Frequently Asked Questions
If your former employer from which you retired provides dental coverage for their active members throught the LGHIP, you will have dental coverage as a Medicare-eligible retiree. This dental coverage will be through Blue Cross and Blue Shield of Alabama (BCBS). You will receive a separate dental card from BCBS.
Yes, this plan offers nationwide coverage which includes all 50 states; all U.S. territories and Washington D.C. Worldwide emergency services are also included. If medical services are needed because of an illness, injury, or condition that you did not expect or anticipate while traveling abroad and you cannot wait until you are back in our plan’s service area, you can seek emergency care and file a claim for the care at a later date.
No. This is a custom Group Medicare Advantage PPO plan designed exclusively for retirees of the SEIB. Your new card will have both the SEIB logo and the United Healthcare logo displayed on the front so that your provider can easily identify the difference.
Medicare Part A and Part B are usually referred to as "Original Medicare." Part A offers coverage for your hospital stays, while Part B offers coverage for doctor visits and outpatient care. You receive your benefits directly from the government. Medicare then pays fees for your care directly to the doctors and hospitals you visit.
Medicare Part C plans are usually referred to as Medicare Advantage plans. All Medicare Advantage plans are provided by private insurance companies, like UnitedHealthcare Insurance Company, and they all combine coverage for hospital stays (Medicare Part A) with coverage for doctor visits and other outpatient care (Medicare Part B) into one plan. Some plans include prescription drug coverage (Medicare Part D), plus extra benefits like vision, hearing and dental coverage. Under Medicare Part C, the Medicare Advantage plan pays the fees for your care directly to the doctors and hospitals that you visit.
Yes. You must be enrolled in Medicare Part A and Part B to be eligible for our retiree plans and you must continue to pay your Part B premium to the government. This is a requirement for Medicare Advantage, Medicare Part D prescription drug, Medicare supplement, and Senior Supplement plans. If you stop paying your Part B premium, you may be disenrolled from your plan.
To find doctors or hospitals in our network, click on “Find a Provider” in the navigation at the top of the page. This directory is updated regularly to provide you with the current listing of network providers. If you would like help finding a network doctor or to request a written copy of the Provider Directory, please call Customer Service.
The UnitedHealthcare® Group Medicare Advantage (PPO) plan does not require a doctor to have a contract with UnitedHealthcare. Under this plan, you may see any doctor (in-network or out-of-network) and doctors without a contract will be paid the same reimbursement as they receive from Medicare. Most doctors accept this type of plan once they understand they do not need a contract and they will be paid the same as Medicare. Beginning in September, you will be able to contact UnitedHealthcare with any questions regarding your new plan. UnitedHealthcare will communicate with providers in your area to explain how the plan works and, if necessary, UnitedHealthcare and the SEIB will contact your provider directly to intervene on your behalf.
In-network providers have a contract with UnitedHealthcare. Out-of-network providers do not have a contract. With this plan, you have the flexibility to see any provider (in-network or out-of-network) at the same cost share, as long as they accept the plan and have not opted out of or been excluded from Medicare. Also, when you go out-of-network for care, the plan pays providers just as much as Medicare would have paid. In Alabama, there are over 1,400 in-network providers and over 100 in-network hospitals across the state.
If your doctor has opted out of the Medicare program in its entirety, you would only have coverage in an emergency situation. Less than 1% of doctors nationally have opted out of the Medicare program.
Whether your provider is in-network or out-of-network, your provider can submit claims to UnitedHealthcare online. If needed, the UnitedHealthcare claim address information is provided on your UnitedHealthcare Member ID card and in your Plan Details book. UnitedHealthcare processes claims payments for out-of-network providers in compliance with all federal regulations.
No. Under this plan, you are protected from any balance billing. If your doctor tries to balance bill you, please contact UnitedHealthcare Customer Service and we will address the issue with the provider directly.
No. The UnitedHealthcare® Group Medicare Advantage (PPO) plan does not have a hospital deductible.
There is no maximum number of days covered for hospital admission. Days are unlimited.
This information is accessible within the member portion of the site. Once logged in, click the "Coverage & Benefits" link in the menu at the top of your screen. This page will provide your maximum out-of-pocket costs for your health and prescription drug plan, as applicable.
This information is accessible within the member portion of the site. Once logged in, click the "Claims" link in the menu at the top of your screen. The Claims page will enable you to search for medical and/or drug claims by date range and will provide an overview of each claim searched.
Click on the Resources tab in the menu at the top of your screen, then on the Appeals & Grievances link. This page provides detailed information about the appeals process.
Although there is no actual limit on your out-of-pocket prescription drugs expenses, once you have spent $6,350 in drug expenses during the plan year, you will only have to pay a small copay or coinsurance amount for the rest of the plan year.
The UnitedHealthcare® Medicare Advantage (PPO) plan includes over 67,000 national chain, regional, local and independent neighborhood pharmacies in the UnitedHealthcare network. Once you are a member with UnitedHealthcare, you will be able to look up pharmacies online or request a printed pharmacy directory by calling UnitedHealthcare Customer Service at the number on your UnitedHealthcare Member ID card. Beginning in September, you can also call UnitedHealthcare Customer Service to check if a pharmacy is in-network, or to get pharmacy contact information.
If you have a limited income, you may qualify for the federal Extra Help program to help pay for your prescription drug costs. If you qualify, Extra Help could pay up to 75% or more of your drug costs. Many people qualify and don’t know it. There’s no penalty for applying and you can re-apply every year. Call Social Security toll-free at 1-800-772-1213, TTY 1-800-325-0778, between 7 a.m. – 7 p.m., local time, Monday – Friday.
Your plan-sponsor may have specific rules that tell you when you can change or disenroll from your plan. Usually there is a defined "open enrollment" period during which those changes can occur. It's important to understand your group's rules and timing. For example, if you disenroll from your group-sponsored retiree health coverage, you may not be allowed to re-enroll in the future. Speak with your Benefits Administrator to see what applies to you.
Each year that you are a member of a UnitedHealthcare Medicare Advantage or Medicare Part D Prescription Drug plan, you will receive an Annual Notice of Changes (ANOC) about six weeks before your plan's effective date. The ANOC explains any changes in coverage, costs, and benefits that will be effective for the upcoming year. You may also call the customer service number listed on your member ID card with any questions.
Your UnitedHealthcare Member ID card should arrive in December and you can start using it on your plan effective date of January 1, 2023. Once you receive your card in the mail, you will have full access to the UHC website and the UHC call center. Be sure to provide this new card to your medical and pharmacy providers beginning January 1, 2023.
No, you will only use your UnitedHealthcare® Group Medicare Advantage Member ID card for all covered medical and prescription drug services. Make sure to put your Medicare card somewhere for safe keeping. It is important that you use your UnitedHealthcare Member ID card each time you receive medical services or fill a prescription. Because UnitedHealthcare pays all claims directly, the so claims no longer go to Medicare first. By always showing your UnitedHealthcare Member ID card, you can help make sure that your claims get processed correctly, timely and accurately.
This information is accessible within the member portion of the site. Once logged in, click on the "View and Print Member ID Card" link on the home page.
If you are unable to find the links noted above, please call customer service using the number listed on your plan materials or the number noted for Plan Members on the Contact Us page.
UnitedHealthcare HouseCalls is an annual wellness program designed to complement your doctor’s care and offered to you for no extra cost. The program sends a licensed health care practitioner to visit you at home. During the visit, they will review your medical history and current medications, perform a health screening, identify health risks and provide health education. It’s also a chance to ask any health questions you may have. Once completed, HouseCalls will send a summary of your visit to your primary care provider so that they have this additional information regarding your health. HouseCalls may not be available in all areas.
You will now have access to Virtual Doctor Visits which allows you to live video chat with a provider from your computer, tablet or smartphone – anytime, day or night, for a $0 copay. UHC’s preferred providers are Doctors on Demand and AMWell.
IRMAA stands for Income Related Monthly Adjustment Amount. Similar to Medicare Part B, high income earners will pay more for their Medicare Part D coverage. If you are a member of a Medicare plan that includes prescription drug coverage and your Modified Adjusted Gross Income on your IRS tax return from two years ago is above $85,000* for an individual or $170,000* for a couple, you may pay an additional amount for Medicare Part D coverage. The extra amount is paid directly to Social Security, not to your plan. If you are subject to IRMAA, Social Security will send you a letter. The letter will explain how they determined the amount you must pay and the actual IRMAA amount. Neither the SEIB nor your health plan determine who will be subject to IRMAA. Therefore, if you disagree with the amount you must pay, contact the Social Security Administration. You can:
- Go online to www.ssa.gov
- Call Social Security toll-free at 1-800-772-1213, TTY 1-800-325-0778 between 7 a.m. – 7 p.m., local time, Monday – Friday.
- Visit your local Social Security office
*These amounts apply for 2020.