Plan Summary

Deductible: $5,500 Individual / $11,000 Family

Out-of-Pocket: $6,350 Individual / $12,700 Family

Office Visit: 30% once medical deductible is satisfied

Inpatient Hospital: 30% once medical deductible is satisfied

UC / ER/ Major Diag Copay: 30% once medical deductible is satisfied

Pharmacy: Tier 1 $10 / Tier 2 $30 / Tier 3 $50 / Mail Order 2.5x

Core Plan Overview

Consumer-Driven Health

UnitedHealthcare Health Savings Account (HSA)

HSA Overview

UnitedHealthcare’s HSA plans are designed with the new health care consumer in mind. Our HSA plans offer a medical plan, coverage for preventive care and a health care account that members control and access themselves to cover some of the costs of qualified medical expenses. Account-based consumer solutions initiate the transformation from passive health plan members into value-conscious consumers.

HSA features

• Members can manage their medical claims and HSA together online or with a customer care professional.

• Three account types offer balance of interest, account fees and spending. Non-proprietary mutual fund investing is available.

• For greater member convenience, HSAs include a debit card and online bill payment.

• Accounts are administered by Optum Bank,SM Member FDIC. OptumHealth Financial ServicesSM provides educational tools that help both employers and individuals successfully engage in their financial health.

UnitedHealthcare HSA plans help members become more-informed and active health care consumers. By taking ownership of their health and health care spending, employees can also help their employers have more control of their health care costs. Recent studies support the value of HSA-eligible plans in reducing costs and promoting a healthier workplace.

• HSA-eligible plans have shown 20 percent to 30 percent lower-cost-than-average premiums, helping U.S. businesses save money. (1)

• Premium savings for employees with an HSA-eligible plan amount to an average of $852.(2)

• HSA plan members are two to three times more likely to participate in wellness programs than those in non-consumer-driven health plans. (3)

Our wellness offerings include worksite wellness programs, a confidential,(*) personalized health assessment, online and telephonic coaching and personal support.

(1) HSA Insider, HSA Road Rules for Employers, Seventh Edition, May 2008.

(2) 14th Annual National Business Group on Health/Watson Wyatt Survey Report – 2009, “The Effect of the Economic Crisis on Health Care Programs”.

(3) 2006 survey of 212,000 UnitedHealthcare members enrolled in UnitedHealthcare Health Savings Accounts for the full year of 2006.

(*) Confidential to the fullest extent permitted by law.