Insurance Exchange keywords

This year, UnitedHealthcare began applying the revised Medicare estimation process to fully insured and level-funded business in the applicable markets for Medicare-eligible members with Medicare Part A but not Medicare Part B, and for whom Medicare is primary.

These changes were effective as follows:

• Fully Insured Small Groups
  • New business: Jan. 1, 2023
  • Renewing business: At renewal beginning with July 1, 2023 renewals

• Fully Insured Large Groups
  • New business: Jan. 1, 2023
  • Renewing business: At renewal beginning with July 1, 2023 renewals

• Level Funded Groups
  • New business: Feb. 1, 2023
  • Renewing business: At renewal beginning with July 1, 2023 renewals

For more details on the specific changes, what Medicare estimation is, and who is impacted, please click here.

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:

• If you have a customer who has UMR, there is a UMR branded Confirmation of Compliance (pdf).
• If you have a customer who has a Surest plan, there is a Surest branded Confirmation of Compliance (pdf).

Click here to read the full article from UnitedHealthcare

2024 Product Portfolio Updates

• 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 provide UHC 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

• New Sales and Conversion Bonus
• Level Funded Benefitter IMQ Bonus

1/1/24 Plan Grids

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 15^th 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:

• Tuesday, July 18, 2:00 pm – 2:30 pm CT
• Tuesday, August 8, 1:00 pm – 1:30 pm CT
• Wednesday, August 30, 11:00 am – 11:30 am CT
• Wednesday, September 20, 1:30 pm – 2:00 pm CT
• Wednesday, October 18, 2:00 pm -2:30 pm CT
• Tuesday, November 14, 11:00 am -11:30 am CT
• Thursday, December 6, 2:00 pm -2:30 pm CT

UHC Broker Bonus:

• 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.
• Broker bonus details are attached here – 2023 UHC Broker Bonus Details

Level-funded training courses:

For questions or additional details, please contact your TIE Sales Representative at 972.991.6500.

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:

• COVID-19 At Home Test FAQs
• COVID-19 Resource Center
• OTC at home testing page
• Preferred Retailers

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.

UnitedHealthcare AllSavers product name is officially changing to UnitedHealthcare Level Funded.

This name change will take effect beginning with 11/1 effective dates.

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.

2021 All Savers Plan Grid

“Why All Savers” Brochure

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..]