United Healthcare 2013 Annual Report Download - page 5

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to customers that elect to self-fund the health care costs of their employees and employees’ dependants,
UnitedHealthcare Employer & Individual receives a fixed service fee per individual served. These customers
retain the risk of financing medical benefits for their employees and employees’ dependants, while
UnitedHealthcare Employer & Individual provides services such as coordination and facilitation of medical and
related services to customers, consumers and health care professionals, administration of transaction processing
and access to a contracted network of physicians, hospitals and other health care professionals, including dental
and vision.
UnitedHealthcare Employer & Individual also offers a variety of non-employer based insurance options for
purchase by individuals, including students, which are designed to meet the health coverage needs of these
consumers and their families. As part of the new public health care exchange market that opened October 1,
2013, UnitedHealthcare Employer & Individual now offers health benefit plans through exchanges in 10 states
and District of Columbia, including four individual exchanges and nine small group (SHOP) exchanges.
The consolidated purchasing capacity represented by the individuals UnitedHealth Group serves makes it
possible for UnitedHealthcare Employer & Individual to contract for cost-effective access to a large number of
conveniently located care professionals.
UnitedHealthcare Employer & Individual typically distributes its products through consultant or direct sales in
the larger employer and public sector segments. In the smaller group size segment of the commercial
marketplace, UnitedHealthcare Employer & Individual’s distribution system consists primarily of direct sales
and producers, including brokers and agents. UnitedHealthcare Employer & Individual also distributes products
through general agents, each of which is a wholesale agent or agency that contracts with a carrier to distribute
individual or group benefits, providing extensive services to customers. In recent years, UnitedHealthcare
Employer & Individual has diversified its model more extensively, distributing through professional employer
organizations, associations, private equity relationships and, increasingly, through both multi-carrier and its own
proprietary private exchange marketplaces. UnitedHealthcare Employer & Individual offers its products through
affiliates that are licensed as insurance companies, health maintenance organizations (HMOs), or third party
administrators (TPAs).
Direct-to-consumer sales will be supported by industry participation in multi-carrier health insurance
marketplaces for individuals and small groups through state or federally led exchanges for coverage effective
January 1, 2014. Additionally, UnitedHealthcare Employer & Individual has expanded distribution to include
retail offerings responsive to the needs of individual consumers. Over the last few years, UnitedHealthcare
Employer & Individual has opened several retail storefronts in various locations across the United States that
provide solutions to consumers at all stages in life, from individual plans to employer coverage, as well as
solutions for Medicare-Medicaid eligible (MME) individuals.
UnitedHealthcare Employer & Individual’s diverse product portfolio offers a continuum of benefit designs, price
points and approaches to consumer engagement, which provide the flexibility to meet the needs of employers of
all sizes as well as individuals shopping for health benefits coverage. UnitedHealthcare Employer & Individual
emphasizes local markets and leverages its national scale to adapt products to meet specific local market needs.
UnitedHealthcare Employer & Individual’s major product families include:
Traditional Products. Traditional products include a full range of medical benefits and network options from
managed plans such as Choice and Options PPO to more traditional indemnity offerings. The plans offer a full
spectrum of covered services, including preventive care, direct access to specialists and catastrophic protection.
Consumer Engagement Products and Tools. Consumer engagement products couple plan design with financial
accounts to increase employee responsibility for their health and well-being. This suite of products includes high-
deductible consumer-driven benefit plans, which include health reimbursement accounts (HRAs), health savings
accounts (HSAs) and consumer activation services such as personalized behavioral incentive programs and
consumer education information. For example, UnitedHealthcare Employer & Individual’s Diabetes Health Plan
3