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Small Group (1-100) Plan and Rate Changes – Effective January 2016

Small Group (1-100) Plan and Rate Changes – Effective January 2016

Small Group (1-100) Plan and Rate Changes – Effective January 2016, UnitedHealthcare,

UnitedHealthcare has announced their plan and underwriting changes, and rate adjustments by product, for small groups effective January 1, 2016. All rates are available now for quoting.

Rate Adjustments


  • PPO – 5.5% Decrease
  • HMO – 3.2% Decrease


  • Dental – Pending
  • Vision – Pending
  • Life – Rate Pass

Plan Changes

PPO Benefits
Summaries will be available on the UnitedHealthcare web site soon. Changes made to PPO plans since the initial 2016 portfolio release are featured below. Please note: there may be additional changes to the Silver HSA plans.

  • All non-HSA Multi-Choice State package plans (AEJK, AEJL, AEJM, AEJQ, AEJR, AEJS) – Outpatient Partial Hospitalization/Intensive Outpatient Treatment for Mental Health/Substance Abuse cost share has changed to 100%, and is not subject to a deductible. There are no changes to the Outpatient MH/SA Office Visit copays.
  • The Rx plan HJ has been discontinued and replaced with the new Rx plan (code to be assigned).
  • All standard Choice Simplified Rx plans have a copay max added to Tier 4. Platinum, Gold, and Silver plans have a $250 Tier 4 copay max. Bronze plans (including Bronze HSA) have a $500 Tier 4 copay max.
  • The TMJ $3000 benefit limit on non-surgical TMJ services has been removed.

HMO Benefits
The plans are pending regulatory approval. Changes made to the HMO plans since the initial 2016 portfolio release are outlined below.

  • Conflicting compliance requirements between CA AB 1305 and Federal IRS regulations on HSA-qualified health plans may impact the Silver Alliance HSA plan. Until the DMHC provides guidance, the Silver Alliance HSA plan will remain as is.
  • The HMO plan description in the Schedule of Benefits has changed to an alternate marketing name. For example, Gold Advantage 1000 for the 30-50/30%/1000ded plan.
  • The HMO Rx tier description changed to Tier 1, Tier 2, etc. It’s no longer referred to as Generic Formulary, Brand Name Formulary, etc.

Alliance Network
In 2016, the Alliance Network will be limited to the current zip code table on file and these counties: Fresno, Kern, Kings, Los Angeles, Madera, Orange, Riverside, San Bernardino, San Diego, and Ventura. A revised small group brochure will be forthcoming.

Commission Schedule
Access the broker commission schedule for new small group cases (up to 100 enrolled employees).

Contact the small group experts at 800.696.4543 or



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