United Health Care

United Health One Virginia Health Insurance

UnitedHealthcare Virginia

More than 26 million customers entrust UnitedHealthcare with their health insurance needs.* Our network plans can ease access to high-quality care from physicians and hospitals nationwide. Together, we combine our strength and stability with nearly three decades of experience serving customers of all sizes.

United Health Insurance Virginia Quotes

UnitedHealthOne Virginia

UnitedHealthOne is the brand name of the UnitedHealthcare family of companies that offers personal health insurance products. Golden Rule Insurance Company, a UnitedHealthcare company, is the underwriter and administrator of these plans. With over 60 years of experience serving individuals and families, Golden Rule provides high-quality products, timely claims handling, and outstanding customer service.

Experience and Expertise

Golden Rule’s experience and expertise has driven the development of easy-to-use and innovative health insurance products. A recognized leader — and one of the nation’s largest providers of health savings account plans — Golden Rule continues building plans that meet the needs of individuals and families.

Our Goal: Your Satisfaction

We understand the importance of your time and concern for the value of your health-care dollars. You will find we go far beyond the industry average, processing an overwhelming majority of health insurance claims in less than two weeks and offering strong discounts when using our vast network of quality health-care providers. Our goal for every customer is an insurance plan at a price that fits his or her needs and budget. UnitedHealthOne — Choices you want. Coverage you need.

Leave it to the experts

For over 60 years, our experience and expertise in the individual health market has driven the development of plans that strive to make health coverage more affordable for more Americans. Because our primary focus is serving individuals and families, we understand the unique needs of people like you.

Don’t just take our word for it

Golden Rule is rated “A” (Excellent) by A.M. Best and “A+” (Strong) by Standard and Poor’s. These worldwide, independent organizations examine insurance companies and other businesses and publish their opinions about them. These ratings are an indication of our financial strength and stability.

Fast claims processing

We recognize the critical importance of being responsive to the service needs of our customers. That’s why more than 94% of all health insurance claims are processed within 10 working days or less.**

Big network, big savings

You can find many providers in your area with more than 580,000 physicians and care professionals and 4,900 hospitals nationwide in the UnitedHealthcare network.* Plus, our network can offer you provider discounts of up to 35-45% on quality health care.***

Initial rate guarantees

Benefit from securing your initial premium amount for 12 months with an option on all plans to extend up to 24 months.****

Benefits for a lifetime

Each of our plans gives you the protection of a $3 million lifetime benefit with an option to enhance your plan to a $5 million lifetime benefit.

Coverage for your children

Your children can benefit from coverage until they marry or until they reach the age of 26.

Get the specialized care you need

If you require care from a specialist, a referral is not required — making it easier for you to receive the care you need.

In case of emergency

From state to state, country to country -rest assured knowing that if you have a medical emergency coverage is available, even when travelling outside the U.S.

Membership has its benefits

FACT members have access to not only UnitedHealthOne health plans from Golden Rule, but also discounts on vision, dental, prescription drug, and even travel expenses. See the back cover of this brochure for more.

Quality Care at Significant Savings

Access to the right doctors can be the most important part of your health care.

Our network gives you:

  • Access to an extensive network of doctors, X-ray and lab facilities, hospitals, and other ancillary providers.*
  • Quality care at reduced costs because these providers have agreed to lower fees for covered expenses.

• Lower premiums — savings up to 35%-45% over the same plans without a network. Please note: Covered expenses for nonemergency care received from a provider outside your network are:

  • Subject to reasonable and customary charges;
  • Reduced by 25%;
  • Subject to an additional deductible amount equal to the per person, calendar-year deductible.

For Services of Non-Network Providers: Your actual out-of-pocket expenses for covered expenses may exceed the stated coinsurance percentage because actual provider charges may not be used to determine insurer and member payment obligations.

Copay Plans in Virginia

Convenient Doctor Office Copay Benefits

Designed for individuals and families, our copay plans are more like traditional employer plans with a copayment for routine health-care expenses. When you use a network doctor for an office visit, we pay 100% of history and exam fees after a $35 copay with Copay SelectSM. Office visits outside your network are covered subject to the applicable deductible and your chosen coinsurance.

Adult and Child Preventive Care Included

After a 3-month waiting period, you pay $35 for the doctor office visit with Copay SelectSM. X-rays and lab tests are covered after you pay your chosen coinsurance (0%, 20%, or 30%).

Prescription Drug* Card Benefits (Copay SelectSM Only)

  • Tier 1 drugs — $15 copay.
    • Tier 2-4 drugs — combined $200 deductible per person, per calendar year, then:
      • $35 copay for Tier 2 drugs.
      • $65 copay for Tier 3 drugs.
      • 25% coinsurance (you pay) for Tier 4 drugs.

Comprehensive Coverage for Inpatient and Outpatient Medical Expenses

(Copay SelectSM Only)

  • You choose $3 million or $5 million lifetime maximum benefit per covered person.
  • Covered inpatient and outpatient expenses are reimbursed after your chosen coinsurance and the deductible.

Copay SaverSM

The Copay SaverSM plan provides the convenience of copays for doctor office visits (limited to 2 visits per person, per calendar year) for a lower monthly premium.

*We have a preferred drug list, which changes periodically. Tier status for a prescription drug may be determined by accessing your prescription drug benefits via our Web site or by calling the telephone number on your identification card. The tier to which a prescription drug is assigned may change as detailed in your policy/certificate.

Health Savings Plans in Virginia

HSA Plans Offer Quality Coverage, Savings

HSA Plans simply combine a lower-cost, high deductible health insurance plan and a tax-favored savings account.

Lower Premiums, Tax-Advantaged Savings, and an Attractive Interest Rate*

High deductible plans typically cost a lot less than many copay or traditional plans. This means lower premiums for you. You can then take the premium savings and place it into your health savings account.

  • You get a tax deduction on the money you put in your HSA.
  • Your dollars can grow tax-deferred.
  • You spend the savings tax-free to help pay your deductible or for qualified medical care (including prescriptions, vision, or dental care).
  • What you don’t use in your account will continue to accumulate year after year. Then, if you ever need it for

health-care expenses, the money will be there.

• With Golden Rule’s HSA custodian, you’ll also earn interest on your savings, beginning with the first dollar deposited.

Adult and Child Preventive Care Included

With our HSA plans, after a 3-month waiting period, you pay a $35 copay (in-network) for the doctor office visit.

Bottom line — HSAs can help make

Traditional Insurance High Deductible Insurance Premium Savings $

health insurance more affordable.

Premium $ Premium $ Put Into HSA

High Deductible Plans in Virginia

Lower Premiums

With high deductible plans, you’re keeping more of your money and taking responsibility for covering minor or routine health-care expenses — if they come up. The higher the deductible, the lower your premiums.

Saver 80SM is our lowest premium plan. This plan provides coverage for hospital confinements, surgical procedures in or out of the hospital (but not in the doctor’s office), and the more costly outpatient expenses, such as CAT scans and MRIs.

Simple to Use

Golden Rule’s top-selling high deductible plan — Plan 100® — pays 100% of covered expenses once you meet your calendar-year deductible. Your benefits are not complicated with multiple copays or coinsurance.

Comprehensive Coverage

  • You choose $3 million or $5 million lifetime maximum benefit per covered person.
  • Plan 100® and Plan 80SM include preventive care and child immunizations with no waiting period.
  • Add optional benefits to increase coverage (see Optional Benefits on page 12 for details).

Plan Enhancements in Virginia

$5 Million Lifetime Maximum

This option is not available in VA. Upgrade your coverage to $5,000,000 of covered expenses per person.

24-Month Initial Rate Guarantee

Extend your rate guarantee to 24 months. Does not apply to benefit and address changes.

No Annual Maximum Prescription Drug

This option is not available with Saver 80SM or Copay SaverSM Eliminates the $3,000 calendar-year limit.

$25 Office Visit Copay

This option is available with Copay SelectSM . Reduce the cost of doctor office visit copay from $35 to $25.

2 Additional Dr. Office Visits

This option is available with Copay SaverSM . Increase the number of Doctor Office Visits from 2 to 4 per person, per calendar year.

Prescription Drug* Copay

This option is available with Plan 100® and Plan 80SM . Cannot be combined with the No Annual Maximum Prescription Drug Plan Enhancement.

With this benefit, you pay:

    Tier 1 drugs — $15 copay.
  • Tier 2-4 drugs — combined $200 deductible per person, per

calendar year, then:

—Tier 2 drugs — $35 copay.
—Tier 3 drugs — $65 copay.

— Tier 4 drugs — you pay 25% coinsurance. (Maximum $3,000 in covered expenses, per person, per calendar year.)

Optional Benefits

Preventive Care

This option is available with Plan 100®, Plan 80SM, Saver 80SM, and Copay SaverSM .

• $35 copay on preventive care network office visits (primary care,

OBGYN, etc).

• The following charges for preventive care that are performed in

conjunction with the network office visit are exempt from the deductible and coinsurance whether performed in the doctor’s office or elsewhere:

—Child (under age 19) and adult immunizations.
—Mammogram, cervical and Pap smears.
—Urinalysis and blood tests.
—Bone density screens.
—EKG and cardiac stress tests.
—PSA tests and digital rectal exams.
—FDA-approved screenings for HPV.

• Copay SaverSM

—3-month waiting period eliminated.
—Not subject to the office visit limit.

Maternity Benefit

This option is available with Plan 100®, Plan 80SM, Saver 80SM, Copay

SelectSM, and Copay SaverSM; not available in AR, MD, NC, or VA. This optional benefit helps cover the costs for routine pregnancy and delivery for the primary insured and spouse only. You pay 20%; we pay 80% of covered expenses. After 4 benefit years, the maximum covered expense amount is $7,500.

No covered expenses will be considered for reimbursement for a pregnancy beginning before the maternity benefit’s effective date.

Benefit Years Maximum Covered Expense Maximum We Pay
1 & 2 $2,500 $2,000
3 & 4 $5,000 $4,000
5+ $7,500 $6,000

If you purchase name-brand when generic is available, you pay your generic copay plus the additional cost above the generic price.

You’ve made the decision to help protect your family’s health by seeking insurance; shouldn’t you consider helping protect their financial future too?

Term life insurance may be an ideal benefit to make sure you provide for your loved ones’ future.

Consider your current financial picture and ask, “Without a term life insurance benefit paid to my loved ones upon my death, would they be able to:

  • Pay for funeral expenses?
  • Pay the mortgage or other debts?
  • Save for college or retire comfortably?”

Remember to select this option as you apply for health coverage.

Enhanced Term Life Benefit

You may choose an optional term life insurance benefit for you and/or a spouse who is also a covered person under the health plan. You and/or your spouse must be age 18 or older. The term life benefit expires when a covered person reaches age 65.

You select one of three benefit amounts. You may select different amounts for you and your spouse.

Benefit Amounts: $50,000 $100,000 $150,000

Accidental Death Benefit

This benefit provides $50,000 in coverage in the event of an accidental death for you and/or your spouse if your spouse is also a covered person under the health plan. You and/or your spouse must be age 18 or older. The accidental death benefit expires when a covered person reaches age 65. It may be purchased with or without the term life benefit.

Motorcyclists are not eligible for this benefit.

Copay SelectSM, HSA 100®, HSA 70SM, Plan 100®, and Plan 80SM

To be considered for reimbursement, expenses must qualify as covered expenses. Expenses are also subject to reasonable and customary limits unless you use a network provider. We recommend review of the more detailed plan information on pages 15-18 and the state variations on pages 19-21.

Medical Expense Benefits

• Daily hospital* room and board and nursing services at the most

common semiprivate rate.

  • Charges for intensive care unit.
  • Hospital emergency room treatment of an injury or illness

(subject to an additional $100 copay each time the emergency room is used for an illness not resulting in confinement — does not apply to HSA Plans).

• Services and supplies, including drugs and medicines, which are

routinely provided by the hospital to persons for use while they are inpatients.

• Professional fees of doctors and surgeons (but not for standby availability).

  • Dressings, sutures, casts, or other necessary medical supplies.
  • Professional fees for outpatient services of licensed physical therapists.

• Diagnostic testing using radiologic, ultrasonographic, or laboratory services in or out of the hospital.

• Local ground ambulance service to the nearest hospital for necessary emergency care. Air ambulance, within U.S., if requested by police or medical authorities at the site of emergency.

  • Charges for operating, treatment, or recovery room for surgery.
  • Dental expenses due to an injury which damages natural teeth if expenses are incurred within six months.
  • Surgical treatment of TMJ disorders (see limitations on page 17).
  • Cost and administration of anesthetic, oxygen, and other gases.
  • Radiation therapy or chemotherapy.
  • Prescription drugs.
  • Hemodialysis, processing, and administration of blood and components.
  • Mammography, Pap smear, and PSA test fees.
  • Artificial eyes, larynx, breast prosthesis, or basic artificial limbs (but not replacements).

• Surgery in a doctor’s office or at an outpatient surgical facility, including services and supplies.

• Occupational therapy following a covered treatment for traumatic hand injuries.

• Rehabilitation and extended care facility services that begin within 14 days of a 3-day or more hospital stay, for the same illness or injury. Combined calendar year maximum of 60 days for both rehabilitation and extended care facilities expenses.

Preventive Care Expense Benefits

Three-month waiting period for wellness benefits (not applicable to

Plan 100® and Plan 80SM). (Plan 100® and Plan 80SM subject to the applicable deductible amount and coinsurance percentage. Copay SelectSM, HSA 100®, and HSA 70SM exempt from any applicable deductible amount.)

Covered expenses are expanded to include charges for the following when incurred for preventive care:

  • Routine office visits (including well-baby).
  • Childhood immunizations for each eligible child under 19 years of age.
  • Urinalysis and blood tests.
  • Bone density screenings.
  • Electrocardiograms (EKG’s).
  • Cardiac stress tests.

The following are not subject to the 3-month waiting period:

  • Mammography screenings.
  • Cervical smears and pap smears.
  • Prostate-specific antigen tests and digital rectal examinations.

Preventive Care Expense Benefits will not include and no benefits will be paid for computerized axial tomography (CAT or CT scan), magnetic resonance imaging (MRI) or positron emission tomography (PET scan) performed on a routine or preventive basis.

Deductible Credit

It can help you reduce your future out-of-pocket expenses. If you don’t meet your per-person calendar-year network deductible, the Deductible Credit applies to next year’s network deductible.

Each qualified covered person* not meeting the plan’s chosen Receives this credit for the network deductible** for: next calendar year:

1 year 20% of chosen network deductible 2 consecutive years 40% of chosen network deductible 3 or more consecutive years 50% of chosen network deductible

With a Health Savings Account plan (HSA 100 and HSA 70), the deductible credit will never reduce the deductible below the minimum required by law to maintain tax-qualified status of the insurance plan. The minimum for 2010 is $1,200 for singles and $2,400 for families.

With the optional Continuity rider, deductible credit is only received when a covered person is “active.”

Transplant Expense Benefit

The following types of transplants are eligible for coverage under the Medical Benefits provision:

Cornea transplants, artery or vein grafts, heart valve grafts, and prosthetic tissue replacement, including joint replacements and implantable prosthetic lenses, in connection with cataracts.

Transplants eligible for coverage under the Transplant Expense Benefit are:

Heart, lung, heart and lung, kidney, liver, and bone marrow transplants. Golden Rule has arranged for certain hospitals around the country (referred to as our “Centers of Excellence”) to perform specified transplant services. If you use one of our “Centers of Excellence,” the specified transplant will be considered the same as any other illness and will include a transportation and lodging incentive (for a family member) of up to $5,000. Otherwise, the acquisition cost for the organ or bone marrow will not be covered, and covered expenses related to the transplant will be limited to $100,000 and one transplant in a 12-month period. To qualify as a covered expense under the Transplant Expense Benefit, the covered person must be a good candidate, and the transplant must not be experimental or investigational. In considering these issues, we consult doctors with expertise in the type of transplant proposed.

Notification Requirements

You must notify us by phone on or before the day a covered person:
  • Begins the fourth day of an inpatient hospitalization; or
  • Is evaluated for an organ or tissue transplant.

Failure to comply with Notification Requirements will result in a 20%

reduction in benefits, to a maximum of $1,000. If it is impossible for you to notify us due to emergency inpatient hospital admission, you must contact us as soon as reasonably possible.

Our receipt of notification does not guarantee either payment of benefits or the amount of benefits. Eligibility for and payment of benefits are subject to all terms and conditions of the policy. You may contact Golden Rule for further review if coverage for a health-care service is denied, reduced, or terminated.

Preexisting Conditions

Preexisting conditions will not be covered during the first 12 months after an individual becomes a covered person. This exclusion will not apply to conditions that are both: (a) fully disclosed to Golden Rule in the individual’s application; and (b) not excluded or limited by our underwriters.

A preexisting condition is an injury or illness: (a) for which a covered person received medical advice or treatment within 24 months prior to the applicable effective date for coverage of the illness or injury; or (b) which manifested symptoms which would cause an ordinarily prudent person to seek diagnosis or treatment within 12 months prior to the applicable effective date for coverage of the illness or injury.

**For family HSA plans, when combined per family deductible is not met

Virginia

• Work-related injuries are covered unless benefits are payable by Workers’ Compensation.

• Coordination of Benefits: If, after Golden Rule coverage is issued, a person becomes insured under (an)other group plan(s), benefits of the plans will be determined under the Coordination of Benefits (COB) clause. One plan will be determined to pay primary based on COB rules described in the policy/certificate. Some of the rules which usually result in a plan paying primary include: not having an appropriate COB clause; covering a person as other than a dependent; with regard to a dependent covered under both parents’ plans, the plan issued to the parent with the earlier date of birth or determined to be primary under the terms of a court decree or determinations based on custody; covering the person as an active employee/dependent of an active employee; or which plan has provided coverage longer.

• Portability plans (guarantee issue without preexisting conditions exclusions) are available to eligible applicants. Review the application for insurance for details.