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Oxford Benefi t Management (OBM)

Member Benefi ts Guide

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Table of contents

Welcome to Oxford Benefi t Management (OBM) . . . 1

Accessing Info . . . 1

Understanding your OBM ID card . . . 1

Dental. . . 2

Vision . . . 3

Optional Life . . . 3

Employee Assistance Program (EAP) with WorkLife Services . . . 4

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1

Welcome to Oxford Benefit Management

Th ank you for selecting this Oxford Benefi t Management (OBM) plan. Our goal is to provide you with a well-balanced package of benefi ts that include dental coverage, vision coverage, employee assistance program (EAP) with WorkLife services and heath discounts.

When you look through this Welcome Brochure, you’ll see that this convenient benefi ts package provides you with a valuable combination of services that you can use to manage the health and well-being for you and your family.

Accessing Info

For more information about your benefi ts, try our Web site, www.oxfordbenefi tmanagement.com. It’s the easiest way to fi nd out about your benefi ts and locate participating providers.

`Visit oxfordbenefi tmanagement.com `Select Member

`Th en, select links in the center, or resources and links along the right side of the member page

Or, if you have questions related to your OBM plan, you can contact OBM Member Services at 800-521-9845 (8:00 AM to 5:00 PM EST) for assistance with:

`Questions on claims and claims payments `Understanding your benefi ts

`Locating a participating provider `Ordering a duplicate member ID card

`Accessing EAP with WorkLife services representatives `Questions about the health discounts

`Answering any other questions you have related to your OBM benefi ts

Understanding your OBM ID Card

Your personal Member ID card contains valuable information for utilizing your OBM benefi ts. On the front of the card, you will fi nd your Member ID number. Refer to this number when you call Member Services and when you access Web site tools, such as those for the discount program.

If you choose to visit an out-of-network dentist or eye care provider, you will fi nd the claims mailing address on the back of your

Member ID card. You can print the Claim form from the OBM Website and mail it to that address for processing.

It is the provider’s responsibility to verify eligibility before providing treatment. Submit Dental claims to:

UnitedHealthcare Dental Attention: Claims Department PO Box 30587

Salt Lake City, UT 84130-0567 Electronic Payer ID # 552133

Submit Vision claims to: UnitedHealthcare Vision Attention: Claims Department PO Box 30978

Salt Lake City, UT 84130 Fax: 248-733-6060

By use of this card, I hereby consent to the release of any information needed by Oxford Benefi t Management, Inc. or third-party vendors.

This plan is underwritten by UnitedHealthcare Insurance Company

Not an Insurance Product

Oxford Benefi t Management Employee Name

Plan: OBM Premier Specialty Option Member ID: 6800000000

Member/Provider Service: 800-521-9845 www.oxfordbenefi tmanagement.com

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Dental

How to access your in-network dental benefi ts:

1. Select a provider from the UnitedHealthcare Dental network. `Visit www.oxfordbenefi tmanagement.com

`Select Member

` Th en, go to the Helpful Links section on the right side of the Member page ` Click on Dental Service Locations to search for an in-network provider 2. Call to schedule an appointment, and be sure to verify the provider’s

participation in the UnitedHealthcare Dental network.

3. At the time of your appointment just show your OBM ID card.

How to access your out-of-network dental benefi ts:

1. You can visit the dental provider of your choice.

2. You will be responsible for paying all costs at the time of service and fi lling out a dental claim form to be reimbursed.

3. To download a dental claim form: ` Visit oxfordbenefi tmanagement.com ` Select Member

` Th en go to the Online Forms section on the right side of the Member page

` Click on the UnitedHealthcare Dental Claim Form to download and print a copy

If you have any questions about your dental benefi ts or need help locating a participating provider, call OBM Member Services at 800-521-9845, and follow the instructions for Dental Benefi ts.

Your dental benefits

include:

• Fully insured dental coverage: Coverage for preventive and diagnostic procedures such as cleanings, X-rays and routine examinations

• Innovative preventive care programs with coverage for prenatal dental care for women in their second and third trimester, for additional preventive and periodontal services with no out-of-pocket costs, and coverage for oral cancer screening • Access to large national network

of more than 185,000 participating dentists and specialists

How to access dental benefi t and claims information:

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3

Vision

How to access your vision benefi ts

1. Select a provider from the UnitedHealthcare Vision network. ` Visit oxfordbenefi tmanagement.com

`Select Member

`Click on Vision Service Locations, on the right side of the Member page under Helpful Links to search for an in-network provider.

` You’ll be able to search for a network provider by your ZIP code. Next to each provider listing you will fi nd symbols that indicate whether the provider off ers eye exams only, dispenses vision care products only, or does both. You can also print directions to the provider location.

2. Call to schedule an appointment and be sure to identify yourself as having UnitedHealthcare Vision coverage. Doing so will better assist the provider in verifying eligibility and obtaining authorization prior to your appointment. 3. At the time of your appointment:

`Just show your OBM Member ID card

`You are only responsible for your copayments and certain patient options – such as tints and coatings or choosing non-selection frames

`Th ere are no claim forms to submit and no referral forms are necessary for covered services when obtained from a participating provider

If you have any questions about your vision benefi ts or need help locating a participating provider, call OBM Member Services at 800-521-9845, and follow the instructions for Vision Benefi ts.

Optional Life

OBM off ers an optional basic employee life insurance off ering that includes a modest life insurance benefi t amount. Your employer may or may not have included this option in your benefi t plan. In addition, a benefi ciary service, which off ers greif consultation and fi nancial/legal assistance services for benefi ciaries, is automatically included in the Life benefi t at no additional cost.

If you have any questions about your Optional Life insurance benefi ts, call OBM member services at 800-521-9845.

Your Vision benefits

include:

• Comprehensive annual eye exams • Allowances toward frames and

lenses, or contacts in lieu of eyeglasses

• National network of more than 34,000 private practice and retail chain providers conveniently located near work or home

• Discounts on many popular services

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Employee Assistance Program (EAP) with WorkLife Services

EAP with WorkLife services is a benefi t that helps reduce stress involved with managing a wide variety of personal and family matters. And, because your needs change over time, not only are our consultations and referrals available but you can also have access to an abundance of online resources 24/7!

Your EAP with WorkLife Services benefi t includes: `Child/Parenting Support Services

`Adult/Elder Support Services `Chronic Condition Support Services

`In addition to the consultative and referral services, you also have 24/7 access to an abundance of online resources

How to access your EAP with WorkLife service benefi ts:

To reach a counselor and resources call 800-521-9845 or: `Visit oxfordbenefi tmanagement.com

`Select Member

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5

Health Discounts

Now you can take advantage of great discounts for services and products not paid for by your insurance. Th rough the OBM health discount program, powered by UnitedHealth Allies, you will enjoy savings of 5 to 50 percent on hundreds of health care products and services, such as:

`Lasik eye surgery `Cosmetic dentistry

`Alternative care, including acupuncture, chiropractic and massage therapy

`Smoking cessation

`Weight management from Jenny Craig®, NutriSystem® and others

` Fitness clubs, including locations of many popular chains ` Infertility treatment

You’ll also get special member discounts on products from dozens of brand-name retailers in the online Marketplace. Save on fi tness apparel, vitamins, exercise equipment, home medical supplies and many more family health and wellness needs.

Using the discount program

Keep in mind that the discount program is not insurance and you should always use your insurance for covered services. Instead, rely on the discount program to help you save on many health care products and services not paid for by insurance.

How to fi nd participating providers and use your health discounts benefi ts

` Visit oxfordbenefi tmanagement.com ` Select Member

` In the Service Locator section on the right of the member page, click on the Heatlh Discounts link. First-time users should follow the New Member/Create Account instructions, inputting the member ID number from your OBM ID card. Select a category (such as

Alternative Care) and a specialty, such as Massage Th erapy, to search for providers by ZIP code.

` Click Details to learn more about a participating provider.

When you have selected the health care provider you would like to visit, click Select Provider to get a discount confi rmation. Th e discount confi rmation introduces you to the provider or facility and helps ensure yo get your discount. It also contains the provider’s telephone number so you can call to make an appointment.

If you choose to make an appointment with the provider, be sure to bring your discount confi rmation and your OBM member ID card with you to your visit.

At your appointment, pay the discounted rate directly to the provider. Remember, the discount program is not insurance and you are responsible for paying the discounted cost at the time of your visit.

To purchase health- and wellness-related products from the online Marketplace, no confi rmation is necessary. Simply follow the on-screen instructions to get your discount. You may need to input a discount code; or the discount may be automatically applied at checkout.

If you have questions related to your health discounts benefi t, call OBM member Services at 800-521-9845.

When to use your health discount program

Is the health product or service paid for by insurance? `If the answer is “yes”, use your medical, vision or dental

insurance to pay for the product service.

`If the answer is “yes,” but you have reached the limits of your insurance, you can use the discount program to save on products and services above or beyond the limits of your insurance*. For example, if your medical insurance covers only a limited number of chiropractic visits, you can use the discount program to save on additional visits to a participating chiropractor.

`If the answer is “no,” use the discount program to save on the product or service.

Remember:

`You must choose provider from the discount network in order to get the discount.

`Always use your dental and vision insurance for covered services.

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Disclosure: The UnitedHealth Allies®, health discount program is administered by HealthAllies®, Inc., a discount medical

plan organization located at 505 N. Brand Blvd., Suite 850, Glendale, CA, 91203, 1-800-860-8773. The health discount program is NOT insurance. The health discount program provides discounts at certain providers for health products and services. The health discount program does not make payments directly to the providers of health products and services. The program member is obligated to pay for all health products and services but will receive a discount from those providers who have contracted with the discount plan organization.

Oxford Benefi t Management packages are not available in all states and state-specifi c requirements may cause limitations or variations to the plans. Packaged Savings is not available for this product. Benefi t options may vary by group size. Components subject to change.

Oxford Benefi t Management products are provided through the following partners: UnitedHealthcare Dental coverage provided by or through United HealthCare Insurance Company, United HealthCare Insurance Company of New York, or its affi liates. Administrative services provided by Dental Benefi t Providers, Inc., Dental Benefi t Administrative Services, United HealthCare Services, Inc. or their affi liates.

UnitedHealthcare VisionSM coverage provided by or through United HealthCare Insurance Company, United HealthCare Insurance Company of New York, or its affi liates. Administrative services provided bySpectera, Inc.., United Healthcare Services, Inc. or their affi liates.

References

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