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State of Connecticut • 2013/2014 Benefit Enrollment Guide • welcometouhc.com/stateofct

Dear State of Connecticut employee or retiree,

We realize that you have a choice in your health benefit plan, and we want State of Connecticut employees and retirees to have a positive experience with UnitedHealthcare. We look forward to serving you and your family in 2013 – 2014.

If you have questions or need more in-depth information about our medical plans, please call our designated customer service team at 800-760-4566 (pre-enrollment) or 800-385-9055 (post-enrollment), or visit welcometouhc.com/stateofct. For dental plan questions, call 800-896-4834 or visit myuhcdental.com/statect.

Sincerely,

Stephen Farrell

CEO, UnitedHealthcare of New England, Inc.

Our NetworkUnitedHealthcare offers a robust local and national network. Nationally and in the tri-state area, we have a vast number of physicians, healthcare professionals and hospitals. For years, our members have accessed our Connecticut, New York and New Jersey tri-state network. Whichever plan you choose, you’ll have seamless access to our UnitedHealthcare Choice Plus Network of physicians and healthcare professionals outside of the tri-state area. This gives State of Connecticut employees and retirees better access to care whether you are in Connecticut, traveling outside the tri-state area or living somewhere else in the country.

For more information about our network or to search for physicians participating in our local and UnitedHealthcare Choice Plus Network, please visit welcometouhc.com/stateofct.

Custom Website A website created for State of Connecticut employees and retirees that provides important tools and data to help you make informed healthcare decisions. Visit your custom website today at

welcometouhc.com/stateofct to search for a doctor or hospital, or learn about the health plans being offered. You may access Health Enhancement Program information at cthep.com, or by phone at 877-687-1448.

Discounts and Special OffersAt UnitedHealthcare, we know that staying well involves more than just visits to the doctor’s office; it is also important to stay active, maintain a healthy weight and manage stress levels. Through the Healthy Bonus programs, we offer access to discounts and special offers on products and services to help you achieve these goals — all at no additional cost.

For information on these discounts and special offers, please visit welcometouhc.com/stateofct.

Medical

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How Do I know Which Plan is Best for Me?We realize that one plan does not fit all, so we’ve created two plans to choose from: the Enhanced Plan and the Basic Plan. With both plans, you have access to in- and out-of-network dentists. However, you may have lower out-of-pocket costs when you visit a participating network dentist. To learn more, compare the options below.

Basic Plan You can visit any dentist or dental specialist,

without a referral

Preventive services covered at 80%, including oral cancer screening

HEP enrollees covered 100% for two cleanings per year

No deductibles

Enhanced Plan Flexibility to seek care outside of the

network with higher out-of-pocket member costs. Non-network payments are paid at the maximum allowable charge (MAC)

Realize cost savings per procedure by utilizing a network dentist or specialist

All preventive services covered at 100% in-network, including oral cancer screening

Coverage for orthodontics, bridges and dentures for adults and children

Comparison of Basic and Enhanced Plans

Basic Dental Plan

Basic Dental Plan with HEP

Enhanced Dental Plan

NetworkNetwork with HEP

Out-of-NetworkOut-of-Network

with HEP

Calendar year deductible (waived for preventive and diagnostic); does not apply to orthodontics

Not applicable Not applicable $25 individual / $75 family $25 individual / $75 family

Calendar year maximum (combined for network and out-of-network); does not apply to orthodontics

Not applicable Not applicable $3,000 $3,000

Periodontics annual maximum $500 per

calendar year

Annual maximum waived for certain

periodontal procedures

Included with calendar year maximum waived on certain procedures for

HEP enrollees

Included with calendar year maximum waived on certain procedures for

HEP enrollees

Cleanings 80% 100% 100% network only 100% network only 100% of MAC 100% of MAC

Sealants Not covered Not covered 100% network only 100% network only 100% of MAC 100% of MAC

Orthodontics lifetime maximum (combined for network and out-of-network)

Not applicable Not applicable $1,500 $1,500

Consumer MaxMultiplierSM Not applicable Not applicable Yes Yes

Prenatal Dental Yes Yes Yes Yes

UnitedHealthcare Dental® Options PPO Plan is underwritten by UnitedHealthcare Insurance Company, Hartford, CT.

Dental

Customer service and website features

Our designated customer service center is available via phone at 800-896-4834, 8:00 a.m. – 11:00 p.m. EST, for benefit, claim and provider questions. Additionally, you can obtain provider listings, access to our treatment cost estimator and provider nomination form on our website for State of Connecticut employees and retirees at myuhcdental.com/statect.

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Insurance coverage provided by or through: UnitedHealthcare Insurance Company, UnitedHealthcare Insurance Company of New York, or their affiliates. Administrative services provided by Oxford Health Plans LLC. Oxford HMO products are administered by Oxford Health Plans (CT), Inc. Oxford insurance products are administered by Oxford Health Insurance, Inc.

Healthy Bonus offers are not insured benefits and are in addition to, and separate from, your Oxford benefit coverage. These arrangements have been made for the benefit of members, and do not represent an endorsement or guarantee on our part. Offers may change from time to time and without notice and are applicable to the items referenced only. Offers are subject to the terms and conditions imposed by the vendor. We cannot assume any responsibility for the products or services provided by vendors or the failure of vendors referenced to make available discounts negotiated with us; however, any failure to receive offers should be reported to Oxford Customer Service by calling the telephone number on your Oxford member ID Card.

UnitedHealthcare Dental® coverage provided by or through UnitedHealthcare Insurance Company, located in Hartford, Connecticut, or its affiliates. Administrative services provided by Dental Benefit Providers, Inc., Dental Benefit Administrative Services (CA only), United HealthCare Services, Inc. or their affiliates.

CT-13-285 9509 R7

welcometouhc.com/stateofctmyuhcdental.com/statect

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