United HealthCare (Health Maintenance Organization or HMO)
Phone toll free at 1-877-366-0011. Customer Service hours are 8:00 am - 5:00 pm EST, Monday through Friday.
To change your Primary Care Physician (PCP) contact the customer service office.
Verification for Dependent Eligibility 
Beginning July 6, 2009 the state will begin mailing letters to healthcare plan participants alerting them to provide Secova, Inc. with proof of eligibility for all enrolled dependents. The letter explains the process and emphasizes the September 4, 2009 deadline to provide such materials to Secova. Secova will enclose a list of acceptable documentation that members may use to verify the status of their dependents. If proof of coverage is not provided, coverage will stop for the dependent effective December 31, 2009. (Posted 7/1/09)
Tobacco Use Surcharge Delayed until 2011
The Tobacco Use Surcharge has now been delayed for one year. The December 2010 deduction for January 2011 coverage will be the first to include the surcharge for covered employees and spouses who use tobacco products. Although the surcharge has been delayed for a year, the lowered co-payments for tobacco quit aids will still be available until Dec. 31, 2009. You can use your health insurance card to obtain certain prescription drugs and over-the-counter nicotine replacement therapies for very low copay. To use this benefit, you must have a prescription, even for the over-the-counter products. (Posted 7/1/09)
Change in Prescription Coverage
Effective May 1, 2009, the HMO Plan will only cover generics for certain medications that control stomach acid and relieve heartburn. These medications are called proton pump inhibitors, or PPIs, and include brand-name drugs like Aciphex, Nexium, Prevacid, Prilosec, Protonix and Zegerid. Coverage
will continue for generic PPIs such as omeprazole and pantoprazole. The plan will not cover the brand-name drug unless prior authorization is given by United HealthCare to the member's primary care physician. If you have questions, please contact customer service. (Posted 3/31/09)
- Member Home Page
- 2009 Member Handbook
- Comparison of PPO, POS, HMO plans
- Comparison of PPO, POS, HMO premiums
- Forms
- Group Insurance Enrollment Form
- Basic Life Insurance Beneficiary must also be submitted
- Primary Care Physician (PCP) Card must also be submitted. Claims incurred without having a PCP will not be paid.
- Frequently Asked Questions
- Provider Search (select State of Tennessee in the drop-down box) Subscribers to the HMO plan must select a Primary Care Physician (PCP). Claims incurred without having a PCP will not be paid.
- Member Health Programs (prevention & disease management initiatives)
- 2009 Plan Highlights
Primary Care Physician (PCP) coordinates health care services; each family member may choose a different physician. To change your PCP contact the customer service office.
Annual Medical Deductible: None
Annual Medical Out-of-Pocket Maximum: None
Physician Office Visit: $20 copay PCP; $25 copay specialist
Lab & X-Ray: 100% benefit
Maternity: $20 copay PCP; $25 copay specialist
Chiropractic Care: $20 copay per visit
Emergency Room Use: $75 copay per visit (This applies only if not admitted to the hospital.)
Annual Pharmacy Copay Maximum: None
Prescription Drug Copay: 34-day supply at retail pharmacies
Tier 1 (generic drugs): $5 copayment
Tier 2 (preferred brand-name drugs): $25 copayment
Tier 3 (non-preferred brand-name drugs): $75 copayment
Prescription Drug Copay: 100-day supply by mail order or at participating "mail at retail" pharmacies
Tier 1 (generic drugs): $10 copayment
Tier 2 (preferred brand-name drugs): $50 copayment
Tier 3 (non-preferred brand-name drugs): $100 copayment
Diabetic Supplies (strips, lancets, syringes): Coinsurance waived when using In-Network Provider
Diabetic Prescription Drug (oral and insulin): Copay waived for generic and preferred brand when using In-Network Provider; $75 for 30-day supply for non-preferred brand; $100 for 90-day supply for non-preferred brand - Prescription Benefit
Prescriptions may be filled for a single course of treatment up to a 34-day supply by participating pharmacies OR receive a 100-day supply of medication for one copayment from either the home delivery program or a retail pharmacy that participates in the home delivery pharmacy retail network. You will need a written prescription from your doctor for a 100-day supply of medication, with three refills, if appropriate. Phone 1-877-366-0011 to verify participating pharmacies. - Mail at Retail Pharmacies
A 100-day supply of medication may be obtained for one copayment in Hamilton County at Bi-Lo, CVS, KMart, Publix, Rite-Aid, Sam's Club, Target, Walmart; in Catoosa County, GA at Bi-Lo, CVS, KMart, Rite-Aid, Walmart, Walgreens. You will need a written prescription from your doctor for a 100-day supply of medication, with three refills, if appropriate. If you utilize a retail pharmacy that does not participate in the home delivery network, you will only be able to obtain up to a 34-day supply of your medication for one copayment. Phone 1-877-366-0011 to verify participating pharmacies. - Vision Care
Routine vision care limited to one visit/year. Eye exams must be obtained from a Spectera Vision provider. Phone 1-800-638-3120 for a participating provider or view the provider directory, using your Social Security number as the subscriber's identification number. You must use an approved provider to receive benefits for an eye exam and ID card must be presented. Exams performed by an optometrist will be covered for $15 copay. - Chiropractic Care
Chiropractic Care will be covered for $15 copay; maintenance visits not covered when no additional progress is apparent or expected to occur. Phone 1-800-873-4575 for more information about chiropractic care.
