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
Now is the time to stay healthy with “FREE” preventive care services!
Preventive health care–including annual physical exams, screenings, and immunizations–is essential to good health. Yet many Americans don’t receive the regular preventive care they need, despite the fact that chronic diseases, which are responsible for 7 of 10 deaths among Americans each year and account for 75% of the country’s health care spending–are often preventable.
Why do so few Americans get the preventive care they need? Often, the reason is cost.
The Affordable Care Act (health care reform) attempts to address this problem by requiring all new group and individual health insurance plans as of September 23, 2010 to pay 100% of the costs for preventive care services ranked A and B by the U.S. Preventive Services Task Force (USPSTF) .
If your health plan qualifies, you can take advantage of a wide range of preventive care services to help you avoid illness and improve your health–at no cost to you, so long as you receive these services from a health care provider within your health plan’s network of doctors and hospitals.
You won’t have to pay a copayment at the office visit, and not a penny toward coinsurance or your deductible. Doctors and health care facilities continue to charge for these services. But now it’s the health insurance companies that pay the costs. Essentially, preventive care becomes ‘free’ for the policyholder, greatly increasing the incentive to take advantage of these services. The following lists outline the preventive care services covered by these rules for adults, women, and children.
Covered preventive services for adults include:
- Abdominal aortic aneurysm
- A one–time screening for men of specified ages who have ever smoked
- Colorectal cancer screening
- Depression screening for adults
- Type 2 diabetes screening
- Diet counseling for adults at higher risk for chronic disease
- HIV screening for all adults at higher risk
- Immunization vaccines for adults (recommendations vary):
- Hepatitis A
- Hepatitis B
- Herpes zoster
- Human papillomavirus
- Influenza (flu shot)
- Measles, mumps, rubella
- Tetanus, diphtheria, pertussis
- Obesity screening and counseling for all adults
- Sexually transmitted infection (STI) prevention counseling for adults at higher risk
- Tobacco use screening for all adults and cessation interventions for tobacco users
- Syphilis screening for all adults at higher risk
Women Covered preventive care services for women, including pregnant women, include:
- Anemia screening on a routine basis for pregnant women
- Bacteriuria urinary tract or other infection screening for pregnant women
- BRCA (breast cancer gene) counseling about genetic testing for women at higher risk
- Breast cancer mammography screenings every one to two years for women over 40
- Breast cancer chemoprevention counseling for women at higher risk
- Breastfeeding comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women*
- Cervical cancer screening for sexually active women
- Chlamydia infection screening for younger women and other women at higher risk
- Contraception : Food and Drug Administration–approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs*
- Domestic and interpersonal violence screening and counseling for all women*
- Folic acid supplements for women who may become pregnant
- Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes*
- Gonorrhea screening for all women at higher risk
- Hepatitis B screening for pregnant women at their first prenatal visit
- Human immunodeficiency virus (HIV) screening and counseling for sexually active women*
- Human papillomavirus (HPV) DNA test : High–risk HPV DNA testing every three years for women age 30 or older* with normal cytology results
- Osteoporosis screening for women over 60, depending on risk factors
- Rh blood incompatibility screening for all pregnant women and follow–up testing for women at higher risk
- Tobacco use screening and interventions for all women, and expanded counseling for pregnant tobacco users
- Sexually transmitted infections (STI) counseling for sexually active women*
- Syphilis screening for all pregnant women or other women at increased risk
- Well–woman visits to obtain recommended preventive services for women under 65*
Note: Services marked with an asterisk (*) must be covered with no cost–sharing in plan years starting on or after August 1, 2012.
Covered preventive care services for children include:
- Alcohol and drug use assessments for adolescents
- Autism screening for children at 18 and 24 months
- Behavioral assessments for children of all ages
- Blood pressure screening for children
- Cervical dysplasia screening for sexually active females
- Congenital hypothyroidism screening for newborns
- Depression screening for adolescents
- Developmental screening for children under age 3, and surveillance throughout childhood
- Dyslipidemia screening for children at higher risk of lipid disorders
- Fluoride chemoprevention supplements for children without fluoride in their water source
- Gonorrhea preventive medication for the eyes of all newborns
- Hearing screening for all newborns
- Height, weight, and body mass index measurements for children
- Hematocrit or hemoglobin screening for children
- Hemoglobinopathies or sickle cell screening for newborns
- HIV screening for adolescents at higher risk
- Immunization vaccines for children from birth to age 18 (recommendations vary): o
- Diphtheria, tetanus, pertussis
- Haemophilus influenzae type B
- Hepatitis A
- Hepatitis B
- Human papillomavirus
- Inactivated poliovirus
- Influenza (flu shot)
- Measles, mumps, rubella
- Iron supplements for children ages 6 to 12 months at risk for anemia
- Lead screening for children at risk of exposure
- Medical history for all children throughout development
- Obesity screening and counseling
- Oral health risk assessment for young children
- Phenylketonuria (PKU) screening for this genetic disorder in newborns
- Sexually transmitted infection (STI) prevention counseling and screening for adolescents at higher risk
- Tuberculin testing for children at higher risk of tuberculosis
- Vision screening for all children
It’s important to keep in mind that while the health plan cannot charge you a copayment, deductible, or coinsurance when the primary purpose of the office visit is the recommended preventive care service and the service is NOT billed separately from the office visit, you may be required to share some of the costs if the preventive service is not the primary purpose of the office visit. And remember, preventive services are covered at 100% only when received from health care providers within the health plan’s network. For the most up–to–date list of covered preventive care services, please visit http://www.uspreventiveservicestaskforce.org
With health care costs continuing to hurt our pocketbook, many consumers have moved to high deductible plans. HSA qualified plans require that the insured (not the insurance company) is responsible to pay prescription costs toward that high deductible. Most of us are unaware of our prescription costs, but with the new HSA plans, we can help ourselves save money if we knew the cost of our prescription options.
UHC has a great online tool to help us identify prescription costs. You can access it here. This is only an example of costs through Medco, so your costs will differ depending on your insurance plan and pharmacy. It also shows you the cost for mail order compared to filling your prescription at a retail pharmacy.
I looked up 80mg tabs of Zocor, a common cholesterol drug. A 30 day supply from a retail outlet showed $163.59, whereas the generic Simvastatin costs only $12.05. Yikes, the brand name was 1300% higher!