Q. What is covered under ABA services?
A. The Plan pays Benefits for behavioral services for Autism Spectrum Disorder including Intensive Behavioral Therapies such as Applied Behavior Analysis (ABA) that are the following:

• Focused on the treatment of core deficits of Autism Spectrum Disorder.
• Provided by a Board Certified Applied Behavior Analyst (BCBA) or other qualified provider under the appropriate supervision.
• Focused on treating maladaptive/stereotypic behaviors that are posing danger to self, others and property and impairment in daily functioning.

These Benefits describe only the behavioral component of treatment for Autism Spectrum Disorder. Medical treatment of Autism Spectrum Disorder is a Covered Health Service for which Benefits are available under the applicable medical Covered Health Services categories.

Q. What is covered under Gender Dysphoria?
A. Psychotherapy is covered under the plans’ mental health benefits. Hormone therapy and surgery are covered for eligible individuals who meet evaluation criteria. Some services may require the covered person to be 18 years or older.

Q. Do I need a referral to see a specialist?
A. The plan does not require a referral to see a specialist. However, the specialist may require a referral from your Primary Care Physician.

Q. What if a specialist (or provider) is not in the UHC network?
A. You can still see that specialist (or provider), but the plan would pay the out-of-network level of benefits.

Q. Are chiropractors included in the network?
A. Yes.

Q. Will we need pre-approvals for certain procedures?
A. Yes, but it is the responsibility of UnitedHealthcare Network Physicians to obtain any required pre-approvals. If the services are Out-of-Network, you will need to notify UHC to obtain any pre-approvals. Call UnitedHealthcare customer services Advocates, using the phone number on your ID card for more detail.

Q. Can I see what needs pre-approval on the UHC website?
A. Yes. The UnitedHealthcare Prior Authorization List and Medical Coverage Policies are located on the UHC Network Provider Portal, www.unitedhealthcareonline.com. This site is open to the public.

Q. What is the copay for Virtual Visits?
A. You will pay your portion of the service costs according to your medical plan. For example, if you are in the Prime Select Plan, you will pay the $20 PCP copay for a Virtual Visit. If you are in the Consumer Choice Plan, you will pay according to your deductible and coinsurance.

Q. Can Virtual Visit doctors provide a doctor’s note to a patient excusing them from work like my primary care physician would?
A. Yes, the virtual visit provider can write a note and put it in the patient’s file, as well as email it to them. The patient can then give it to their employer.

Q. What are the average waiting times for Virtual Visits?
A. Usually in 5-10 minutes of receiving the request.

Q. If the Virtual Visit wait becomes too long, can you cancel and receive a refund?
A. Instead of waiting you will have the option to set an appointment.

Q. Can I get routine, maintenance prescriptions from Virtual Visits?
A. No. A Virtual Visit is not designed to replace your PCP. Virtual Visit Doctors can diagnose and treat a wide range of non-emergency medical conditions. Treatment may include issuing a prescription. Here’s a list of typical conditions:

• Bladder infection/Urinary tract infection
• Bronchitis
• Cold/Flu
• Diarrhea
• Fever
• Migraine/headaches
• Pink eye
• Rash
• Sinus problems
• Sore throat
• Stomach ache

Q. In the Medical Plan Comparison the Consumer Choice plan lists the deductible and the out of pocket maximum as applying to individual coverage or all other coverage levels. What does this mean?
A. In the Consumer Choice plan, someone enrolled in individual coverage only must meet a deductible of $1,500 and then an out-of-pocket maximum of $2,500. For all other coverage levels (employee plus 1, employee plus 2 or more), all family members contribute towards the family plan deductible of $3,000 and out-of-pocket maximum of $5,000. The plan cannot pay an individual’s claims until the total $3,000 family plan deductible has been met, even if he or she has met the $1,500 individual plan deductible. Similarly, all family members contribute towards the $5,000 family out-of-pocket maximum. The plan cannot pay an individual’s covered expenses at 100% until the total family out-of-pocket maximum has been reached.

Q. It appears that certain expenses count towards reaching the deductible and out of pocket maximum in the Consumer Choice plan but not in the Prime Select plan. Can you explain?
A.

• In the Consumer Choice plan both medical and prescription drug expenses (including retail and mail order) count toward the deductible and out-of-pocket maximum. The amount you pay for out-of-network services does not count toward your in-network deductible and out-of-pocket maximum.
• In Prime Select there is no in-network plan deductible. The Out-of-Pocket Annual Limit for in-network providers is set at the maximum amount determined by the Department of Health & Human Services each year. For 2018, the out-of-pocket annual limit is $7,350 individual / $14,700 for all other coverage levels. The limit includes prescription drug expenses. For out-of-network providers, there is no annual out-of-pocket annual limit.