SeeChange Rates are Changing May 1, 2012

Here is what SeeChange is saying  . . .

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

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

UnitedHealthcare New Alliance HMO Plans, April 2012

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.

Delta Dental PPO vs. Premier Network – What’s the Difference?

Network Information

  • PPO Network: 56% of dentist locations in California. PPO
    Dentists are considered In-network for all PPO, PPO Plus Premier, and
    Premier plans.
  • 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:

New 2012 Summary of Benefits

UHC provides Rx cost calculator

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!

Why not check your costs.



Anthem Revised Rules Regarding Lipitor

 Anthem Blue Cross of California has recently announced that all members with prescriptions for Lipitor will need to have their prescriptions pre-authorized effective April 1, 2012 

This change is due to the addition of atorvastatin, a new generic for the brand name Lipitor, on their covered drug list.

This change impacts all of the commercial and individual business in California and New York. Medicare Part D and state-sponsored business are not impacted.

Aetna – CA Small Group New Rates & Plan Changes effective April 1, 2012

Aetna will introduce six new plans for Small Group clients in California. The new portfolio includes two HMOs and four Managed Choice® (MC) plans. All are effective April 1, 2012.

All of these new plans build on rates and benefits that brokers and plan sponsors have requested. 

More on the new plans: 

  • The new plans were designed to help employers and employees save on health care costs while getting a plan that meets their needs.
  • All of the HMO and MC/PPO plans alongside each other.
  • Plan sponsors can set their contribution rates on the lowest priced plan, and their employees can “buy up” to different plans if they wish to do so.

Just look at some of the key benefits these plans offer your employees:

IMPORTANT PLAN CHANGES: In addition to introducing new plans, some changes were made to existing plans. Look at the Renewal guide for details about the changes to specific plans. Please note: There are changes to every plan — so it is important for you to review the changes. You can also view the new Plan Guide here

Other plan highlights include:

  • Vision benefit now included with all plans — One exam every 24 months. Includes refractive testing. 
  • Wellness/health incentive benefit — Employees and their spouses/domestic partners can earn up to $100 for completing a wellness program through simple steps.
  • Brokers and employees can complete adds and terms online.
  • As of March 2012, an employer can obtain a new employee’s member ID right in the on-line enrollment tool as soon as the enrollment has been processed.