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UnitedHealthcare

Archive for the ‘UnitedHealthcare’ Category

RxDC Reporting Deadlines and Resources

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Article last updated: March 4, 2025.

Most of your clients have upcoming deadlines under the federal prescription drug benefits reporting (RxDC) requirements. Here’s a summary of the requirements, carrier support initiatives, and critical submission deadlines to ensure timely compliance.

General Information

Under Section 204 of the 2021 Consolidated Appropriations Act (CAA), insurance companies and employer-based health plans must submit information regarding prescription drug benefits and health care spending. The information must be submitted to the Centers for Medicare and Medicaid Services (CMS) by June 1st of each year for the prior year’s coverage.

The CMS requires the following information be submitted by insurance companies and employers:

CMS Resources

Anthem

Anthem will follow the same process as in prior years and will file on behalf of their fully insured and ASO clients for the benefits they administer and maintain. This includes ASO groups who opt-in to the D1 reporting. To submit all required information and ensure reporting accuracy, they will request some information from their clients.

Week of February 17th – Large Group, Small Group, and National Account clients were notified about required RxDC filings and necessary actions.

Early June 2025 – RxDC Filing Confirmation

For more information, please visit Anthem’s CAA/Transparency Resource Center.

Blue Shield

Blue Shield will collect D1 Premium Contribution data from groups between February 19, 2025 and April 19, 2025. Blue Shield will also submit D2 for all groups and D3-D8 for groups with prescription drug benefits under a Blue Shield health benefit plan. If a group does not have prescription drug benefits with Blue Shield, they should coordinate submission of D3-D8 with their pharmacy/prescription drug benefits carrier.

Key Details

Who Needs to Submit The Survey?
Any group (or broker/delegate on behalf of the group) who would like Blue Shield to submit D1 Premium data on their behalf to the CMS. This includes:

Third-Party Administrators (TPAs) and Pharmacy Benefit Managers (PBMs) may assist in reporting. Groups that miss the deadline will not be included in Blue Shield’s filing and may be subject to non-compliance if they do not report the required data directly to the CMS by the June 1, 2025 deadline.

Other Details

Information Requested

Health Net

Health Net will not require any data from employer groups to complete Plan List (P2) and Data File (DI) submissions with the CMS on behalf of their clients. No action or any fees are required by employer groups or brokers. This includes groups with members enrolled in Health Net through CaliforniaChoice.

Kaiser Permanente

Fully insured employer groups will need to complete the Kaiser Permanente RxDC data collection form by March 31, 2025.

Information Requested

Self-funded groups: Kaiser Permanente representatives will reach out to each self-funded group, via email, with instructions and offline forms that will be prepopulated with the group’s information along with blank fields for the group to complete and return to Kaiser Permanente.

Specific CA Small Groups: Covered California for Small Business (CCSB) and CaliforniaChoice groups do not need to complete the form as these exchanges will be providing the needed data for all the employers they serve, aggregated at the exchange level, to Kaiser Permanente.

Kaiser Permanente plans to submit all applicable reports and required responses for all employer groups to CMS by the June 1, 2025 deadline. To learn more, view the Kaiser Permanente RxDC FAQs.

Sharp Health Plan

Sharp Health Plan will request employer contribution data via a Request for Information (RFI) survey and will file on behalf of the group. Deadline: April 18, 2025.

UnitedHealthcare

UnitedHealthcare will complete the CAA Prescription Drug (RxDC) reporting for its fully insured and self-funded/level funded groups, including those with OptumRx as the integrated PBM. However, groups with these will need to complete the Request for Information (RFI) tool for RxDC reporting between February 1, 2025, and March 31, 2025.

To support its customers with this important filing, UnitedHealthcare will be submitting the P2 (Group Health Plan), D1 (Premium and Life Years) and D2 (Spending by Category) files for all employers who had active coverage during the reference year (2024). However, completion of the submission requires gathering some information not currently maintained in their system.

UnitedHealthcare will also submit the D3-D8 data files for customers with OptumRx as an integrated PBM. UnitedHealthcare has access to all data required to complete the submission of the D3-D8 data files. Customers who use any other PBM, including OptumRx Direct, must work with that PBM to submit the D3-D8 files.

Resources

Western Health Advantage

Western Health Advantage will request employer contribution data via a Request for Information (RFI) survey and will file on behalf of the group. Deadline: April 15, 2025.

Covered California for Small Business

Covered California for Small Business (CCSB) serves as an administrator of their participating Health Plan Issuers and is not an insurance company nor an employer-based health plan. Therefore, CCSB is not subject to RxDC data collection requirements on behalf of their employer groups. Claremont recommends that the employer follow the reporting guidelines for the enrolled carrier(s).

CCSB’s Small Business Service Center is available to help with questions at 855.777.6782.

CaliforniaChoice

CaliforniaChoice serves as an administrator of their participating Health Plan Issuers and is not an insurance company nor an employer-based health plan. Therefore, CaliforniaChoice is not subject to RxDC data collection requirements on behalf of their employer groups.

Like last year, CaliforniaChoice is facilitating the RxDC for its employers and their plans for the 2024 reference year (reporting due June 1, 2025). CaliforniaChoice will coordinate directly with their carriers to facilitate all reporting obligations. There is no action required from the employer.

Summary

The carriers are actively assisting your clients with federal reporting compliance and will require specific information from each employer group. Watch for direct communication from the carriers and follow their instructions. If you or your clients need assistance we can connect you with appropriate carrier representatives.

Contact us today for assistance.

 

Questions?
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RxDC Reporting Deadlines

Posted by

Article last updated: March 19, 2024.

Most of your clients likely have upcoming deadlines under the federal prescription drug benefits reporting (RxDC) requirements. Here’s a summary of the requirements, how carriers are helping, and the deadlines.

General Information

Under Section 204 of the 2021 Consolidated Appropriations Act (CAA), insurance companies and employer-based health plans must submit information regarding prescription drug benefits and health care spending. The information must be submitted to the Centers for Medicare and Medicaid Services (CMS) by June 1st of each year for the prior year’s coverage.

According to the CMS, the information that is required to be submitted by insurance companies and employers are:

CMS Resources

Blue Shield

Blue Shield will collect D1 Premium information from groups between February 5, 2024 and April 19, 2024. Blue Shield will also submit D2 for all groups and D3-D8 for groups with prescription drug benefits under a Blue Shield health benefit plan, and P2 accordingly. If a group does not have prescription drug benefits with Blue Shield, they should coordinate submission of D3-D8 with their pharmacy/prescription drug benefits carrier, and P2 accordingly.

Key Details

Other Details:

Information Requested

UnitedHealthcare

Due to technical issues on their end and updated guidance from CMS about the 2024 submission, below are revised dates:

UnitedHealthcare will complete the CAA Prescription Drug (RxDC) reporting for its fully insured and self-funded/level funded groups, including those with OptumRx as the integrated PBM. However, groups with these will need to complete the Request for Information (RFI) tool for RxDC reporting between February 1, 2024, and March 31, 2024. The March 31, 2024, deadline is firm.

To support its customers with this important filing, UnitedHealthcare will be submitting the P2 (Group Health Plan), D1 (Premium and Life Years) and D2 (Spending by Category) files for all employers who had active coverage during the reference year (2023). However, completion of the submission requires gathering some information not currently maintained in their system.

UnitedHealthcare will also submit the D3-D8 data files for customers with OptumRx as an integrated PBM. UnitedHealthcare has access to all data required to complete the submission of the D3-D8 data files. Customers who use any other PBM, including OptumRx Direct, must work with that PBM to submit the D3-D8 files.

Resources

Kaiser Permanente

Kaiser Permanente is required to submit information on prescription drugs and healthcare spending to CMS. On February 1, 2024 Kaiser Permanente began to send out a survey form from Kaiser-Permanente-RxDC@kp.org to all contract signers to request this information. The form must be completed by March 15, 2024.

Information Requested

Kaiser Permanente plans to submit all applicable reports and required responses for all employer groups to CMS by the June 1, 2024 deadline.

Sutter Health Plus

Employer groups must submit information to Sutter Health Plus regarding the average monthly premiums paid on behalf of enrollees and the amount paid by enrollees each year.

For calendar year 2023 reporting, employers or brokers are to submit the required information through the online Premium Reporting Form.

Submissions are due no later than March 1, 2024.

Cigna + Oscar

Cigna is reporting on behalf of Cigna + Oscar groups, so no action is required by employer groups or brokers.

Covered California for Small Business

Covered California for Small Business (CCSB) serves as an administrator of their participating Health Plan Issuers and is not an insurance company nor an employer-based health plan. Therefore, CCSB is not subject to RxDC data collection requirements on behalf of their employer groups. Claremont recommends that the employer follow the reporting guidelines for the enrolled carrier(s).

CCSB Resources – CCSB’s Small Business Service Center is available to help with questions at 855.777.6782.

CaliforniaChoice

CaliforniaChoice serves as an administrator of their participating Health Plan Issuers and is not an insurance company nor an employer-based health plan. Therefore, CaliforniaChoice is not subject to RxDC data collection requirements on behalf of their employer groups. Claremont recommends that the employer follow the reporting guidelines for the enrolled carrier(s).

Summary

The carriers are taking action to support your clients with the federal reporting requirements. In order to do so, they require information from each employer group. Look out for emails directly from the carriers, and follow their instructions. If you or your clients have questions, we can help direct you to the right contacts at the carriers.

Contact us today for assistance.

 

Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.


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UnitedHealthcare Specialty Plans – Update and Reminders

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The recent specialty plans update and reminders are listed below.

Update

5% Dental Rate Cap Extended Through July 2021 Effective Dates

The UnitedHealthcare Dental Rate Cap Program guarantees that groups enrolling in a new plan will receive no more than a 5% increase at their first renewal.

Reminders

Enhanced Dental Plan Options

Off-Cycle Specialty Adds
UnitedHealthcare allows certain specialty products to be added off-cycle without any approvals. The rate guarantee period will be adjusted so the off-cycle products renew at the policy anniversary.

Products that DO NOT require approval to be added off-cycle:

Products that DO require approval to be added off-cycle:

Start quoting UnitedHealthcare specialty plans today!

 

Questions?
Contact your Claremont team at 800.696.4543 or info@claremontcompanies.com.


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UnitedHealthcare Specialty Plans – Update and Reminders

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The recent specialty plan update and reminders are listed below.

Update

Employer Bundling Program extended to July 2021 to earn up to a $3,000 credit by bundling 3+ lines of new ancillary coverage.

Qualifications

Eligibility Requirements

Download the Employer Bundling Program flyer to learn about the savings on specialty plans.

Employer Bundling Program

Reminders

Dental and Vision Rate Passes Extended Through April 2021

Q2-2021 Small Group Rate Actions and Broker Bonus Programs

Broker bonus for new sales and renewing groups.

Specialty Benefits Quick-Quote-Tool

Start quoting UnitedHealthcare specialty plans today!

 

Questions?
Contact your Claremont team at 800.696.4543 or info@claremontcompanies.com.


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UnitedHealthcare Webinar: COVID-19 Briefing on The Latest Vaccination Efforts

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Stay up to date on the latest COVID-19 vaccination efforts by attending UnitedHealthcare’s webinar on January 27th at 12:00 pm PST.

Topics Include:

Register now.

Register for The Webinar

 

Questions?
Contact your Claremont team at 800.696.4543 or info@claremontcompanies.com.


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Your success is important to us, and we’re actively working on new solutions to support you throughout the year. To get the latest news via text messaging in the future, simply provide your cell phone number here.

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UnitedHealthcare Small Group Rate Actions and Bonus Programs

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Prepare for Q2-2021 with these rates actions, broker bonus programs, updates, and reminders from UnitedHealthcare.

Q2-2021 Small Group Rate Actions

Broker Bonus Programs*

‘New’ Sales Bonus

Renewal Bonus

Current Small Business Broker Bonus
The current bonus program is in place and will be in addition to the bonus programs mentioned above for new groups written in 2021.

UHC Current Bonus Program

*Only agents permanently located in California are eligible for the bonus.

Underwriting

Choice Simplified Packages

Staff Model Guidelines
Only 5 California employees enrolled in UnitedHealthcare to offer alongside up to 2 Staff Model carriers, 60% overall participation required.

Out-of-State Guidelines
Does not require 51% to reside in a state.

Participation Certificate
Groups with 10+ employees can submit a participation certificate in lieu of a DE9C.

Start-Up Groups
6 weeks in business and 2 weeks payroll prior to the effective date.

Packaged Savings
Discounts for bundling specialty coverage (dental, vision, life and/or short-term disability) with medical coverage.

Specialty Updates

Dental 
UnitedHealthcare is extending the 5% dental rate cap until July 2021 effective dates.

Vision

Wellness Reminders

Motion HSA Prepaid Debit Card

HSA members (employee or spouse) can choose to receive incentives via an HSA deposit or via a prepaid debit card during Motion registration. The debit card may be used for non-health care-related expenses.

Motion and Apple Fitness+

Motion members with an Apple Watch® can now receive 5 months access to Apple Fitness+ at no additional cost from January 1, 2021 through June 30, 2021.

Important Dates

 


Drive sales with UnitedHealthcare’s valuable free services, including:

Start quoting UnitedHealthcare today!

 

Questions?
Contact your Claremont team at 800.696.4543 or info@claremontcompanies.com.


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UnitedHealthcare Vision Provider Network Update

Posted by

UHC Vision Provider Network Update

Reminders

Vision Coverage

Specialty Benefits Quick-Quote-Tool

Dental and Vision Rate Passes Through April 2021

Start quoting UnitedHealthcare Specialty plans today!

 

Questions?
Contact your Claremont team at 800.696.4543 or info@claremontcompanies.com.


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Apple Fitness+ Now available to UnitedHealthcare Motion Members

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UnitedHealthcare Apple Watch - Apple FItness+

Starting in 2021, UnitedHealthcare Motion® members with an Apple Watch® will be eligible to sign up for Apple Fitness+ and get a five consecutive month subscription at no additional cost.

Members will have access to Apple Fitness+ digital studio-style workouts with real-time metrics from Apple Watch synced to their iPhone, iPad or Apple TV, so they can follow their workout progress on screen. And they can choose from 10 workout types, with new workouts added every week that can be completed anytime, anywhere. Members can handpick music from their favorite artists to stay motivated. What’s more, Motion members may earn financial rewards for participating in Apple Fitness+ workouts.

Eligibility

The Apple Fitness+ promotion is available to any Motion-eligible member who activates the offer between January 1 – June 30, 2021, and has registered for UnitedHealthcare Motion and paired an Apple Watch on the UHCMotion mobile app. Once members pair an Apple Watch, they’ll receive a notification on how to redeem the Fitness+ promotion code.

Check out the press release to learn more.

Start quoting UnitedHealthcare today!

 

Questions?
Contact your Claremont team at 800.696.4543 or info@claremontcompanies.com.


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UnitedHealthcare Vision Benefits Update

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UnitedHealthcare Specialty plan reminders:

UnitedHealthcare’s Flexible Vision Network

Enhanced Maternity and Pediatric Vision Benefits 

Online Vision Providers: Warby Parker and GlassesUSA.com

Start quoting UnitedHealthcare Specialty plans today!

 

Questions?
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UnitedHealthcare Specialty Benefits Quick Quote Tool and Plan Administrator Guide for Life and Disability Products

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Specialty Benefits Quick Quote Tool for Small Business

UnitedHealthcare’s newly launched Specialty Benefits Quick Quote Tool is a web-based self-service quoting tool that allows brokers to quickly and easily provide dental, vision, and basic life quotes for groups with 2-100 eligible employees. Easily access it through United eServices using your UeS login information

New Features Include:

Check out the Quick Quote Tool guide to learn more.

Get The Quick Quote Tool Guide

Plan Administrator Guide for Life and Disability Products

Get helpful action items and definitions to review as you administer your UnitedHealthcare life and disability coverage. Download the Plan Administrator Guide.

Get The Plan Administrator Guide

 

Questions?
Contact your Claremont team at 800.696.4543 or info@claremontcompanies.com.


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