2013 HEALTH CARE PLAN SUMMARIES Plan Code: UHC Retiree Personal Choice Option Plan Type Indemnity Basic Plan Information Member Servic (800) 603-3813 Is a PCP Required No Web Address Group Number 704077 Provider Network UnitedHealthcare Options PPO (not required) MRF www.myuhc.com/groups/abt Benefits for Covered Services and Supplies* Preventive Care Benefits Annual Physical Exams for Adults Annual Immunizations for Adults 80% coverage after deductible; annual physical exam adults age 18+ incl. all related blood and urine laboratory testing performed as part of the annual exam and determined necessary by the patient’s doctor 80% coverage after deductible; adults age 18+ for adult immunizations as defined by the CDC and U.S. Preventive Services task force (excludes immunizations for travel) Annual Screenings for Adults 80% coverage after deductible; adults age 18+ for recommended screenings as part of the annual physical exam incl.: hearing, vision, cholesterol, hypertension, diabetes, skin cancer, discussion of overall health and lifestyle Annual Colorectal Screenings for Adults 80% coverage after deductible; colorectal cancer screening incl.: fecal occult blood test, flexible sigmoidoscopy, colonoscopy Annual Bone Density Screenings for Adults 80% coverage after deductible Annual PSA Screening Annual Well Woman Exam 80% coverage after deductible for adult males 100% coverage; ded. does not apply; for annual well-woman exam (in addition to annual physical exam) incl. pap smear and mammogram*** Well Child Visits Under Age 2 80% coverage after deductible; well child care visits based on American Academy of Pediatrics standards (0-12 months: 6 visits, 12-24 months: 3 visits) incl. all related blood and urine laboratory testing performed as part of the annual well child exam and determined necessary by patient's doctor, incl. lead and TB testing Well Child Visits Over Age 2 80% coverage after deductible; one annual well child exam (age 2 to 18) incl. all related blood and urine laboratory testing performed as part of the annual well child exam and determined necessary by patient's doctor, incl. lead and TB testing Childhood Immunizations 100% coverage; ded. does not apply; all recommended childhood immunizations, incl. HPV vaccine (excludes immunizations for travel) Childhood Screenings 80% coverage after deductible; recommended screenings as part of the annual exam incl. health and developmental history, hearing, vision, and skin screening Notes: *Benefits are based on reasonable charges. *** Benefits for services younger than listed are covered at 80% after deductible-in addition services listed outside of the schedule stated above will be paid at 80% after deductible (for example, a second physical in same calendar year will be paid at 80% after deductible). These benefits do not apply to individuals employed outside of the United States or in Puerto Rico, except for certain designated transferred employees. Each plan or program has its own eligibility requirements. See your Employee Benefits Handbook or Retiree Benefits Handbook for details. Abbott reserves the right to change or end their benefit plans or programs at any time. This document is not a full summary of the plans or policies or a description of their key features or details. In case of any conflict or question, the official plan documents or applicable policies, as amended from time to time, will govern. 2013 2013 HEALTH CARE PLAN SUMMARIES Plan Code: UHC Retiree Personal Choice Option MRF Benefits for Covered Services and Supplies* Annual Deductible $400 per person; $1,000 per family Out-of-Pocket Maximum $2,500 per person; $6,250 per family Lifetime Maximum $500,000 per person Inpatient Benefits Hospital Services Maternity (newborn and delivery) In-Hospital Physicians and Surgeons Prenotification required; $250 penalty applies for failure to prenotify 80% coverage after deductible 80% coverage after deductible; separate deductibles may apply to mother and baby 80% coverage after deductible Outpatient Benefits Ambulatory Surgery 80% coverage after deductible** Ambulance 80% coverage after deductible Emergency Room 80% coverage after deductible Urgent Care 80% coverage after deductible Diagnostic X-Ray and Lab 80% coverage after deductible Physician and Professional Services Office Visits 80% coverage after deductible Maternity (physician charges: delivery, prenatal care, first postnatal visit) Notes: 80% coverage after deductible (payable after delivery)** * Benefits are based on reasonable charges. **Some procedures require precertification. These benefits do not apply to individuals employed outside of the United States or in Puerto Rico, except for certain designated transferred employees. Each plan or program has its own eligibility requirements. See your Employee Benefits Handbook or Retiree Benefits Handbook for details. Abbott reserves the right to change or end their benefit plans or programs at any time. This document is not a full summary of the plans or policies or a description of their key features or details. In case of any conflict or question, the official plan documents or applicable policies, as amended from time to time, will govern. 2013 2013 HEALTH CARE PLAN SUMMARIES Plan Code: UHC Retiree Personal Choice Option MRF Benefits for Covered Services and Supplies* Prescription Drugs Prescription Drugs Mental Health Benefits Inpatient Services Outpatient Services Substance Abuse Benefits 80% coverage after deductible Must precertify inpatient (and most outpatient) services through United Behavioral Health: (866) 808-5075; prenotification is required for autism, biofeedback, electroshock therapy, hypnosis and psychological testing 80% coverage, after deductible; A $250 penalty applies for failure to precertify. 80% coverage after deductible Must precertify inpatient (and most outpatient) services through United Behavioral Health: (866) 808-5075 Inpatient Services Same as mental health benefits Outpatient Services Same as mental health benefits Other Benefits Chiropractic Services 80% coverage after deductible; $750 benefit max. per year Physical Therapy 80% coverage after deductible Home Health Care Durable Medical Equipment 80% coverage after deductible** 80% coverage after deductible** Hospice Care Vision Benefits 80% coverage after deductible** 80% coverage after deductible for one routine exam per calendar year; eyewear not covered 80% coverage after deductible; $750 benefit max. per year for non surgical care including physical therapy Podiatrist Care Notes: * Benefits are based on reasonable charges. **Some procedures require precertification. These benefits do not apply to individuals employed outside of the United States or in Puerto Rico, except for certain designated transferred employees. Each plan or program has its own eligibility requirements. See your Employee Benefits Handbook or Retiree Benefits Handbook for details. Abbott reserves the right to change or end their benefit plans or programs at any time. This document is not a full summary of the plans or policies or a description of their key features or details. In case of any conflict or question, the official plan documents or applicable policies, as amended from time to time, will govern. 2013 2013 HEALTH CARE PLAN SUMMARIES UHC Retiree Personal Choice Option Plan Code: MRF Benefits for Covered Services and Supplies* Infertility Precertification Requirements/Additional Benefit Limits Precertification and required use of providers from United Resource Network Centers of Excellence for all infertility consultations with a reproductive endocrinologist, and all infertility treatments (otherwise no coverage); lifetime maximum medical infertility limit for post-diagnosis services of $35,000 while covered under any Abbott or AbbVie medical plan. Services to diagnose infertility are not included in the lifetime maximum Fertility Drugs Covered under prescription drug benefit; lifetime infertility prescription drug max. of $15,000 while covered under any Abbott or AbbVie medical plan Incentives Custom Care Management You could earn up to $200 in gift card incentives by participating in the program. If you or a covered spouse/domestic partner have a chronic condition such as asthma, diabetes, congestive heart failure, coronary artery disease, and low back pain there’s a lot you can do to take charge of your health. By partnering with a specialty trained registered nurse you can learn about self-care, how to manage your medications and tips for working with your doctor more effectively. Plus, you could be rewarded with gift card incentives for being engaged in your own health management. If you are identified as having a chronic condition an enrollment specialist will reach out to you over the phone. To self refer or learn more about the program call (800) 603-3813. Healthy Pregnancy You could earn a $50 gift card incentive by participating in the program. Healthy Pregnancy provides you or your covered spouse/domestic partner with information and support through all the stages of pregnancy. You have access to maternity nurses 24 hours a day and can receive educational material specific to your needs. After you are enrolled and complete an initial health assessment, you will receive a pregnancy book to help guide you through your nine month journey. After completing a final health assessment, you may be eligible to receive a $50 Gift Card. Depending on your health situation, a maternity nurse may even help coordinate your care. To enroll or learn more call (877) 222-9605. These benefits do not apply to individuals employed outside of the United States or in Puerto Rico, except for certain designated transferred employees. Each plan or program has its own eligibility requirements. See your Employee Benefits Handbook or Retiree Benefits Handbook for details. Abbott reserves the right to change or end their benefit plans or programs at any time. This document is not a full summary of the plans or policies or a description of their key features or details. In case of any conflict or question, the official plan documents or applicable policies, as amended from time to time, will govern. 2013