UnitedHealthcare Q4-2018 Small Group Rates and Updates

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UnitedHealthcare’s Q4 PPO rates for small groups (1-100) will remain unchanged through December 31, 2018. Rates, benefits, and underwriting updates are listed below.

Updates

Rates for October – December 2018 Effective Dates

• PPO rate pass.
• HMO statewide average increase of 1.5%. HMO network increases:
  • Full: 2%
  • Advantage: 2%
  • Alliance: 0%
  • Focus: 1.5%

Benefits, Plans, and Packages

• No benefit changes to the existing plans.
• Two new HMO plans will be available, effective November 1, 2018, on all four HMO networks. These two plans will offer a hospital copay instead of the usual coinsurance benefit.
  • HMO 20-40/500d paired with existing HMP Rx plan 407.
  • HMO 30-60/1000d paired with the new HMO Rx plan 859.

Download the detailed Benefit Grid for more information on the new HMO plans.

• A new “Choice Simplified III” package option will be added effective November 1, 2018, giving employers four plan packages to choose from. Choice Simplified III will be the only portfolio with access to the two new HMO plans.

Zip Codes

• Marin County zip code 94924 has been added to the Signature (full HMO) network and all PPO networks. View UnitedHealthcare’s rating areas and zip codes.

Underwriting Changes Effective July 1, 2018

• Minimum 60% participation is required for contributory groups, excluding COBRA participants.*

• Groups offering the UnitedHealthcare Choice Simplified Package and a staff model:
  • Must have at least 60% participation between the participating carriers with 5 California employees enrolling with UnitedHealthcare, excluding COBRA participants.*
  • The most recent billing statement from the current carriers reflecting employee census and applications/waivers from any employees not reflected on the billing statement is required.
  • Coverage may be written alongside two other carriers (must be a staff-model carrier). Eligible staff models include Chinese Community Health Plan, Kaiser, MediExcel, Sharp, SIMSA, Sutter, and Western Health Advantage. Coverage may not be written alongside California Choice or Covered California.
• Groups offering the UnitedHealthcare Multi-Choice® State Package and a staff model:
  • Must have at least 60% participation with UnitedHealthcare, excluding COBRA participants.*
  • The most recent billing statement from the current carriers reflecting employee census and applications/waivers from any employees not reflected on the billing statement is required.
• Additional participation guidelines for all groups:
  • When the employer contributes 100% towards the employee premium, 100% of eligible employees must enroll.
  • COBRA participants and employees in the waiting period are not considered eligible employees and are not included when determining the participation requirement.

Forms and Marketing Materials
Underwriting guidelines, the Product Benefit Selection Form (PBSF), product grid, product catalog, and the two new HMO plans’ Schedule of Benefits are available on the UnitedHealthcare Broker Portal.

Questions?
Contact the small group experts at 800.696.4543 or info@claremontcompanies.com.

*Excluding valid waivers for spousal group coverage through another employer’s plan, parental group coverage through another employer’s group plan for a dependent up to age 26, spousal COBRA/state continuation, Medicare (Parts A and B required), TRICARE or at-no-cost, government-sponsored plans including an Exchange. Individual waivers are considered valid waivers for non-grandfathered groups beginning January 2014. This does not apply to groups written or renewed in 2013.