SHOP Plan Brochure

So many ways into the complex health care system
One guide to make shopping for your
employees’ health insurance simpler.
For small businesses
Michigan
SHOP Marketplace (Small Business Health Options Program)
simpler
welc me to
insurance shopping
Use this guide to find coverage for
your employees. It’s easier than you
might think. And we’re here to help.
2
Open Enrollment
Small Business Health Insurance
UnitedHealthcare
Michigan SHOP Marketplace
(Small Business Health Options Program)
Let’s get started.
Finding health insurance for your small business is as easy as 1, 2, 3.
1
2
3
How to choose
insurance.
Compare
plans.
What comes
next?
Learn how to compare
insurance plans and
when to sign up.
Look closely at the
plans to see which
one is right for
your employees.
Get health insurance
for your employees
and find out what
happens next.
3 easy ways to sign up:
sign up by the 15th to start coverage on the 1st of the following month
Work with us.
1-877-856-2430
uhc.com/sbSHOP
Have questions?
Work with
a broker.
uhcbroker.com
Shop on
your own.
healthcare.gov
| 1-877-856-2430 | uhc.com/sbSHOP | uhcbroker.com | healthcare.gov
3
1
How to choose insurance.
3 key
decisions.
1) See if your business is eligible.
You’ll need to meet three requirements before buying a SHOP group health plan.
Principal employee work site.
Your business must have an employee office or work site in the state
where you’re buying coverage.
Number of employees.
You must have 50 or fewer full-time equivalent employees (FTE). Get help
calculating how many FTEs you have at healthcare.gov
Offer health insurance to all FTEs.
You’ll need to offer coverage to any employee that works an
average of 30 or more hours a week.
2) Choose coverage options.
You can offer your employees one plan or a choice of plans.
There are four categories (metal levels) of plans.
Bronze
Silver
Gold
Platinum
Monthly
Premium
$
$$
$$$
$$$$
Co-pay
(cost per
visit/drug)
$$$$
$$$
$$
$
Is this plan
category right
for you?
You rarely see a
doctor, and you´re
willing to pay a
higher co-pay
when you do.
You want to balance monthly premium,
co-pay and deductible costs. There are
several of choices in between the bronze
and platinum plans.
You see doctors more
often and are willing
to pay higher monthly
premiums to lower your
co-pay.
3) See if you qualify for a tax credit.
If you have fewer than 25 full-time equivalent employees (FTEs), you could be
eligible for the small business health care tax credit worth up to 50% of your
premium costs. Plus, you could also deduct the remaining part of your
premium on your taxes.
4
Open Enrollment
Additional
Considerations.
Wide variety of coverage and premiums.
You control coverage options and how much of your employees’ monthly
premiums you pay. There are a variety of plans and options that offer the
flexibility to customize your employees’ insurance.
Saving you time and money.
Through a variety of affordable insurance plans and cost estimator tools, your
employees may meet their health and budget needs. That’s because we negotiate
with in-network doctors and hospitals to keep costs down.
Easy access to care.
Your employees have access to top doctors, clinics and hospitals with all our
insurance plans. In fact, we screen all of our providers and facilities for care quality
and cost-savings. If you simply have a question or need advice, call our NurseLine℠
to talk with registered nurses 24/7.
Virtual visits:
With virtual visits, your employees can see a health care provider for minor health
issues right from their computer, tablet or mobile phone.
Your employees can use tools to manage their health and costs.
Through online resources, mobile apps and myuhc.com®, your employees will find:
24/7 access
to benefit info.
Health care
providers.
Health care
cost estimator.
Apps, tools
and programs
to manage
health.
More than 45 million*people across
the nation rely on UnitedHealthcare
for their health insurance.
*UnitedHealthcare serves 45 million domestically and internationally
through its market facing business. Source: UnitedHealth Group
2014 Annual Report, pg. 6.
Have questions?
| 1-877-856-2430 | uhc.com/sbSHOP | uhcbroker.com | healthcare.gov
5
UnitedHealthcare
2
Michigan SHOP Marketplace
Compare plans
UnitedHealthcare Navigate® and Choice Plus
Plans (1-50 Employees)
Navigate and Choice Plus plans are smart options for cost conscious employers looking to offer quality care
to their employees. With a Navigate plan, your employees will choose a network primary care provider (PCP)
to manage their care and refer them to specialists, if needed. There is no coverage for seeing out of network
providers. Choice Plus plans give your employees the freedom to visit any doctor, clinic or hospital in this
large national network without a referral or choosing a primary care provider. Your employees can also go out
of network, but they will likely pay more for covered services.
Copay
Plan Type
Plan Name
Silver Navigate
4000-1
Gold Navigate
2000-1
Bronze Choice Plus
HSA 6300-1
Plan Code
AC-GT
AC-GS
AC-GU
HSA Employer Funding
Amount Minimum
N/A
N/A
$0
HSA Employer Funding
Amount Maximum
N/A
N/A
$50
40/4000/80%
25/2000/80%
6300/100%
PCP Office Visit
$45 copay
$25 copay
No charge after
deductible
Specialist Office Visit
$90 copay
$50 copay
No charge after
deductible
Urgent Care
$100 copay
$75 copay
No charge after
deductible
$400 copay and
20% coinsurance
$200 copay and
20% coinsurance
No charge after
deductible
20% after deductible
No charge
No charge after
deductible
80%
80%
100%
INN Individual Deductible
$4,000
$2,000
$6,300
INN Family Deductible
$12,000
$6,000
$12,600
INN Individual Out-ofPocket Maximum
$6,350
$4,000
$6,300
Pharmacy Plan Code
DT
DT
MM
Description
Emergency Room
Minor Lab and X-ray
INN Coinsurance
Notes:
6
HSA
Open Enrollment
3
What comes next?
Set up.
Sign up.
Make sure you’re eligible.
Employee enrollment period.
Visit uhc.com or
healthcare.gov
Tell employees about
coverage and dates.
Let them know what’s offered,
when and where to sign up.
Choose coverage
for your employees*.
Need help? Visit healthcare.gov or
uhcbroker.com
Employer finalizes enrollment.
Learn about tax credits.
See if you can get a tax credit at
healthcare.gov
*UnitedHealthcare policies may have exclusions or limitations or terms
under which the policy may be continued in force or discontinued.
For costs and complete details of the coverage, contact your broker,
consultant or UnitedHealthcare Representative.
3
Your employees choose the
insurance that fits their needs.
Enter employee information.
Use this simple sign-up checklist.
Have everything ready for every
employee you’re insuring.
3 First and last name
3 Date of birth
Log on to healthcare.gov to review
your employees enrollment. Submit
your application to finish signing up.
Pay the first month’s premium.
Be sure to pay your bill online to
start your employees’ coverage.
Before your employees’
coverage starts.
You can choose how long you’d like
your employees to wait before their
coverage starts. However, a waiting
period cannot exceed 90 days
from enrollment.
3 Social Security number
3 Date of hire
3 Full- or part-time status
3 Email address
Sign up now:
Sign up by the 15th to start coverage on the 1st of the following month.
Work with us.
1-877-856-2430
uhc.com/sbSHOP
Have questions?
Work with
a broker.
uhcbroker.com
Shop on
your own.
healthcare.gov
| 1-877-856-2430 | uhc.com/sbSHOP | uhcbroker.com | healthcare.gov
7
Choosing your small business
health plan just got simpler.
Visit uhc.com/sbSHOP or
contact your UnitedHealthcare broker
Virtual visits are not an insurance product, health care provider or a health plan. Unless otherwise required,
benefits are available only when services are delivered through a Designated Virtual Network Provider.
NurseLineSM is for informational purposes only. Nurses cannot diagnose problems or recommend specific
treatment and are not a substitute for your doctor's care. NurseLine services are not an insurance program
and may be discontinued at any time.
UnitedHealthcare policies may have exclusions or limitations or terms under which the policy may be
continued in force or discontinued. For costs and complete details of the coverage, contact your broker,
consultant or UnitedHealthcare Representative.
Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates.
© 2015 United HealthCare Services, Inc.
UHCMI758442_000
320-5892 10/15