The CAA provision requires an annual “gag clause prohibition compliance attestation” (GCPCA). UnitedHealthcare completed the review of agreements and ensured compliance with the prohibition on gag clauses on price or quality information as required under the CAA Gag Clause.
UnitedHealthcare will make the attestation for fully insured customers as required.
For ASO and Level Funded customers, UnitedHealthcare is providing a Confirmation of Compliance (pdf) to support the customers doing their own attestation.
For customers with both fully insured and self-funded business, UnitedHealthcare will attest for fully insured plans and customers must attest for the self-funded plans.
UMR and Surest will follow the same process. Brokers may share the following UMR or Surest branded documents with customers, as appropriate:
CVS is back in the Broad Pharmacy Network, effective 1/1/2024. Existing groups will need to make a plan change at renewal to a 2024 plan design to take advantage of the broad network addition.
$0 Virtual Visit Copay on HSA Plans
NEXUS plan design
Q4 Reminders
Digital ID card and paperless preference options to launch this month. Beginning in October, UnitedHealthcare will introduce digital medical ID cards to plan subscribers who have elected “paperless” in their account preference settings. Subscribers who have elected to go paperless for “required communications” will receive an email between Oct. 4 and Oct. 31 containing information about their new digital medical ID card, how to access and change their medical ID card paperless preference and how to add their medical ID card to their Apple or Google wallet.
When a subscriber selects paperless on myuhc.com they will not receive a physical ID card.
Subscribers that selected paperless will receive an email starting 10/4/2023 with notification that future ID cards will be digital.
ID card preference will launch 11/7/2023.
When will a physical medical ID card be mailed?
New UHC sponsored plan subscribers will receive a physical ID card.
If a subscriber moves to a new employer and then comes back to the same employer, they will receive a physical medical ID card again, as a first issue.
If a subscriber moves to a non-UHC plan and then moves back in a subsequent year, they will not receive a physical medical ID card.
BCBS Claims Data – Request HB2015 for all of your BCBS TX groups with 10+ enrolled employees
Ordering these reports allows us to provideUHC Level Funded underwritten rates for your group without the need for employee applications. UHC Level Funded rates can save your client up to 20%
January groups – request HB2015 beginning 9/15
UHC Broker Bonus extended to include effective dates through Jan. 31, 2024
As part of our effort to keep you informed, we’ve included the updates and reminders that UnitedHealthcare has released for the month of July.
HB2015 reports – make sure to order HB2015 reports for your fully insured renewals after the 15th of the month, to get the prior month’s data
For groups 10+, this allows you to receive underwritten group rates for UHC level-funded
UHC Broker Rollout Meetings are next week! If you cannot attend, please reach out to your Insurance Exchange Sales rep for updates or watch your inbox for a Broker Broadcast.
15-month rate guarantees are back:
Offered for effective dates from 8/1/2023 to 4/1/2024
This means level-funded group installs from 8/1/2023 to 4/1/2024 will need either the 12 OR 15-month rate guarantee form included
Current UHC groups are eligible to move from FI to LF – renewal teams are hosting Conversion Training Calls. Links to register are below. Reach out to your TIE renewal rep for more information on this:
For any new business case sold or existing case transitioned from UHC fully insured to level-funded with an effective date between 4/1/2023 and 9/1/2023, you will receive an additional one-time bonus of $60 per enrolling employee.
As a quick example, selling 50 new members during the bonus period would result in an additional $3000 in compensation.
Level Funded – UHC is no longer accepting old versions of the level-funded application – the latest 5 health question app must be used.
Level Funded – All Texas Enrollment Packages have been updated.
New Billing & Collection Agreement
15 month rate guarantee option now available August through April
Contact me for other states enrollment package and underwriting checklist
Level Funded – TX Updated Underwriting Checklist – New Guidelines! Updated language for participation requirements and ineligible groups
PCORI – The amounts are now sent directly to the group
Reports were mailed to the groups June 15th
Not posted on uhceservices.com for the employer or broker
Your assigned Customer Service Account Manager is able to access it upon request
Small Group Fully Insured – All groups with only 1 enrolled subscriber are now required to submit not only the latest wage & tax report, but also the previous calendar year’s 4 quarterly wage & tax reports.
Charter Torch – Improving network strength in rural areas
Baylor – Bosque – Coryell – Eastland – Titus
Wichita – Wilbarger -Young
New Vision Benefit Summaries
Benefit lens options now in body of summary
If you have any questions, please do not hesitate to reach out to us. We’re here to help!
Beginning January 15, 2022, UnitedHealthcare Fully Insured and Level Funded individual and group health plan members can get up to eight FDA-authorized or approved OTC COVID-19 at home tests at no cost to them, after reimbursement, and without a doctor’s prescription.
There are two ways that eligible members can receive reimbursement for these COVID-19 at home test kits:
Preferred Retailers – The list of Preferred Retailers and their websites may be found in the Preferred Retailer list on uhc.com.
Other retailers or online – For purchases of FDA-authorized or approved OTC COVID-19 at home tests at any in-store or online retailer other than at the in-store pharmacy counter, members must submit a receipt for reimbursement via the UnitedHealthcare member portal for a maximum reimbursement of $12 per test. Many COVID-19 tests are sold as a two-pack so that means the test pack would be reimbursed at $24 ($12 for each test).
For more information/details, please see these UHC resources:
UnitedHealthcare has created new enrollment forms for UnitedHealthcare Level Funded plans. The new enrollment forms will be required for all submitted business beginning with 11/1 effective dates.
As a courtesy, we have compiled the forms and created separate enrollment packages for Small and Large group.
The All Savers portfolio update, effective 9/1/21 is now live. The following are the big talking points: Prescription Drug Lists
Advantage & Essential Prescription Drug List on Standard Select Network
Specialty Medication Cost Share (SMCS)
Plan Designs
Personal Protect Plan Category
Networks: Choice+/Choice
100% Coinsurance
Deductible Levels: $3000, $4000, $5000, $6000, $7000 and $8500
Prescription Benefit Option applies: Advantage or Essential
1 – 3% higher premium compared to Traditional PPO/EPO 100% plans
No Emergency Room Copay
HSA plan with Core Plus Preventive Prescription Drug List
Please see below for the new plan grid as well as the popular “Why All Savers” brochure. Please remember we can enroll All Savers groups with a minimum of 5 EEs enrolling.
UnitedHealthcare has released the Texas Producer Performance Guide for 2021. Inside the guide, you will find updated medical base commissions for fully insured groups with up to 50 eligible employees will be effective 7/1/21. Click the icon below and see page 7 for additional details regarding the change in commissions.
American Rescue Plan Act of 2021 (ARPA) includes provision for a COBRA continuation coverage premium subsidy for individuals and families who experienced a loss in coverage due to select circumstances, like involuntary job loss or reduction of hours.
UnitedHealthcare has released an overview of changes for brokers, the resource can be viewed here.
Please contact Stacey Priddy, TIE Director of Account Management, at 972.404.2611 with any questions.
In an effort to help small businesses understand the intricacies of the CARES Act and benefits available to them, the U.S Senate Committee on Small Business & Entrepreneurship has created the following guide.
As always, The Insurance Exchange is here for you and your clients. We are closely monitoring the constant changes and guidance provided by the U.S. government and our local carrier partners. Please do not hesitate to reach out to us with any questions or concerns you may have.
UHC is offering a special enrollment period for their fully insured groups from March 23rd through April 3rd with an April 1st effective date. While UHC is trying to do right by those who may not have elected coverage during open enrollment, employers have the option to choose whether or not they offer this to their employees .
Please see attached document for more information as it also includes a notice that employers can share with their employees.
If you think you might be infected with coronavirus (COVID-19), HealthiestYou doctors will answer your questions about the disease, ask a series of questions to evaluate your risk, and advise you on next steps. Their team is trained on the latest protocols for local and national notification, testing, and management of people under investigation for the virus.
Current members can request a phone or video visit with a HealthiestYou doctor by clicking here.
Not currently a member? You can signup instantly by clicking here!
With the spread of Coronavirus (COVID-19), many employers are desperately searching for guidance. We have complied the information below in an effort to keep you informed. The attached articles include recommended strategies from the CDC for employers
Interim Guidance for Businesses to Plan and Respond to COVID-19 This guide provides information from the Centers for Disease Control and Prevention about how businesses and employers can plan for and respond to coronavirus disease 2019 (COVID-19). Click Here
Coronavirus Disease 2019 (COVID-19) Fact Sheet This one-page fact sheet from the Centers for Disease Control and Prevention provides an overview of COVID-19 and coronaviruses in general. Click Here
Based on recent guidance for the Affordable Care Act, most printed 1095-B forms will have been suppressed and not mailed in January. These were previously sent to fully insured group subscribers. However, since the forms are no longer required for federal tax purposes, they are not required to be mailed in January like they have in the past. [Read more..]
The 2019 4th Quarter Survival Guide for UnitedHealthcare and All Savers is here! Product portfolios, value added benefit information, and much more are included in the pdf attached below. If you have any questions, please contact your TIE Sales rep at 972.991.6500.
Available for 10/1, 11/1, 12/1, 1/1, 2/1, 3/1 and 4/1 effective dates!!
Same rates for either 12 months or 15 months
15 Month rate guarantee is a 3 month contract followed by a 12 month contract
Example: 12/1s become 3/1’s
15 Month Rate Guarantee Confirmation Form to be signed by the Broker and Employer
*Note: Group forfeits surplus for the first 3 months
Reconciliation for the 15 months will follow the normal process from 2nd 12-month policy. Reconciliation rules still follow; the group has to be effective 3 months beyond the renewal date in order to be eligible for a potential surplus. *See Chart above
Questions? Please Contact: Joe Sherman – 972.404.2621 Kevin Balkin – 972.404.2620 Amanda Wooldridge – 972.404.2619 Paula Johnson – 972.404.2623 Stacey Priddy – 972.404.2611
This All Savers portfolio update is effective 8/1/19:
PROFORMANCE Plans being added to All Savers
Most plans – $0 copay on kids 19 and under (similar to the UHC fully insured plans)
15 month rate guarantee is available for groups with effective dates of 10/1/19 through 4/1/20 (no rate increase for choosing the 15 month option) **click here for details**
Navigate & Charter plans are now part of the All Savers portfolio (prior to this there were only PPO / EPO options) – make sure to ask your sales rep for specific details
You also have the option of having the Lab & X-rays being covered under the OV – Plans ending in e
OR
Lab & X-rays being subject to the deductible and coinsurance – Plans ending in LX (roughly a 5 – 7% savings)
We have attached the new plan grid as well as the popular “Why All Savers” brochure below . Please remember we can enroll All Savers groups with a minimum of 5 EEs enrolling.
Effective May 7, 2019,
UnitedHealthcare made the decision to place AHP quoting on hold pending the
appeal decision by the court.
If you have already received an existing New Rule AHP employer participant
quote, UnitedHealthcare will honor the quote and will continue to install
previously sold employer participant groups.
Employees and their covered dependents of previously enrolled employer
participant groups may continue to enroll in coverage consistent with the terms
and conditions of the policy.
This action does NOT
impact trade-based Old Rule bona fide employer AHPs that met the requirements
in effect prior to the 2018 DOL Final Rule. The decision only affects
geography-based New Rule AHPs.
"Your office does an exceptional job, in my opinion. I am sure you have brokers who do much more volume than I could ever do. Your employees, however, make me feel like I am the biggest producer you ever had. As a 'one man show', that support is very important to me. I have thanked you before, for the excellent service I receive from your firm. This is not exactly a redundant thanks – because your people keep doing the things that deserve additional thanks.
2021 Texas Producer Performance Guide