2011 Enrollment Kit

Hospitals Doctors Rx Drugs

convenient
$0 monthly plan premium

OnE

plan

AARP® MedicareComplete ® Plus (HMO-POS)
H2182-001

Georgia: Chatham, Cherokee, Clayton, Cobb, DeKalb, Forsyth, Fulton counties

Y0004Y0066_100707_142434 CMS Approved 08202010

What You’ll Find in this Booklet
Cover Letter.........................................................................1 Medicare Advantage Explained............................................3 Benefits at a Glance.............................................................4 Passport Brochure...............................................................6 Ready to Enroll.................................................................... 8 Summary of Benefits............................................................9 Additional Plan Information .....................................33 - Appeals & Grievances............................................35 - Plan Ratings.......................................................... 37 - Dental Platinum Rider............................................39 - Fitness Rider..........................................................41 - Disclaimers............................................................43 Pharmacy Options Enrollment Materials - Outbound Education & Verification Call Checklist (See back of Enrollment Materials Divider) - Scope of Appointment Form Enrollment Form Roadmap After Enrollment ..........................................45 - Drug List................................................................47

Health Care to Fit Your Needs…

now that is peace of mind

At UnitedHealthcare we realize more than ever the importance of affordable health care coverage. We are dedicated to helping you make the right choices by providing quality, costeffective health care solutions. As one of the largest and most recognized health carriers in the United States, you can be confident we will be here when you need us.

We Make Health Care Simple…
and provide the answers you need
INSIDE THIS BOOKLET:
• Understand the basics of Medicare Advantage • Learn how our plans can benefit you • View plan details and how they compare to your Original Medicare

use our Medicare Advantage Programs
• Start your application process • Continue on your path to good health

ONE out of FIVE Medicare members

• Look up your medications

We’re Here For You
Y0035Y0066_100624_153203 CMS Approved 08032010
Talk with your local sales agent. Health care is personal. Your agent will answer your questions and help you enroll.

If you don’t have a local sales agent, call SecureHorizons toll-free: x-xxx-xxx-xxxx, <8 a.m.– 1-800-547-5514, 8a.m. – 8 p.m. local time, 7 days a week>. week. TTY users, call 711.
Go online: www.AARPMedicarePlans.com. <WebsiteAddress>. Thank you for your interest in this plan. The world of Medicare can be confusing, but we’re here to help. Together we’ll find a plan that’s right for you. Sincerely,

Thomas S. Paul Chief Executive Officer, UnitedHealthcare Medicare Solutions

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You may contact 1-800-MEDICARE (1-800-633-4227) and TTY users should call 1-877-486-2028, 24 hours a day, 7 days a week or visit www.medicare.gov for more information about Medicare benefits and services including general information regarding health and Part D benefit. The AARP® MedicareComplete® plans are SecureHorizons® plans insured or covered by an affiliate of UnitedHealthcare Insurance Company, a Medicare Advantage organization with a Medicare contract. AARP MedicareComplete plans carry the AARP name, and UnitedHealthcare pays a royalty fee to AARP for use of the AARP intellectual property. Amounts paid are used for the general purpose of AARP and its members. AARP is not the insurer. You do not need to be an AARP member to enroll. AARP does not recommend health related products, services, insurance or programs. You are strongly encouraged to evaluate your needs. This document is available in alternative formats. You must have both Medicare Part A and B, and must reside in the service area of the plan. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party. Your ability to enroll may be limited certain times of the year. For more information contact Customer Service at 1-800-547-5514 7 days a week, between 8:00 a.m. and 8:00 p.m. local time. TTY users can call 711 or write us at P.O. Box 29675, Hot Springs, AR 71903-9675, or go to www.AARPMedicarePlans.com. You must use plan providers except in emergency or urgent care situations or for out-of-area renal dialysis. If you obtain routine care from out-of-network providers neither Medicare nor AARP MedicareComplete RX plans will be responsible for the costs. For PPO and HMO-POS members, with the exception of emergency or urgent care or out-of-area renal dialysis, it may cost more to get care from out-of-network providers. For PPO members, reimbursement is provided for all covered benefits regardless of whether they are received in network. Out of network services may cost more than in network services. You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week; Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778; or your State Medicaid Office. The Medicare Prescription Drug benefit is only available to members of the Medicare Advantage with Prescription Drug (MA-PD) plans. By enrolling in an MA-PD you will automatically be disenrolled from any existing Medicare Prescription Drug coverage. To receive the highest level of benefit you must use contracted network pharmacies to access your prescription drug benefit except in the case of emergency. The pharmacy network includes retail, mail order, long-term care, home infusion and I/T/U (Indian Health Service, Tribes, or Urban Indian) pharmacy services. You may obtain your prescriptions from pharmacies outside the contracted network at a reduced benefit. Quantity limitations and restrictions may apply. For more information about mail order, names and addresses of network pharmacies or for more information call 1-800-547-5514, or TTY 711, Monday through Friday, 8:00 a.m. to 8:00 p.m. local times. Or write us at P.O. Box 29675, Hot Springs, AR 71903-9675, or go to www.AARPMedicarePlans.com. The AARP ® MedicareComplete® benefit packages, plan premiums, copayments/coinsurance may vary by county, and service areas are all subject to change annually at the Medicare Advantage contract renewal time with the Centers for Medicare & Medicaid Services (January 1). Availability of coverage beyond the end of the current year is not guaranteed.

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Medicare Advantage Explained
Medicare is health insurance for people 65 and older and others with certain disabilities. You have choices about how you get your Medicare coverage. You can choose Original Medicare (Parts A and B) or a Medicare Advantage plan. Many people with Original Medicare find there are expenses that are not covered. To help pay for some of these additional costs, many people choose to enroll in a Medicare Advantage plan.

Original Medicare consists of Medicare Parts A and B
• Part A helps with hospital costs • Part B helps with doctor services and outpatient care • Part D (optional add-on) stand-alone prescription drug plans can be added to help with the cost of prescription drugs • Most preventive care services are not covered – expect to pay additional costs for these services • Original Medicare has unpredictable out-of-pocket expenses

Original Medicare (Parts A and B) Operated by the Federal government. Medicare pays fees for your care directly to the doctors and hospitals you visit

=

PAR T

A

PAR T

B

+

PAR T

D

Original Medicare

Optional Plan You Can Add

Medicare Advantage (Part C) Combines Your Coverage into ONE Plan
[CMSCODE] Y0004Y0066_100722_192352 File & Use 08092010 • Medicare Advantage plans cover at least the same services as Parts A and B • Prescription drug coverage (Part D) is included in many Medicare Advantage plans • Preventive care services like dental, vision, hearing and foot care may be included at no extra charge • Medicare Advantage plans have predictable out-of-pocket expenses

Operated by private companies approved by Medicare. Individuals must have both Parts A and B to enroll. You pay a low or no additional monthly plan premium beyond the Medicare Part B premium

=

PA R T

C

+

PA R T

D

+
Other Services May Be Included

Prescription Drug Coverage

Medicare Advantage plans may be a lower-cost alternative to Original Medicare. Medicare Advantage can offer extra preventive benefits and prescription drugs all in ONE convenient plan. Plan is insured or covered by UnitedHealthcare Insurance Company or one of its affiliates, a Medicare Advantage Organization with a Medicare contract. OVEX11MP3244608_000 3 3

Benefits at a Glance
This plan is a Health Maintenance Organization (HMO) with a Point-of-Service (POS) option plan or HMO-POS. HMO-POS plans provide care through a network of local doctors and hospitals, and the POS plans may provide covered services out-of-network. HMO-POS plans may be a good fit for someone looking for predictable cost shares, benefits above Original Medicare, and the freedom to receive out-of-network services.

Benefit
Monthly plan premium Deductible

In-Network
$0 None $0 copay $0 copay $0 copay $10 copay $35 copay (No Referral Needed) $295 copay per day: days 1-7. $0 thereafter. 20% coinsurance $30 copay $50 copay $200 copay $0 copay $100 copay per day: days 1-34. $0 copay $10 copay 0% - 20% coinsurance 20% coinsurance $16 copay $3380 $0 31-day retail supply $5 $45 $85 33% No Coverage

Out-of-Network

Medical Coverage
Annual physical Preventive services (Medicare-covered) Immunizations (pneumonia and flu) Primary Care Physician (PCP) office visit Specialist office visit Inpatient hospitalization Outpatient surgery and hospital services Urgently needed care Emergency care Ambulance services Home health care Skilled nursing facility (SNF) care Lab services: HIV & cardiovascular screenings All other lab services Diagnostic testing: EKG & AAA screenings All other diagnostic tests X-rays Annual out-of-pocket maximum $15 copay 30% coinsurance $0 copay $15 copay $40 copay $325 copay per day for unlimited days. 30% coinsurance $40 copay $50 copay $200 copay 30% coinsurance $175 copay per day: days 1-40. $0 - $10 copay $10 copay 30% coinsurance 30% coinsurance $21 copay Unlimited

Prescription Drugs
Prescription drug deductible Initial coverage stage n Tier 1: n Tier 2: n Tier 3: n Tier 4: Coverage gap stage (after prescription costs paid reach $2840) Catastrophic coverage stage (after you have paid $4550 out-of-pocket) 90-day mail order supply $10 $125 $245 33%

The greater of $2.50 for generic, $6.30 for brand-name, or 5%

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To verify your provider is in the plan’s network or for additional plan information visit us online at www.AARPMedicarePlans.com

Y0004Y0066_100622_141023 CMS Approved 08032010

Also included in this plan
Foot care Vision services

In-Network

Out-of-Network

Hearing services

UnitedHealth Passport® Program NurselineSM

$35 copay for 6 visits per year* $40 copay for 6 visits per year* $0 copay for Medicare-covered $40 copay for Medicare-covered glaucoma screening glaucoma screening $35 copay for routine exams; 1 $40 copay for routine exams; 1 per year* per year* $30 copay for coverage up to No coverage for eyewear $70 every 2 years for frames (standard lenses included) or $105 for contact lenses $0 copay for Epic Hearing $40 copay for annual hearing Healthcare provider or $35 test* copay for other network provider No coverage for hearing aids for annual hearing test* $300 hearing aids allowance every 2 years Included in this plan. See the Passport brochure in this booklet for more information. Speak with a registered nurse (RN) 24 hours a day $32 additional monthly premium See the “Additional Information” section for more information $13 additional monthly premium See the “Additional Information” section for more information

Optional additional plan coverage
Dental Platinum Rider Fitness Rider

* Benefit combined in and out-of-network The benefit information provided here in is a brief summary, not a comprehensive description of benefits. For more information contact the plan or review the Summary of Benefits provided within this booklet for more benefit information.

Plan is insured or covered by UnitedHealthcare Insurance Company or one of its affiliates, a Medicare Advantage Organization with a Medicare contract. To verify your provider is in the plan’s network or for additional plan information visit us online at www.AARPMedicarePlans.com 5

The 2011 UnitedHealth Passport Program
®

The UnitedHealth Passport® Program is Included in Your Plan.
You pay no additional charge (beyond your monthly health plan premium) for health care coverage while you travel within the UnitedHealth Passport® service area. Simply pay the same copay or coinsurance as you would at home to receive non‑emergency care benefit coverage when traveling within the service area, including preventive care, specialist care and hospitalizations. Emergency care is covered worldwide. The gray states on the map to the right show the states in which there are UnitedHealth Passport® service areas. If you are a plan member who resides within one of the counties in this list, you are eligible to participate in the UnitedHealth Passport Program. If you travel to any of the counties on this list, you will be able to use the Passport benefit to access routine and preventive care as needed. Alabama Autauga, Baldwin, Bibb, Blount, Chilton, Elmore, Jefferson, Lowndes, Macon, Mobile, Montgomery, Russell, Shelby, St. Clair, Walker Arizona Cochise, Graham, Maricopa, Pima, Pinal, Santa Cruz, Yavapai Arkansas Benton, Carroll, Crawford, Sebastian, Washington Connecticut1 All Counties in the State of Connecticut Florida All Counties in the State of Florida Georgia Chatham, Cherokee, Clayton, Cobb, Columbia, DeKalb, Forsyth, Fulton, Harris, Muscogee, Rich‑ mond Hawaii All Counties in the State of Hawaii Idaho Ada, Canyon Illinois Bureau, Carroll, Cook, Henderson, Henry, Jersey, Jo Daviess, Kane, Knox, Madison, Marshall, Mercer, Monroe, Peoria, Putnam, Rock Island, Stark, St. Clair, Tazewell, Warren, Whiteside, Will, Woodford Indiana Adams, Allen, Boone, Fulton, Hamilton, Hancock, Hendricks, Huntington, Johnson, Kosciusko, Madi‑ son, Marion, Noble, Posey, St. Joseph, Vanderburgh, Warrick, Wells, Whitley

Kansas Johnson, Sedgwick

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To verify your provider is in the plan’s network or for additional plan information visit us online at www.AARPMedicarePlans.com

Y0066_100716_122643 File & Use 08032010

Iowa Appanoose, Benton, Black Hawk, Boone, Bremer, Buchanan, Butler, Cedar, Chickasaw, Clarke, Clayton, Clinton, Crawford, Dallas, Davis, Delaware, Des Moines, Dubuque, Fayette, Floyd, Greene, Grundy, Guthrie, Hamilton, Hardin, Henry, Iowa, Jackson, Jasper, Jefferson, Johnson, Jones, Keokuk, Lee, Linn, Louisa, Lucas, Madison, Mahaska, Marion, Marshall, Monroe, Muscatine, Page, Polk, Pottawattamie, Poweshiek, Scott, Shelby, Story, Tama, Van Buren, Wapello, Warren, Washington, Wayne

Kentucky Boone, Campbell, Kenton Maine Cumberland, Kennebec, Sagadahoc, York Massachusetts All Counties in the State of Massachusetts Michigan Allegan, Kent, Ottawa Missouri Barry, Cass, Christian, Cole, Crawford, Dade, Dallas, Douglas, Franklin, Gasconade, Greene, Jackson, Jefferson, Laclede, Lafayette, Lawrence, Lincoln, McDonald, Polk, St. Charles, St. Louis, St. Louis City, Stone, Texas, Warren, Washington, Webster, Wright Nebraska Burt, Cass, Douglas, Otoe, Sarpy, Washington New Mexico Dona Ana, Grant, Hidalgo, Luna, Sierra New York1 All Counties in the State of New York North Carolina Alamance, Caswell, Catawba, Chatham, Cumberland, Davidson, Davie, Durham, Forsyth, Guilford, Haywood, Henderson, Iredell, Mecklenburg, Orange, Person, Randolph, Rockingham, Rowan, Stokes, Surry, Wake, Wilkes, Yadkin Ohio Butler, Clark, Clermont, Cuyahoga, Delaware, Franklin, Greene, Hamilton, Madison, Mahoning, Montgomery, Preble, Stark, Summit, Trumbull, Warren Oregon2 Clackamas, Lane, Marion, Multnomah, Washington, Yamhill Pennsylvania Erie, Lancaster, Lehigh, Northampton, York

Rhode Island All Counties in the State of Rhode Island South Carolina Beaufort, Charleston, Greenville, York Tennessee Anderson, Blount, Bradley, Campbell, Carter, Claiborne, Cocke, Davidson, DeKalb, Fayette, Grainger, Greene, Hamblen, Hamilton, Hancock, Hawkins, Hickman, Jefferson, Johnson, Knox, Loudon, McMinn, Meigs, Monroe, Morgan, Roane, Rutherford, Scott, Sevier, Shelby, Sullivan, Tipton, Unicoi, Union, Washington Texas Austin, Brazoria, El Paso, Fort Bend, Hardin, Harris, Jefferson, Liberty, Montgomery Utah Box Elder, Cache, Davis, Morgan, Salt Lake, Summit, Tooele, Utah, Wasatch, Weber Vermont All Counties in the State of Vermont Virginia Bland, Botetourt, Bristol City, Buchanan, Chester‑ field, Craig, Dickenson, Floyd, Franklin, Goochland, Grayson, Lee, Hanover, Henrico, Montgomery, Newport News City, Norfolk City, Norton City, Ports‑ mouth City, Radford City, Richmond City, Roanoke, Roanoke City, Russell, Salem City, Scott, Smyth, Tazewell, Washington, Wise, Wythe Washington Skagit, Spokane, Whatcom Wisconsin Brown, Calumet, Dodge, Fond Du Lac, Green Lake, Kewaunee, La Crosse, Manitowoc, Milwaukee, Monroe, Oconto, Outagamie, Ozaukee, Racine, Shawano, Sheboygan, Trempeleau, Vernon, Washington, Waukesha, Waupaca, Waushara, Winnebago

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Members of HMO plans H3307 in New York as well as Point of Service plans H0752 in Connecticut and H3107 in New Jersey may access Passport services in the state of Florida only. The H3805 HMO plans in the Oregon counties of Clackamas, Lane, Marion, Multnomah and Washington do not participate in UnitedHealth Passport. Therefore, members of these plans are not eligible to participate in the program. Plan is insured or covered by UnitedHealthcare Insurance Company or one of its affiliates, a Medicare Advantage organization with a Medicare contract. 3 7

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Ready to Enroll?
Things to Do Before You Enroll:
Review the benefit information in this booklet. You may choose to contact your doctor to confirm if he or she is in the network or you may ask your sales agent to check for you. For a complete list of plan providers, visit our Web site.

an informed

makE

CHOICE

Check the Drug List in this booklet to see if your medications are included. Visit our Web site for a detailed listing of prescription medications. (for MAPD plans) Have your Original Medicare ID card ready or other proof that states you are eligible for Medicare. This information will help you fill out the Enrollment Form.

I’m a Member…What’s Next?
Enjoy Peace of Mind with One Convenient Plan
After Medicare approves your enrollment you will receive your Welcome Letter, New Member Kit and your Member ID card.

This is a sample card; your card may look different.

Customer service phone number is located on the back of your card. Please secure your Original Medicare card in a safe place.

www.myaaRPmedicare.com
Register online to view your personal information, plan details, coverage summaries, payment history, options and claims. Plan is insured or covered by UnitedHealthcare Insurance Company or one of its affiliates, a Medicare Advantage organization with a Medicare contract.

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Y0066_100720_090630 File & Use 08102010

Summary of

Benefits
H2182-001

January 1, 2011 — December 31, 2011

AARP® MedicareComplete® Plus (HMO-POS)
Georgia: Chatham, Cherokee, Clayton, Cobb, DeKalb, Forsyth, Fulton counties

AAGA11PO3240581_000 H0755Y0066_100816EA01_SB_MAMAPD CMS Approved 09082010

Section I - Introduction to Summary of Benefits
Thank you for your interest in AARP MedicareComplete Plus (HMO-POS). Our plan is offered by UNITEDHEALTHCARE INSURANCE COMPANY/SecureHorizons by UnitedHealthcare, a Medicare Advantage Health Maintenance Organization (HMO), with a point-of-service option (POS). This Summary of Benefits tells you some features of our plan. It doesn't list every service that we cover or list every limitation or exclusion. To get a complete list of our benefits, please call AARP MedicareComplete Plus (HMO-POS) and ask for the "Evidence of Coverage".

You Have Choices in Your Health Care
As a Medicare beneficiary, you can choose from different Medicare options. One option is the Original (fee-for-service) Medicare Plan. Another option is a Medicare health plan, like AARP MedicareComplete Plus (HMO-POS). You may have other options too. You make the choice. No matter what you decide, you are still in the Medicare Program. You may join or leave a plan only at certain times. Please call AARP MedicareComplete Plus (HMO-POS) at the number listed at the end of this introduction or 1-800-MEDICARE (1-800-633-4227) for more information. TTY/TDD users should call 1-877-486-2048. You can call this number 24 hours a day, 7 days a week.

How Can I Compare My Options?
You can compare AARP MedicareComplete Plus (HMO-POS) and the Original Medicare Plan using this Summary of Benefits. The charts in this booklet list some important health benefits. For each benefit, you can see what our plan covers and what the Original Medicare Plan covers. Our members receive all of the benefits that the Original Medicare Plan offers. We also offer more benefits, which may change from year to year.

Where is AARP MedicareComplete Plus (HMO-POS) Available?
The service area for this plan includes: Chatham, Cherokee, Clayton, Cobb, DeKalb, Forsyth, Fulton Counties, GA. You must live in one of these areas to join the plan.

Who is Eligible to Join AARP MedicareComplete Plus (HMO-POS)
You can join AARP MedicareComplete Plus (HMO-POS) if you are entitled to Medicare Part A and enrolled in Medicare Part B and live in the service area. However, individuals with End Stage Renal Disease are generally not eligible to enroll in AARP MedicareComplete Plus (HMO-POS) unless they are members of our organization and have been since their dialysis began.

Can I Choose My Doctors?
AARP MedicareComplete Plus (HMO-POS) has formed a network of doctors, specialists, and hospitals. You can use any doctor who is part of our network. In some cases, you may also go to doctors outside of our network. The health providers in our network can change at any time. You can ask for a current Provider Directory or for an up-to-date list visit us at www.AARPMedicarePlans.com Our customer service number is listed at the end of this introduction.

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What Happens if I go to a Doctor Who's Not in Your Network?
You can go to doctors, specialists, or hospitals in or out of network. You may have to pay more for the services you receive outside the network, and you may have to follow special rules prior to getting services in and/or out of network. For more information, please call the customer service number at the end of this introduction.

Where can I Get My Prescriptions if I Join This Plan?
AARP MedicareComplete Plus (HMO-POS) has formed a network of pharmacies. You must use a network pharmacy to receive plan benefits. We may not pay for your prescriptions if you use an out-of-network pharmacy, except in certain cases. The pharmacies in our network can change at any time. You can ask for a pharmacy directory or visit us at www.AARPMedicarePlans.com Our customer service number is listed at the end of this introduction. AARP MedicareComplete Plus (HMO-POS) has a list of preferred pharmacies. At these pharmacies, you may get your drugs at a lower co-pay or co-insurance. You may go to a non-preferred pharmacy, but you may have to pay more for your prescription drugs.

Does My Plan Cover Medicare Part B or Part D Drugs?
AARP MedicareComplete Plus (HMO-POS) does cover both Medicare Part B prescription drugs and Medicare Part D prescription drugs.

What is a Prescription Drug Formulary?
AARP MedicareComplete Plus (HMO-POS) uses a formulary. A formulary is a list of drugs covered by your plan to meet patient needs. We may periodically add, remove, or make changes to coverage limitations on certain drugs or change how much you pay for a drug. If we make any formulary change that limits our members' ability to fill their prescriptions, we will notify the affected enrollees before the change is made. We will send a formulary to you and you can see our complete formulary on our Web site at www.AARPMedicarePlans.com If you are currently taking a drug that is not on our formulary or subject to additional requirements or limits, you may be able to get a temporary supply of the drug. You can contact us to request an exception or switch to an alternative drug listed on our formulary with your physician's help. Call us to see if you can get a temporary supply of the drug or for more details about our drug transition policy.

How Can I Get Extra Help With My Prescription Drug Plan Costs or Get Extra Help With Other Medicare Costs?
You may be able to get extra help to pay for your prescription drug premiums and costs as well as get help with other Medicare costs. To see if you qualify for getting extra help, call: * 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day/7 days a week and see www.medicare.gov 'Programs for People with Limited Income and Resources' in the publication Medicare & You. * The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call 1-800-325-0778 or * Your State Medicaid Office.

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What Are My Protections in This Plan?
All Medicare Advantage Plans agree to stay in the program for a full year at a time. Each year, the plans decide whether to continue for another year. Even if a Medicare Advantage Plan leaves the program, you will not lose Medicare coverage. If a plan decides not to continue, it must send you a letter at least 90 days before your coverage will end. The letter will explain your options for Medicare coverage in your area. As a member of AARP MedicareComplete Plus (HMO-POS), you have the right to request an organization determination, which includes the right to file an appeal if we deny coverage for an item or service, and the right to file a grievance. You have the right to request an organization determination if you want us to provide or pay for an item or service that you believe should be covered. If we deny coverage for your requested item or service, you have the right to appeal and ask us to review our decision. You may ask us for an expedited (fast) coverage determination or appeal if you believe that waiting for a decision could seriously put your life or health at risk, or affect your ability to regain maximum function. If your doctor makes or supports the expedited request, we must expedite our decision. Finally, you have the right to file a grievance with us if you have any type of problem with us or one of our network providers that does not involve coverage for an item or service. If your problem involves quality of care, you also have the right to file a grievance with the Quality Improvement Organization (QIO) for your state. Please refer to the Evidence of Coverage (EOC) for the QIO contact information. As a member of AARP MedicareComplete Plus (HMO-POS), you have the right to request a coverage determination, which includes the right to request an exception, the right to file an appeal if we deny coverage for a prescription drug, and the right to file a grievance. You have the right to request a coverage determination if you want us to cover a Part D drug that you believe should be covered. An exception is a type of coverage determination. You may ask us for an exception if you believe you need a drug that is not on our list of covered drugs or believe you should get a non-preferred drug at a lower out-of-pocket cost. You can also ask for an exception to cost utilization rules, such as a limit on the quantity of a drug. If you think you need an exception, you should contact us before you try to fill your prescription at a pharmacy. Your doctor must provide a statement to support your exception request. If we deny coverage for your prescription drug(s), you have the right to appeal and ask us to review our decision. Finally, you have the right to file a grievance if you have any type of problem with us or one of our network pharmacies that does not involve coverage for a prescription drug. If your problem involves quality of care, you also have the right to file a grievance with the Quality Improvement Organization (QIO) for your state. Please refer to the Evidence of Coverage (EOC) for the QIO contact information.

What is a Medication Therapy Management (MTM) Program?
A Medication Therapy Management (MTM) Program is a free service we offer. You may be invited to participate in a program designed for your specific health and pharmacy needs. You may decide not to participate but it is recommended that you take full advantage of this covered service if you are selected. Contact AARP MedicareComplete Plus (HMO-POS) for more details.

What Types of Drugs May be Covered Under Medicare Part B?
Some outpatient prescription drugs may be covered under Medicare Part B. These may include, but are not limited to, the following types of drugs. Contact AARP MedicareComplete Plus (HMO-POS) for more details. Some Antigens: If they are prepared by a doctor and administered by a properly instructed person (who could be the patient) under doctor supervision. Osteoporosis Drugs: Injectable drugs for osteoporosis for certain women with Medicare.

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Erythropoietin (Epoetin Alfa or Epogen®): By injection if you have end-stage renal disease (permanent kidney failure requiring either dialysis or transplantation) and need this drug to treat anemia. Hemophilia Clotting Factors: Self-administered clotting factors if you have hemophilia. Injectable Drugs: Most injectable drugs administered incident to a physician's service. Immunosuppressive Drugs: Immunosuppressive drug therapy for transplant patients if the transplant was paid for by Medicare, or paid by a private insurance that paid as a primary payer to your Medicare Part A coverage, in a Medicare-certified facility. Some Oral Cancer Drugs: If the same drug is available in injectable form. Oral Anti-Nausea Drugs: If you are part of an anti-cancer chemotherapeutic regimen. Inhalation and Infusion Drugs provided through DME.

Where Can I Find Information on Plan Ratings?
The Medicare program rates how well plans perform in different categories (for example, detecting and preventing illness, ratings from patients and customer service). If you have access to the web, you may use the web tools on www.medicare.gov and select "Compare Medicare Prescription Drug Plans" or "Compare Health Plans and Medigap Policies in Your Area" to compare the plan ratings for Medicare plans in your area. You can also call us directly to obtain a copy of the plan ratings for this plan. Our customer service number is listed below. Please call SecureHorizons by UnitedHealthcare for more information about AARP MedicareComplete Plus (HMO-POS). Visit us at www.AARPMedicarePlans.com or, call us: Customer Service Hours: Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday, 8:00 a.m - 8:00 p.m Eastern Current members should call toll-free 1-800-643-4845 for questions related to the Medicare Advantage Program and Medicare Part D Prescription Drug program. TTY/TDD: 711 Prospective members should call toll-free 1-800-547-5514 for questions related to the Medicare Advantage and Medicare Part D Prescription Drug Program. TTY/TDD: 711 For more information about Medicare, please call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You can call 24 hours a day, 7 days a week. Or, visit www.medicare.gov on the web. This document may be available in a different format or language. For additional information, call customer service at the phone number listed above. Este documento puede estar disponible en diferentes formatos e idiomas. Por favor, llame al número de Servicio al Cliente dado anteriormente si necesita obtener más información. 本資訊可以不同形式或語言提供。如需更多資訊,請撥打上文所列的電話號碼,與客戶服 務部聯絡。 If you have special needs, this document may be available in other formats.

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Section II - Summary Of Benefits
If you have any questions about this plan's benefits or costs, please contact SecureHorizons by UnitedHealthcare for details.
Benefit Important Information Original Medicare AARP MedicareComplete Plus (HMO-POS)

1 Premium and Other In 2010 the monthly Part B Premium General
Important Information was $96.40 and may change for 2011 and the yearly Part B deductible amount was $155 and may change for 2011.

$0 monthly plan premium in addition to your monthly Medicare Part B premium.

Most people will pay the standard If a doctor or supplier does not accept monthly Part B premium in addition to assignment, their costs are often their MA plan premium. However, higher, which means you pay more. some people will pay higher Part B and Part D premiums because of their Most people will pay the standard yearly income (over $85,000 for monthly Part B premium. However, some people will pay a higher premium singles, $170,000 for married because of their yearly income (over couples). For more information about Part B and Part D premiums based on $85,000 for singles, $170,000 for married couples). For more information income, call Medicare at 1-800-MEDICARE (1-800-633-4227). about Part B premiums based on TTY users should call 1-877-486-2048. income, call Medicare at 1-800-MEDICARE (1-800-633-4227). You may also call Social Security at TTY users should call 1-877-486-2048. 1-800-772-1213. TTY users should call 1-800-325-0778. You may also call Social Security at 1-800-772-1213. TTY users should call This plan covers all Medicare-covered 1-800-325-0778. preventive services with zero cost sharing. In-Network $3,380 out-of-pocket limit. This limit includes only Medicare-covered services.

2 Doctor and Hospital You may go to any doctor, specialist
Choice or hospital that accepts Medicare. (For more information, see Emergency Care #15 and Urgently Needed Care - #16.)

In-Network No referral required for network doctors, specialists, and hospitals. Out of Service Area Plan covers you when you travel in the U.S.

Inpatient Care

14

Benefit

Original Medicare

AARP MedicareComplete Plus (HMO-POS)

Inpatient Care (continued)

3 Inpatient Hospital

In 2010 the amounts for each benefit Care period were: (includes Substance Days 1 - 60: $1100 deductible Abuse and Days 61 - 90: $275 per day Rehabilitation Days 91 - 150: $550 per lifetime reserve day These amounts will Services) change for 2011. Call 1-800-MEDICARE (1-800-633-4227) for information about lifetime reserve days. Lifetime reserve days can only be used once. A "benefit period" starts the day you go into a hospital or skilled nursing facility. It ends when you go for 60 days in a row without hospital or skilled nursing care. If you go into the hospital after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of benefit periods you can have.

In-Network No limit to the number of days covered by the plan each benefit period. For Medicare-covered hospital stays: Days 1 - 7: $295 copay per day Days 8 - 90: $0 copay per day $0 copay for each additional hospital day.

4 Inpatient Mental
Health Care

In-Network Same deductible and copay as inpatient hospital care (see "Inpatient You get up to 190 days in a Psychiatric Hospital Care" above). Hospital in a lifetime. 190 day lifetime limit in a Psychiatric For Medicare-covered hospital stays: Hospital. Days 1 - 7: $295 copay per day Days 8 - 90: $0 copay per day

5 Skilled Nursing

Facility (SNF) (in a Medicare-certified skilled nursing facility)

In 2010 the amounts for each benefit In-Network period after at least a 3-day covered Plan covers up to 100 days each hospital stay were: benefit period Days 1 - 20: $0 per day No prior hospital stay is required. Days 21 - 100: $137.50 per day These amounts will change for 2011. For Medicare-covered SNF stays: Days 1 - 34: $100 copay per day 100 days for each benefit period. Days 35 - 100: $0 copay per day A "benefit period" starts the day you go into a hospital or SNF. It ends when you go for 60 days in a row without hospital or skilled nursing care. If you

15

Benefit

Original Medicare

AARP MedicareComplete Plus (HMO-POS)

Inpatient Care (continued) go into the hospital after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of benefit periods you can have.

6 Home Health Care $0 copay.
(includes medically necessary intermittent skilled nursing care, home health aide services, and rehabilitation services, etc.)

In-Network $0 copay for each Medicare-covered home health visit.

7 Hospice

You pay part of the cost for outpatient General drugs and inpatient respite care. You must get care from a Medicare-certified hospice. You must get care from a Medicare-certified hospice.

Outpatient Care

8 Doctor Office Visits 20% coinsurance

In-Network $10 copay for each primary care doctor visit for Medicare-covered benefits. $30 copay for each in-area, network urgent care Medicare-covered visit. $35 copay for each specialist visit for Medicare-covered benefits.

9 Chiropractic
Services

Routine care not covered 20% coinsurance for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part) if you get it from a chiropractor or other qualified providers.

In-Network 50% of the cost for each Medicare-covered visit. Medicare-covered chiropractic visits are for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part) if you get it from a chiropractor or other qualified providers.

16

Benefit

Original Medicare

AARP MedicareComplete Plus (HMO-POS)

Outpatient Care (continued)

10 Podiatry Services

Routine care not covered.

In-Network $35 copay for each Medicare-covered 20% coinsurance for medically necessary foot care, including care for visit. medical conditions affecting the lower $35 copay for up to 6 routine visit(s) limbs. every year Medicare-covered podiatry benefits are for medically-necessary foot care.

11 Outpatient Mental
Health Care

45% coinsurance for most outpatient In-Network mental health services. $40 copay for each Medicare-covered individual therapy visit. $30 copay for each Medicare-covered group therapy visit.

12 Outpatient

Substance Abuse Care

20% coinsurance

In-Network $40 copay for Medicare-covered individual visits. $30 copay for Medicare-covered group visits.

13 Outpatient

Services/Surgery

20% coinsurance for the doctor

In-Network 20% of the cost for each Specified copayment for outpatient hospital facility charges. Copay cannot Medicare-covered ambulatory surgical exceed than Part A inpatient hospital center visit. deductible. 20% of the cost for each Medicare-covered outpatient hospital 20% coinsurance for ambulatory facility visit. surgical center facility charges 20% coinsurance In-Network $200 copay for Medicare-covered ambulance benefits.

14 Ambulance

Services (medically necessary ambulance services) (You may go to any emergency room if you reasonably believe you need emergency care.)

15 Emergency Care

20% coinsurance for the doctor

General $50 copay for Medicare-covered Specified copayment for outpatient hospital emergency room (ER) facility emergency room visits. charge. Worldwide coverage. ER Copay cannot exceed Part A inpatient hospital deductible. If you are admitted to the hospital within 24-hour(s) for the same

17

Benefit

Original Medicare

AARP MedicareComplete Plus (HMO-POS)

Outpatient Care (continued) You don't have to pay the emergency condition, you pay $0 for the room copay if you are admitted to the emergency room visit hospital for the same condition within 3 days of the emergency room visit. NOT covered outside the U.S. except under limited circumstances.

16 Urgently Needed

General 20% coinsurance, or a set copay Care NOT covered outside the U.S. except $40 copay for Medicare-covered (This is NOT urgently needed care visits. under limited circumstances. emergency care, and in most cases, is out of the service area.) Rehabilitation Services (Occupational Therapy, Physical Therapy, Speech and Language Therapy, Respiratory Therapy Services, Social/ Psychological Services, and more) 20% coinsurance In-Network $35 copay for Medicare-covered Occupational Therapy visits. $35 copay for Medicare-covered Physical and/or Speech and Language Therapy visits. $35 copay for Medicare-covered Cardiac Rehab services.

17 Outpatient

Outpatient Medical Services and Supplies

18 Durable Medical

Equipment (includes wheelchairs, oxygen, etc.) (includes braces, artificial limbs and eyes, etc.)

20% coinsurance

In-Network 20% of the cost for Medicare-covered items.

19 Prosthetic Devices 20% coinsurance

In-Network 20% of the cost for Medicare-covered items.

18

Benefit

Original Medicare

AARP MedicareComplete Plus (HMO-POS)

Outpatient Medical Services and Supplies (continued)

20 Diabetes

Self-Monitoring Training, Nutrition Therapy, and Supplies (includes coverage for glucose monitors, test strips, lancets, screening tests, self-management training, retinal exam/glaucoma test, and foot exam/ therapeutic soft shoes) X-Rays, Lab Services, and Radiology Services

20% coinsurance

Nutrition therapy is for people who have diabetes or kidney disease (but aren't on dialysis or haven't had a $0 copay for Nutrition Therapy for kidney transplant) when referred by a Diabetes. doctor. These services can be given by $0 copay for Diabetes supplies. a registered dietitian or include a nutritional assessment and counseling to help you manage your diabetes or kidney disease.

In-Network $0 copay for Diabetes self-monitoring training.

21 Diagnostic Tests,

20% coinsurance for diagnostic tests In-Network and x-rays $0 to $10 copay for Medicare-covered lab services. $0 copay for Medicare-covered lab services Lab Services: Medicare covers medically necessary diagnostic lab services that are ordered by your treating doctor when they are provided by a Clinical Laboratory Improvement Amendments (CLIA) certified laboratory that participates in Medicare. Diagnostic lab services are done to help your doctor diagnose or rule out a suspected illness or condition. Medicare does not cover most routine screening tests, like checking your cholesterol. 0% to 20% of the cost for Medicare-covered diagnostic procedures and tests.

$16 copay for Medicare-covered X-rays. 20% of the cost for Medicare-covered diagnostic radiology services (not including x-rays). 20% of the cost for Medicare-covered therapeutic radiology services.

Preventive Services

22 Bone Mass

In-Network Measurement $0 copay for Medicare-covered bone (for people with Covered once every 24 months (more mass measurement. Medicare who are at often if medically necessary) if you risk) meet certain medical conditions.

No coinsurance, copayment or deductible.

19

Benefit

Original Medicare

AARP MedicareComplete Plus (HMO-POS)

Preventive Services (continued)

23 Colorectal

No coinsurance, copayment or Screening Exams deductible for screening colonoscopy (for people with or screening flexible sigmoidoscopy. Medicare age 50 and Covered when you are high risk or older) when you are age 50 and older. (Flu vaccine, Hepatitis B vaccine for people with Medicare who are at risk, Pneumonia vaccine)

In-Network $0 copay for Medicare-covered colorectal screenings. $0 copay up to 1 additional screening(s) every year.

24 Immunizations

$0 copay for Flu, and Pneumonia and In-Network Hepatitis B vaccines. $0 copay for Flu and Pneumonia vaccines. You may only need the Pneumonia vaccine once in your lifetime. Call your No referral needed for Flu and doctor for more information. pneumonia vaccines.

$0 copay for Hepatitis B vaccine.

25 Mammograms

In-Network No coinsurance, copayment or (Annual Screening) deductible. $0 copay for Medicare-covered (for women with screening mammograms. No referral needed. Medicare age 40 and Covered once a year for all women older) with Medicare age 40 and older. One baseline mammogram covered for women with Medicare between age 35 and 39. Pelvic Exams (for women with Medicare) No coinsurance, copayment, or deductible for Pap smears. In-Network $0 copay for Medicare-covered pap smears and pelvic exams

26 Pap Smears and

No coinsurance, copayment, or deductible for Pelvic and clinical breast $0 copay up to 1 additional pap exams. smear(s) and pelvic exam(s) every year Covered once every 2 years. Covered once a year for women with Medicare at high risk.

27 Prostate Cancer

Screening Exams (for men with Medicare age 50 and for other related services. older) Covered once a year for all men with Medicare over age 50.

20% coinsurance for the digital rectal In-Network exam. $0 copay for Medicare-covered $0 for the PSA test; 20% coinsurance prostate cancer screening.

20

Benefit

Original Medicare

AARP MedicareComplete Plus (HMO-POS)

Preventive Services (continued)

28 End-Stage Renal
Disease

20% coinsurance for renal dialysis

In-Network 20% coinsurance for Nutrition Therapy 20% of the cost for renal dialysis for End-Stage Renal Disease $0 copay for Nutrition Therapy for End-Stage Renal Disease. Nutrition therapy is for people who have diabetes or kidney disease (but aren't on dialysis or haven't had a kidney transplant) when referred by a doctor. These services can be given by a registered dietitian or include a nutritional assessment and counseling to help you manage your diabetes or kidney disease.

29 Prescription Drugs Most drugs are not covered under

Original Medicare. You can add prescription drug coverage to Original Medicare by joining a Medicare Prescription Drug Plan, or you can get all your Medicare coverage, including prescription drug coverage, by joining a Medicare Advantage Plan or a Medicare Cost Plan that offers prescription drug coverage.

Drugs covered under Medicare Part B General 20% of the cost for Part B-covered chemotherapy drugs and other Part B-covered drugs. Drugs covered under Medicare Part D General This plan uses a formulary. The plan will send you the formulary. You can also see the formulary at www.AARPMedicarePlans.com on the web. Different out-of-pocket costs may apply for people who have limited incomes, live in long term care facilities, or have access to Indian/Tribal/Urban (Indian Health Service). The plan offers national in-network prescription coverage (i.e., this would include 50 states and DC). This means that you will pay the same cost-sharing amount for your prescription drugs if you get them at an in-network pharmacy outside of the plan's service area (for instance when you travel).

21

Benefit

Original Medicare

AARP MedicareComplete Plus (HMO-POS)

Preventive Services (continued) Total yearly drug costs are the total drug costs paid by both you and the plan. The plan may require you to first try one drug to treat your condition before it will cover another drug for that condition. Some drugs have quantity limits. Your provider must get prior authorization from AARP MedicareComplete Plus (HMO-POS) for certain drugs. You must go to certain pharmacies for a very limited number of drugs, due to special handling, provider coordination, or patient education requirements that cannot be met by most pharmacies in your network. These drugs are listed on the plan's website, formulary, printed materials, as well as on the Medicare Prescription Drug Plan Finder on Medicare.gov. If the actual cost of a drug is less than the normal cost-sharing amount for that drug, you will pay the actual cost, not the higher cost-sharing amount. If you request a formulary exception for a drug and AARP MedicareComplete Plus (HMO-POS) approves the exception, you will pay Tier 3: Non-Preferred Generic and Non-Preferred Brand Drugs cost sharing for that drug. In-Network Initial Coverage Retail Pharmacy $0 deductible. You pay the following until total yearly drug costs reach $2,840: Tier 1: Preferred Generic Drugs

22

Benefit

Original Medicare

AARP MedicareComplete Plus (HMO-POS) $5 copay for a one-month (31-day) supply of drugs in this tier $15 copay for a three-month (90-day) supply of drugs in this tier Tier 2: Generic and Preferred Brand Drugs $45 copay for a one-month (31-day) supply of drugs in this tier $135 copay for a three-month (90-day) supply of drugs in this tier Tier 3: Non-Preferred Generic and Non-Preferred Brand Drugs $85 copay for a one-month (31-day) supply of drugs in this tier $255 copay for a three-month (90-day) supply of drugs in this tier Tier 4: Specialty Tier Drugs 33% coinsurance for a one-month (31-day) supply of drugs in this tier 33% coinsurance for a three-month (90-day) supply of drugs in this tier

Preventive Services (continued)

Long Term Care Pharmacy

Tier 1: Preferred Generic Drugs $5 copay for a one-month (31-day) supply of drugs in this tier Tier 2: Generic and Preferred Brand Drugs $45 copay for a one-month (31-day) supply of drugs in this tier Tier 3: Non-Preferred Generic and Non-Preferred Brand Drugs $85 copay for a one-month (31-day) supply of drugs in this tier Tier 4: Specialty Tier Drugs 33% coinsurance for a one-month (31-day) supply of drugs in this tier

Mail Order

Tier 1: Preferred Generic Drugs $10 copay for a three-month (90-day) supply of drugs in this tier from a preferred mail order pharmacy.

23

Benefit

Original Medicare

AARP MedicareComplete Plus (HMO-POS) $15 copay for a three-month (90-day) supply of drugs in this tier from a non-preferred mail order pharmacy. Tier 2: Generic and Preferred Brand Drugs $125 copay for a three-month (90-day) supply of drugs in this tier from a preferred mail order pharmacy. $135 copay for a three-month (90-day) supply of drugs in this tier from a non-preferred mail order pharmacy. Tier 3: Non-Preferred Generic and Non-Preferred Brand Drugs $245 copay for a three-month (90-day) supply of drugs in this tier from a preferred mail order pharmacy. $255 copay for a three-month (90-day) supply of drugs in this tier from a non-preferred mail order pharmacy. Tier 4: Specialty Tier Drugs 33% coinsurance for a three-month (90-day) supply of drugs in this tier from a preferred mail order pharmacy. 33% coinsurance for a three-month (90-day) supply of drugs in this tier from a non-preferred mail order pharmacy.

Preventive Services (continued)

Coverage Gap

After your total yearly drug costs reach $2,840, you receive a discount on brand name drugs and pay 93% of the plan's costs for all generic drugs, until your yearly out-of-pocket drug costs reach $4,550. After your yearly out-of-pocket drug costs reach $ 4,550, you pay the greater of:

Catastrophic Coverage

24

Benefit

Original Medicare

AARP MedicareComplete Plus (HMO-POS) A $ 2.50 copay for generic (including brand drugs treated as generic) and a $ 6.30 copay for all other drugs, or 5% coinsurance.

Preventive Services (continued)

Out-of-Network

Plan drugs may be covered in special circumstances, for instance, illness while traveling outside of the plan's service area where there is no network pharmacy. You may have to pay more than your normal cost-sharing amount if you get your drugs at an out-of-network pharmacy. In addition, you will likely have to pay the pharmacy's full charge for the drug and submit documentation to receive reimbursement from AARP MedicareComplete Plus (HMO-POS). You will be reimbursed up to the full cost of the drug minus the following for drugs purchased out-of-network until total yearly drug costs reach $2,840: Tier 1: Preferred Generic Drugs $5 copay for a one-month (31-day) supply of drugs in this tier Tier 2: Generic and Preferred Brand Drugs $45 copay for a one-month (31-day) supply of drugs in this tier Tier 3: Non-Preferred Generic and Non-Preferred Brand Drugs $85 copay for a one-month (31-day) supply of drugs in this tier Tier 4: Specialty Tier Drugs 33% coinsurance for a one-month (31-day) supply of drugs in this tier You will not be reimbursed for the difference between the Out-of-Network

Out-of-Network Initial Coverage

25

Benefit

Original Medicare

AARP MedicareComplete Plus (HMO-POS)

Preventive Services (continued) Pharmacy charge and the plan's In-Network allowable amount. Out-of-Network Coverage Gap You will be reimbursed up to 7% of the plan allowable cost for generic drugs purchased out-of-network until total yearly out-of-pocket drug costs reach $4,550. You will be reimbursed up to the discounted price for brand name drugs purchased out-of-network until total yearly out-of-pocket drug costs reach $4,550. You will not be reimbursed for the difference between the Out-of-Network Pharmacy charge and the plan's In-Network allowable amount. Out-of-Network Catastrophic Coverage After your yearly out-of-pocket drug costs reach $ 4,550, you will be reimbursed for drugs purchased out-of-network up to the full cost of the drug minus your cost share, which is the greater of: A $ 2.50 copay for generic (including brand drugs treated as generic) and a $ 6.30 copay for all other drugs, or 5% coinsurance. You will not be reimbursed for the difference between the Out-of-Network Pharmacy charge and the plan's In-Network allowable amount.

30 Dental Services

Preventive dental services (such as cleaning) not covered.

In-Network In general, preventive dental benefits (such as cleaning) not covered. $35 copay for Medicare-covered dental benefits.

31 Hearing Services

Routine hearing exams and hearing aids not covered.

In-Network $35 copay for Medicare-covered diagnostic hearing exams

26

Benefit

Original Medicare

AARP MedicareComplete Plus (HMO-POS) $0 to $35 copay for up to 1 routine hearing test(s) every year $0 copay per hearing aid $300 plan coverage limit for hearing aids every two years.

Preventive Services (continued) 20% coinsurance for diagnostic hearing exams.

32 Vision Services

In-Network 20% coinsurance for diagnosis and treatment of diseases and conditions $0 copay for one pair of eyeglasses or contact lenses after cataract of the eye. surgery. Routine eye exams and glasses not $0 to $35 copay for exams to diagnose and treat diseases and covered. conditions of the eye. Medicare pays for one pair of $35 copay for up to 1 routine eye eyeglasses or contact lenses after exam(s) every year $30 copay for contacts cataract surgery. $0 copay for up to 1 pair(s) of lenses Annual glaucoma screenings covered every two years for people at risk. $30 copay for up to 1 frame(s) every two years $105 plan coverage limit for contact lenses every two years. $70 plan coverage limit for eye glass frames every two years.

33 Welcome to

Medicare; and Annual Wellness Visit

When you join Medicare Part B, then you are eligible as follows.

In-Network $0 copay for the required During the first 12 months of your new Medicare-covered initial preventive physical exam and annual wellness Part B coverage, you can get either a visits. Welcome to Medicare exam or an Annual Wellness visit. After your first 12 months, you can get one Annual Wellness visit every 12 months. There is no coinsurance, copayment or deductible for either the Welcome to Medicare exam or the Annual Wellness visit. The Welcome to Medicare exam does not include lab tests.

27

Benefit

Original Medicare

AARP MedicareComplete Plus (HMO-POS)

Preventive Services (continued)

34 Health/Wellness
Education

Smoking Cessation: Covered if ordered by your doctor. Includes two counseling attempts within a 12-month period if you are diagnosed with a smoking-related illness or are taking medicine that may be affected by tobacco. Each counseling attempt includes up to four face-to-face visits. You pay coinsurance, and Part B deductible applies. $0 copay for the HIV screening, but you generally pay 20% of the Medicare-approved amount for the doctor's visit. HIV screening is covered for people with Medicare who are pregnant and people at increased risk for the infection, including anyone who asks for the test. Medicare covers this test once every 12 months or up to three times during a pregnancy.

In-Network The plan covers the following health/ wellness education benefits: Written health education materials, including Newsletters Nursing Hotline $0 copay for each Medicare-covered smoking cessation counseling session. $0 copay for each Medicare-covered HIV screening. HIV screening is covered for people with Medicare who are pregnant and people at increased risk for the infection, including anyone who asks for the test. Medicare covers this test once every 12 months or up to three times during a pregnancy.

Transportation (Routine) Acupuncture Point of Service

Not covered.

In-Network This plan does not cover routine transportation. In-Network This plan does not cover Acupuncture. Out-of-Network Point of Service coverage is available for the following benefits: - Inpatient Hospital Acute Inpatient Hospital Psychiatric Skilled Nursing Facility (SNF) Comprehensive Outpatient Rehabilitation Facility (CORF) Partial Hospitalization Home Health Services Primary Care Physician Services Chiropractic Services Occupational Therapy Services Physician Specialist Services Mental Health Specialty Services

Not covered. You may go to any doctor, specialist or hospital that accepts Medicare.

28

Benefit

Original Medicare

AARP MedicareComplete Plus (HMO-POS) Podiatry Services Other Health Care Professional Psychiatric Services Physical Therapy and Speech/ Language Pathology Services Outpatient Diag Procs/Tests/Lab Services Diagnostic Radiological Services Therapeutic Radiological Services Outpatient X-Rays Outpatient Hospital Services Ambulatory Surgical Center (ASC) Services Outpatient Substance Abuse Cardiac Rehabilitation Services Ambulance Services DME Prosthetics/Medical Supplies Diabetes Monitoring Supplies Blood Health Education/Wellness Immunizations Routine Physical Exams Pap Smears and Pelvic Exams Prostate Screening Colorectal Screening Bone Mass Measurement Mammography Screening Diabetes Monitoring Nutrition Therapy for Diabetes and Renal Disease Comprehensive Dental Eye Exams Eye Wear Hearing Exams $325 copay per hospital day. For Inpatient Psychiatric Hospital stays: Days 1 - 90: $325 copay per day For each SNF stay: Days 1 - 40: $175 copay per SNF day Days 41 - 100: $0 copay per SNF day $15 copay for Primary Care Physician Services Other Health Care Professional Routine Physical Exams

Preventive Services (continued)

29

Benefit

Original Medicare

AARP MedicareComplete Plus (HMO-POS)

Preventive Services (continued) $40 copay for Comprehensive Outpatient Rehabilitation Facility (CORF) Occupational Therapy Services Physician Specialist Services Podiatry Services Physical Therapy and Speech/ Language Pathology Services Cardiac Rehabilitation Services Comprehensive Dental Eye Exams Hearing Exams 30% of the cost for Home Health Services Diagnostic Radiological Services Therapeutic Radiological Services Outpatient Hospital Services Ambulatory Surgical Center (ASC) Services DME Prosthetics/Medical Supplies Diabetes Monitoring Supplies Pap Smears and Pelvic Exams Prostate Screening Colorectal Screening Bone Mass Measurement Mammography Screening Diabetes Monitoring Nutrition Therapy for Diabetes and Renal Disease Eye Wear $10 copay or 30% of the cost for Outpatient Diag Procs/Tests/Lab Services $21 copay for Outpatient X-Rays $75 copay for Partial Hospitalization $200 copay for Ambulance Services $35 to $45 copay for Mental Health Specialty Services Psychiatric Services

30

Benefit

Original Medicare

AARP MedicareComplete Plus (HMO-POS) Outpatient Substance Abuse $0 copay for Blood Health Education/Wellness Immunizations 50% of the cost for Chiropractic Services

Preventive Services (continued)

Optional Supplemental Package #1 Premium and Other Important Information General Package: 1 - Dental Platinum Rider: $32 monthly premium, in addition to your $0 monthly plan premium and the monthly Medicare Part B premium, for the following optional benefits: Preventive Dental Comprehensive Dental Dental Services General Plan offers additional comprehensive dental benefits. In-Network $0 copay for up to 1 cleaning(s) every six months $0 copay for up to 1 fluoride treatment(s) every six months $0 copay for up to 1 oral exam(s) every six months $0 copay for up to 1 dental x-ray(s) $1,000 plan coverage limit for dental benefits every year. Optional Supplemental Package #2 Premium and Other Important Information General Package: 2 - Fitness Rider: $13 monthly premium, in addition to your $0 monthly plan premium and the monthly Medicare Part B premium, for the following optional benefits: Health Education/Wellness

31

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Additional Information

This Page Intentionally Left Blank

Member Appeals and Grievances Process
Members of our Medicare Advantage health plans have the right to request an organization determination including the right to file an appeal and the right to file a grievance. Medicare Advantage health plan organizations must identify, track, resolve and report all activity related to an appeal or grievance.

Medicare Advantage Member Appeals
What is an Appeal?
An appeal is a type of request you make when you want us to reconsider a decision concerning coverage of a service or the amount your health plan pays or will pay for a service. The initial decision concerning medical care or services is called an “organization determination.”

When can an Appeal be filed?

You may file an appeal within 60 calendar days of the date of the initial organization determination. The 60-day limit may be extended for good cause. Include in your written request the reason why you could not file within the 60-day timeframe.

Who can file an Appeal?

You may file an appeal or someone else may file an appeal on your behalf. You must appoint the individual to act as your representative to file the appeal for you. To learn how to name a representative, contact Customer Service.

How can an Appeal be filed?

An appeal must be filed in writing directly to us. You may call Customer Service for additional information. To learn how to file an appeal, contact Customer Service.

Fast Reviews

Y0004Y0066_100618_124951 CMS Approved 07022010

You have the right to request and receive fast decisions affecting your medical treatment in “time-sensitive” situations. A situation is time-sensitive if waiting for a decision to be made within the standard timeframe could seriously harm your health or your ability to function. If your doctor provides a written or oral statement supporting your need of a fast review we will automatically give you a fast review. A decision will be issued as quickly as possible but no later than 72 hours after receiving the request.

Medicare Advantage Member Grievances
What is a Grievance?
A grievance is a complaint that doesn’t involve coverage for an item or service by your health plan or a contracting medical provider. If your grievance involves quality of care, you have the right to file a grievance with the Quality Improvement Organization (QIO) of your state. Refer to Section I of the Summary of Benefits for the name of the QIO in your state.

When can a Grievance be filed?

You may file a grievance within 60 calendar days of the date of the event causing the grievance. The 60-day limit may be extended for good cause. Include in your written request the reason why you could not file within the 60-day timeframe. There is no time limit for complaints concerning quality of care.

Who can file a Grievance?

You may file a grievance or someone else may file a grievance on your behalf. You must appoint the individual to act as your representative to file the grievance for you. To learn how to name a representative, contact Customer Service. 1 35

How can a Grievance be filed?

A grievance for Quality of Care may be filed verbally by contacting Customer Service. All other grievances must be submitted in writing.

Fast Grievances

You have the right to file a fast grievance. We will respond to fast grievances within 24 hours of receipt. You may file a fast grievance if you disagree with our decision to deny your request for a fast review. You may also file a fast grievance if we notify you that we are extending our timeframe to make an organization determination or reconsideration decision, or if we downgrade your expedited appeal request to standard due to not meeting expedited criteria.

For Members with Medicare Part D Drug Coverage through our Plan
Coverage Determinations
We will make an initial decision as to whether or not we will provide the Part D drug you are requesting or pay for the Part D drug you already received. This initial decision is called a “coverage determination.”

Exceptions

You or your doctor may ask us to make an exception to our Part D coverage determination. You may request an exception if you believe you need a drug that is not on our list of covered drugs or believe you should get a non-preferred drug at a lower out-of-pocket cost. Generally, we will only approve your request for an exception if the alternative Part D drug is included in your plan’s formulary or the Part D drug in the preferred tier would not be as effective in treating your condition and/or would cause you to have adverse medical effects. Your doctor or other prescriber must submit a statement supporting your exception request. In order to help us make a decision more quickly, the supporting medical information from your doctor or other prescriber should be sent to us with the exception request. If we approve your exception request for a Part D non-formulary drug, you can’t request an exception to the copayment or coinsurance amount we require you to pay for the drug. If you think you need an exception, you should contact us before you try to fill your prescription at a pharmacy.

Part D Drug Appeals

If you are getting Medicare prescription Part D drug coverage through our plan you have the right to file an appeal. This includes the right to appeal our decision regarding your exception request. Follow the process outlined above to file an appeal. An appeal concerning coverage determinations must be filed in writing directly to us.

Part D Drug Grievances

If you are getting Medicare prescription Part D drug coverage through our plan, you have the right to file a grievance. Follow the process outlined above to file a grievance concerning your Part D prescription drug coverage.

Plan is insured or covered by UnitedHealthcare Insurance Company or one of its affiliates, a Medicare Advantage organization with a Medicare contract.

36

SecureHorizons by UnitedHealthcare - H2182

Medicare Health Plan Ratings
The Medicare Program rates how well Medicare Advantage performs in different categories (for example, detecting and preventing illness, rating from patients, patient safety and customer service). The information provided below is a summary rating of our plan’s overall performance. This information is available to help you make the best choice. If you would like to get additional information on our plan’s performance please contact us at 1-800-547-5514 (toll-free) or 711 (TTY/TDD) for prospective members, 1-800-643-4845 (toll-free) or 711 (TTY/TDD) for current members or you may visit www.medicare.gov. Below is a summary of how our plan rated in quality and performance. The number of stars show how well our plans perform.

 means excellent  means very good  means good  means fair  means poor
SecureHorizons by UnitedHealthcare - H2182 Summary Rating of Health Plan Quality Y0066_100827_H2182_001_Plan Rating File & Use 09072010

Plan too new to be measured
This summary rating gives an overall score on the health plan’s quality and performance on 33 different topics in 5 categories: • Staying healthy: screenings, tests, and vaccines. Includes how often members got various screening tests, vaccines, and other check-ups that help them stay healthy. • Managing chronic (long-term) conditions. Includes how often members with different conditions got certain tests and treatments that help them manage their condition. • Ratings of health plan responsiveness and care. Includes ratings of member satisfactions with the plan. • Health Plan member complaints, appeals, and choosing to leave the health plan. Includes how often members have made complaints against the plan and how often members choose to leave the plan. • Health plan telephone customer service. Includes how well the plan handles member calls.

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SecureHorizons by UnitedHealthcare - H2182

Medicare Prescription Drug Plan Ratings
The Medicare Program rates how well Medicare Prescription Drug Plans perform in different categories (for example, customer service, drug pricing, patient safety). The information provided below is a summary rating of our plan’s overall performance. This information is available to help you make the best choice. If you would like to get additional information on our plan’s performance please contact us at 1-800-547-5514 (toll-free) or 711 (TTY/TDD) for prospective members, 1-800-643-4845 (toll-free) or 711 (TTY/TDD) for current members, or you may visitt www.medicare.gov. Below is a summary of how our plan rated in quality and performance. The number of stars show how well our plans perform.

 means excellent  means very good  means good  means fair  means poor
SecureHorizons by UnitedHealthcare - H2182 Summary Rating of Prescription Drug Plan Quality

Not enough data to calculate summary score
This summary rating gives an overall score on the drug plan’s quality and performance on 19 different topics in 4 categories: • Drug plan customer service: Includes how well the drug plan handles calls and makes decisions about member appeals. • Drug plan member complaints, members who choose to leave, and Medicare audit findings: Includes how often members complain about the drug plan and how often members choose to leave the drug plan. • Member experience with drug plan: Includes member satisfaction information. • Drug pricing and patient safety: Includes how well the drug plan prices prescriptions and provides accurate pricing information on the Medicare website. Includes information on how often members with certain medical conditions get prescription drugs that are considered safer and clinically recommended for their condition. This information is gathered from several different sources, including results from Medicare’s regular monitoring activities, reviews of billing and other information that plans submit to Medicare, and Medicare’s member surveys.

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Dental Platinum Rider
If you’re looking for extra dental protection and coverage, our SecureHorizons® optional supplemental dental rider may be right for you. The Platinum Rider is available for an additional monthly premium of $32.

What Dental Benefits Do I Receive?
With the Platinum Rider, you get: • 100% coverage for preventive and diagnostic services such as oral exams, X-rays and routine cleanings. Partial coverage for basic services such as fillings and for major services such as crowns, dentures, root canals and oral surgery. There is a $100 member deductible and a $1,000 calendar year maximum. Deductible does not apply to preventive and diagnostic services.

How Do I Enroll?
You must be enrolled in a SecureHorizons® health plan in order to purchase a rider. Purchasing a rider is optional. Please contact Customer Service at the number listed on the back of your Member ID Card to enroll in a rider.

When is the Enrollment Effective Date?
If your completed enrollment request is received by the last day of the month, your benefits will be effective the first day of the following month. For example, if you call Customer Service and enroll on March 31, your benefits will begin on April 1. If you are an existing plan member, you may enroll any time during the year. Please note that you can’t be enrolled in more than one dental rider at a time during the calendar year, including the Deluxe Rider.

Can I See Any Dentist?
Choose your dentist from a large national network of providers. You may change network dentists at any time however you will need to complete any dental service currently in progress. Please see your Provider Directory for a listing of participating dentists. When you receive your Covered Dental Services from an Out-of-Network Dentist, the plan pays according to a Maximum Allowable Fee Schedule*. You pay all fees in excess of this amount. Y0066_100812_073716 File & Use 09052010 Please refer to your Evidence of Coverage to learn more about the full range of covered services, including a dental procedural and fee chart.

*Allowable Fee Schedules vary according to geographic area and is a set amount that may not be equal to the Dentist’s full fee. For further details, please contact Customer Service.

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The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. The AARP® MedicareComplete® plans are SecureHorizons® plans insured or covered by an affiliate of UnitedHealthcare Insurance Company, a Medicare Advantage organization with a Medicare contract. AARP MedicareComplete plans carry the AARP name, and UnitedHealthcare pays a royalty fee to AARP for use of the AARP intellectual property. Amounts paid are used for the general purpose of AARP and its members. AARP is not the insurer. You do not need to be an AARP member to enroll. AARP does not recommend health related products, service insurance or programs. You are strongly encouraged to evaluate your needs. AAEX11MP3244438_000

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SilverSneakers Fitness Rider
®

The SilverSneakers® Fitness Rider can help you take charge of your health and maintain an active lifestyle. This award-winning program is available for an additional $13 monthly premium.

Take advantage of the following SilverSneakers® services:
• A basic fitness center membership at over 10,000 participating locations. • Access to cardio equipment, resistance machines, free weights and a heated pool at certain locations. • SilverSneakers classes for Medicare-eligible beneficiaries who want to improve their strength, flexibility, balance and endurance (available at select locations). • Access to any participating fitness center while traveling throughout the United States. To find participating locations in your area, please visit www.SilverSneakers.com. The SilverSneakers® Fitness Program is a winner of the 2004 Healthcare and Aging Network Award of the American Society on Aging.

How Do I Enroll?
You must be enrolled in a SecureHorizons® health plan in order to purchase a rider. Purchasing a rider is optional. Please contact Customer Service at the number listed on the back of your Member ID Card to enroll in a rider.

When is the Enrollment Effective Date?
If your completed enrollment request is received by the last day of the month, your benefits will be effective the first day of the following month. For example, if you call Customer Service and enroll on March 31, your benefits will begin on April 1.

Y0066_100811_124823 File & Use 09012010

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The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. SilverSneakers® is a registered trademark of Healthways, Inc. Healthways, Inc., is an independent company. Consult a health care professional before beginning any exercise program. The AARP® MedicareComplete® plans are SecureHorizons® plans insured or covered by an affiliate of UnitedHealthcare Insurance Company, a Medicare Advantage organization with a Medicare contract. AARP MedicareComplete plans carry the AARP name, and UnitedHealthcare pays a royalty fee to AARP for use of the AARP intellectual property. Amounts paid are used for the general purpose of AARP and its members. AARP is not the insurer. You do not need to be an AARP member to enroll. AARP does not recommend health related products, service insurance or programs. You are strongly encouraged to evaluate your needs. AAEX11MP3244453_000

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2011 Disclaimers
Your Plan may contain one or more of the following:
OptumHealthSM is a health and well-being company that provides information and support as part of your health plan. NurseLineSM nurses cannot diagnose problems or recommend specific treatment and are not a substitute for your doctor’s care. NurseLineSM services are not an insurance program and may be discontinued at any time. SilverSneakers® is a registered trademark of Healthways, Inc. Healthways, Inc., is an independent company. The SilverSneakers® program is made available as part of this Plan’s benefits to those insured through this Plan. Neither AARP nor UnitedHealthcare endorse or are responsible for the services or information provided by this program. Consult a health care professional before beginning any exercise program. Silver & Fit is provided by American Specialty Health Networks, Inc. and Healthyroads, Inc., subsidiaries of American Specialty Health Incorporated. Evercare™ Hospice and Palliative Care is committed to the policy that all persons shall have equal access to its programs, facilities, and employment without regard to race, sex, religion, color, age, national origin, disability, sexual orientation or other protected factor. Evercare™ Hospice and Palliative Care is offered by Evercare Hospice, Inc.

NurseLineSM

SilverSneakers®

Silver & Fit

Evercare™ Hospice

General Information

Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January1, 2012. The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the Plan.

Y0066_100722_182504 File & Use 08022010

This document is available in alternate formats or languages. For more information please contact the Plan at 1-800-547-5514, TTY: 711, 8 a.m. to 8 p.m., 7 days a week. Este documento está disponible en diferentes formatos o idiomas. Para obtener más información, por favor comuníquese con el Plan llamando al 1-800-547-5514, TTY: 711, de 8:00 a.m. a 8:00 p.m., los 7 días de la semana. 本文件可以其他形式或語言提供。如需更多資訊,請與本計劃聯絡,電話號碼是 1-800-547-5514,TTY: 711,每週七天,上午八時至晚上八時。 Plan is insured or covered by UnitedHealthcare Insurance Company or one of its affiliates, a Medicare Advantage Organization with a Medicare contract.

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