path or for the entire care path? You will be rewarded for the entire care path. No need to worry about specific services included in your treatment; just ensure that you are visiting a green facility or premium care provider for your procedure.
Will I have to change my doctor? In many cases, your doctor may have ‘admitting privileges.’ That means he or she may perform the service in a number of locations. You can ask your doctor to perform the service wherever you choose. Your doctor may not be able to treat you in a different facility, so it’s important to talk to him/her about your options after you call Plan Advisor or search in the Health Cost Estimator tool. Because you chose whether or not to use the program, you may decide whether or not to change doctors. You are free to choose any doctor for your service.
What if my doctor has already scheduled me at another facility? Call Plan Advisor or check the Health Cost Estimator provider list to see if the service at that facility qualifies for a reward. You may need to reschedule your appointment to qualify.
Is this a change in my Group Health benefits? No. The program does not affect your Group Health benefits in any way. All benefit, pre-authorization and pre-certification guidelines still apply, and this program does not affect your claim payment.
Does the program offer medical advice? No, the program does not offer medical advice. Please see your doctor or health care professional for medical advice.
Is the program confidential? Absolutely. No employee or dependent claims information will be shared. It is completely confidential.
Key Terms & Conditions • Y ou earn rewards when you visit a high-quality, i.e., Premium Care Physician (2 blue hearts) and/or green facility for qualifying care paths. Green facilities are banded green in the Health Cost Estimator tool and are below the average cost in your area. • Y ou must call Plan Advisor or use the Health Cost Estimator tool on umr.com for qualifying care paths to be eligible for a reward. You will need to visit the provider within 2 months of your call/search. We will track claims for 2 months after your provider visit. For instance, if you called Plan Advisor or used the tool in February 2020, you would need to visit the provider(s) by April 2020 and we would track your claims data until the end of June 2020.
© 2019 United HealthCare Services, Inc. 1019 No part of this document may be reproduced without permission.