UHC Releases UW Updates, Q4 Rate Action, New HMO Plan Designs and More!

Q4 Rate Action for October – December 2018 effective dates:

  • PPO: Rate Pass!
  • HMO: 1.5% overall statewide average. Statewide average per HMO network listed below:
    • Signature: 2.0%
    • Advantage: 2.0%
    • Alliance: 0%
    • Focus: 1.5%
  • Q4 rates are available for quoting in Health Connect.

NEW for 11-1-2018 and later effective dates:

Two new HMO plan designs with copays instead of coinsurance for hospitalization and outpatient surgery.

  • Platinum HMO 20-40/500d
  • Gold HMO 30-60/1000d
  • Rates and key benefits are available in Health Connect to quote for November and December 2018 groups.
  • Benefit Summaries and SBC’s are pending

NEW Choice Simplified III package effective 11-1-2018

  • New HMO plan designs above will available only in the Choice Simplified 3 package.
  • See the updated Product and Benefit Selection Form for 11-1-2018 and later effective dates for additional details on plans available in the Choice Simplified III package.
  • Groups renewing on and after 11-1-18 should use the updated Group Acceptance and Change Form which includes the Choice Simplified III package.

Underwriting Updates:

Groups may now be written alongside two (2) staff-model carriers!

  • Eligible staff-model carriers have been expanded to include: Chinese Community Health Plan (CCHP), Kaiser, MediExcel, Sharp Health Plan, SIMNSA, Sutter Health Plus and Western Health Advantage (WHA).
  • Participation guidelines apply (see below).
  • UHC may not be written alongside CaliforniaChoice or Covered California.

Participation Guidelines:

  • UHC as the sole carrier: 60% participation required
  • UHC Choice Simplified Package alongside staff model carrier(s): requires 60% participation between the participating carriers with 5 California based employees enrolling with UHC
  • UHC State Package alongside staff-model carrier(s): 60% participation with UHC is required
  • See the Updated UnitedHealthcare Underwriting Guidelines (07-18) for more information.

Zip Code Update:

  • Marin County zip code 94924 has been added to the Signature HMO network and all PPO networks

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