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UnitedHealth Premium

What is UnitedHealth Premium? How do doctors and facilities earn the Premium designation? How does the designation system work? What are the benefits to members? How do I find a Premium doctor? Which companies have additional Premium benefits?. UnitedHealth Premium.

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UnitedHealth Premium

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  1. What is UnitedHealth Premium? How do doctors and facilities earn the Premium designation? How does the designation system work? What are the benefits to members? How do I find a Premium doctor? Which companies have additional Premium benefits? UnitedHealth Premium Enroller Consultant Training

  2. Overview • The UnitedHealth Premium designation identifies doctors and cardiac facilities that meet nationally recognized medical guidelines for quality and efficiency of care. • Premium is a big differentiator for UnitedHealthcare. When you’re out at enrollment events, be prepared to speak at length about the program and its member benefits. • Premium is a designation within the UnitedHealthcare provider network. Premium is not a separate network.

  3. What is UnitedHealth Premium? • The following conditions are included in Premium: • Adult Primary Care and Internal Medicine • Cardiac (Heart) • Oncology (Cancer) • Orthopedic (Musculoskeletal, Rheumatology) • Respiratory (Allergies, Lungs) • Metabolic (Diabetes, Endocrine Glands, Thyroid, Kidneys) • Nervous System (Neurology) • Pediatrics, OB/GYN • Premium is a free, added value program for UnitedHealthcare members. They don’t enroll for it separately. • IMPORTANT: Premium works a bit differently for some employer groups. See the latter part of this training module for more information.

  4. How do doctors and facilities earn the Premium designation? • Doctors are designated as Premium doctors by meeting fixed standards for quality and efficiency of care. • There are not pre-set numbers of doctors that will be identified as Premium. • On average, 56% meet our designation standards. Of the 56%, approximately 11% are designated quality only and an additional 45% are designated both quality and efficiency. • Doctors and cardiac facilities are evaluated every year using guidelines published by: • State medical boards • National organizations such as the American College of Cardiology • Government sources such as the Center for Medicare Services • Only specialties for which there are published national guidelines for quality of care are evaluated in the UnitedHealth Premium program. • We are working with those specialties that currently do not have national guidelines to support and encourage them to develop these standards. • UnitedHealthcare relies extensively on these external, national guidelines.

  5. How does the designation system work? • UnitedHealth Premium-designated providers meet national standards for quality or quality and efficiency. • Members can identify Premium providers on myuhc.com by the star or stars next to the provider’s name. • Quality • Meets quality standards based on the most up-to-date medical practices, expert doctor advice and performance during care. • Quality and Efficiency • Doctors and cardiac facilities that meet Quality and Efficiency standards are more efficient in providing appropriate testing, medications, procedures and follow-up care. • More efficient doctors typically perform fewer tests and procedures and have lower surgical redo and complication rates • Specialty not evaluated, insufficient data, or designated physician opt-out Text Only

  6. What are the benefits to members? • Informed Choice Provides important information on specialty physicians and hospitals to help make informed choices • Peace of Mind Employees are receiving care from hospitals and physicians that meet or exceed evidence based quality standards and efficiency standards. • Resources at Your Fingertips Easy to access information • Customer Care professionals 24/7 • NurseLine • Myuhc.com • Mychoicenotchance.com • Ease of Use Easily identify and access leading specialty physicians and centers without a referral

  7. How do I find a Premium doctor? • The Premium program will be in approximately 130 markets across the United States by late 2007. • To find a Premium doctor, go to myuhc.com and look under Physicians & Facilities. • When searching, Premium physicians automatically sort to the top. • Member may also select to only search for Premium providers. • A symbol or blank will appear next to each provider. • Members may also call Customer Care or the NurseLine.

  8. V Which companies have additional Premium benefits? • The following companies have tiered plan designs with special member benefits for using Premium providers • Members at these companies enjoy a lower copay or coinsurance for services received with a Premium doctor or hospital. • See employer-specific Benefit Summaries for more details.

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