Presentation: SecureHorizons

SecureHorizons MedicareDirect
NARHC Technical Assistance Conference Call
March 13, 2007

SecureHorizons by UnitedHealthcare
(Live Secure. Be Secure.)

• Since acquiring PacifiCare in 2005, UnitedHealth Group combined the Medicare Advantage plans offered by PacifiCare Secure Horizons, UnitedHealthcare, John Deere Health Care, and Oxford Health into a single national brand called SecureHorizons by UnitedHealthcare.
  
  
• In 2007, the PFFS plan's name changed to SecureHorizons MedicareDirect.

• Although the plan is filed in 1515 counties in 50 states, remember that a PFFS enrollee's benefit plan is not restricted by geography or network affliation.
  
  -- Enrollees can see any "deemed" doctor or hospital, who is Medicare eligible and agrees to the plan's terms, conditions and payment rates.
  
  -- Health care professionals make their "deeming" decision each time they see an enrollee in a PFFS plan and, if it is negative, the enrollee must find another health care professional who agrees to be deemed. The exception is emergency care.
  
  
• Several plans contain Part D prescription coverage but a number of plans do not include drug coverage and these MA-Only Plans can be sold throughout the year after "lock-in".
  
  
• We pay a 5% bonus on the portion of reimbursement based on the Interim Rate Letter.

How to find online 2007 PFFS materials, such as Terms and Conditions, Reimbursement Guide, and Quick Reference:

1. Go to: UnitedHealthcare Online
2. On the top menu: click on "Tools and Resources".
3. On the left menu: click on "Products and Services".
4. On the left menu, below "Products and Services": click on "Medicare".
   (Or click here: UnitedHealthcare Online Medicare)
5. On the main part of the page, under "Secure Horizons": click on "MedicareDirect Private Fee for Service (PFFS) Plans".
   (Or click here: MedicareDirect Private Fee for Service (PFFS) Plans)

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