Rate Adjustment (Small Group Plans Only)
We’re not using the term “adjustment” just to avoid the word “increase.” Premiums are going down for some products and some rating areas (pending Department of Insurance approval, of course).
- The average unweighted increase (the average premium change based on all our plans in all our rating areas) is 1.3%
- The average weighted increase (the average premium change our existing groups will experience) approximately 7%
- Rates will now be based on the employee’s residence, not the employer’s location. This could impact rates for specific groups whose employees reside in a different rating area than the one in which they work.
- These are averages: the rating changes vary significantly by product and area. Please see our Rating Matrix at www.SeeChangeHealth.com/brokers
Benefit Improvements (For Both Small and Large Group Plans)
Our value-based benefit approach rewards members who take steps to improve and manage their health. We’ve increased the reward for some of our plans.
- Classic Plans (2200, 3500 and 5000):
We’ll now contribute $500 to the Health Incentive Account for employees who complete their Preventive Health Actions—and another $500 when their spouse or domestic partner completes theirs. That’s a total of $1,000 per couple, up from the $200 per person contribution we make today.
- No-Deductible 3.0:
We’ve improved the co-insurance levels by 10%:
- Standard in-network benefit is improving from 60/40 to 70/30.
- Enhanced in-network benefit is improving from 70/30 to 80/20.
For details concerning the rate adjustments rate adjustments and benefit improvements please see our new Rate Tables and Benefit Summaries at www.SeeChangeHealth.com/brokers.
UnitedHealthcare is pleased to introduce their new SignatureValue Alliance
HMO plans, a new set of HMO plans with their own tailored network, available as
of April 1, 2012. The medical groups in the Alliance network have been
recognized for offering exceptional care, quality and cost efficiency. Plans will be available to members in parts of Fresno, Kern, Kings, Los Angeles,
Madera, Orange, Riverside, San Bernardino, San Diego, and Ventura counties.
Alliance Plan Highlights
Alliance HMO plans come with built-in health and wellness programs, at no
additional cost, to help your clients’ employees take steps toward an overall
healthier lifestyle. They can get information on their specific health needs and
enroll in online health coaching or other motivational programs for improving
their health. UnitedHealthcare will also send personalized messages and
reminders for preventive care and screenings. Their disease management and case
management programs offer support and guidance to members who are looking for
treatment options for chronic conditions.
Plans also include prescription drug benefits based on clinical quality and
evidence-based medicine, which may lead to potentially better health outcomes
and cost savings. Members can also receive personalized messages to help them
make more informed decisions and save money at the pharmacy.
Alliance Network Overview
Alliance HMO provides coordinated care to members with access to more than
26,000 physicians and specialists and more than 90 hospitals. With
UnitedHealthcare SignatureValue Alliance, members choose a Primary Care
Physician (PCP) from a network of highly acclaimed medical groups in the state,
which consists of:
- HealthCare Partners Medical Group
- Heritage Provider Network
- Monarch HealthCare Medical Group
- PrimeCare Medical Group
- Santé Community Physicians
- Scripps Health
Alliance HMO Plan Line-up
- SignatureValue Alliance 15-30/300a
- SignatureValue Alliance 20-40/300d
- SignatureValue Alliance 30-40/500d
- SignatureValue Alliance 40-60/800d
- SignatureValue Alliance 40-60/60%
- SignatureValue Alliance 20-40/70%/1500ded
- SignatureValue Alliance 40-60/70%/2000ded
- SignatureValue Alliance HRA 30-45/90%/1500ded
- SignatureValue Alliance HRA 35-50/80%/2000ded
- SignatureValue Alliance HRA 40-55/70%/3000ded
- SignatureValue Alliance HSA 1500/90%
- SignatureValue Alliance HSA 2000/80%
- SignatureValue Alliance HSA 3000/80%
The Alliance plans may be offered standalone or as part of a multi-choice
package, allowing employers to pair the HMO Alliance network alongside specific
PPO plan designs. Premier Source Alliance is also available for employers who
wish to offer HMO Alliance plans alongside another carrier.
- PPO Network: 56% of dentist locations in California. PPO
Dentists are considered In-network for all PPO, PPO Plus Premier, and
- Premier Network: 90% of dentist locations in California. Delta
Premier dentists are considered Out-of-Network for all PPO and PPO plus Premier plans, and are considered In-Network for Premier plans.
Dentist Reimbursement by Plan
- PPO: Ina Classic or OPTIONS PPO plan, all dentists (PPO, Premier, and Non-contracted) are reimbursed at the lesser of the submitted charge or the PPO provider’s contracted fee.
- PPO Plus Premier: If a member visits a PPO dentist, charges are reimbursed at
the lesser of the submitted charge or PPO contracted fee. If visiting a Premier dentist, charges are reimbursed at the lesser of the submitted charge or the Premier provider’s contracted fee.
If a Delta Dental member goes to a Non-contracted dentist, charges are reimbursed at the lesser of the submitted charge OR the fee that satisfies a majority of dentists with the same training and geographical area.
- Premier: If a member visits a PPO or Premier dentist, charges are reimbursed at the
lesser of the submitted charge or the Premier provider’s contracted fee. Non-contracted dentist charges are reimbursed at the lesser of the submitted charge OR the fee that satisfies a majority of dentists with the same training and geographical area.
For more information, view the following:
- Delta Dental PPO and PPO Plus Premier Network Information
- Delta Dental Online – About PPO and PPO Plus Premier
- Delta Dental Online – About Premier
New 2012 Summary of Benefits
According to a recent study by CIGNA, individuals enrolled in consumer-driven health plans (CDHP) can lower their costs. Their study advises that members compared to those customers in traditional PPO and HMO plans, those in a CDHP:
- Lowered their health risks: CDHP customers lowered their risk of developing or worsening a chronic condition. According to the study, when employers fully transitioned to offering only a CDHP option, individuals improved their health risk profile by 10 percent in the first year compared to customers in a traditional plan option.
- Reduced total medical costs: CDHP medical cost trend was 16 percent lower than traditional plans during the first year. Over five years, cumulative cost savings averaged $9,700 per employee enrolled in a CDHP compared to employees who remained in a traditional health plan. Cost reductions were achieved without employers shifting out-of-pocket health expenses to their employees.
- Received higher levels of care: CDHP customers had consistent or higher use of over 400 evidenced-based medical best practices (than their counterparts in traditional plans. CDHP customers also sought preventive care, such as annual office visits and mammograms, more frequently than customers enrolled in a traditional plan.
- Were more engaged in health improvement: Through proper plan design plan and the use of incentives, CDHP customers were more likely to have completed a health risk assessment and participated in their health coaching program than those enrolled in a traditional plan.
- Were more savvy consumers of health care: CDHP customers enrolled in their pharmacy management program were more likely to choose generic medications and had 14 percent lower pharmacy costs compared to those in a traditional plan. In addition, CDHP customers used the emergency room at a 13 percent lower rate than individuals enrolled in HMO and PPO plans.
- More likely to compare cost and quality: CDHP customers were twice as likely to use myCigna.com online cost and quality information to help them select a doctor or to review potential medical costs than customers enrolled in traditional plans.
“Each year the evidence increasingly shows that properly designed consumer-driven health plans can lower health risks, reduce medical costs and drive engagement,” said Cigna Chief Medical Officer, Dr. Alan Muney.
Please contact Gary Whiddon at Health Plans Online for more information on Consumer Directed Health Plans. He can be reached at (888) 474-6627 or firstname.lastname@example.org.