UEA BENEFITS PROGRAM: Brief Overview

Q: What medical plans and carriers are offered through the UEA Benefits Program in 2017?

The UEA Benefits Program sponsors fully insured medical plans underwritten by UnitedHealthCare (UHC) and Kaiser Permanente (Kaiser). There is a wide array of medical, dental, vision, and other coverages available for qualifying employers. For larger employers with 100 or more employees, both UHC and Kaiser have agreed to dual choice carrier offerings (certain conditions apply).

Q: What are the primary advantages of the UEA Benefits Program?

The UEA Program creates a number of advantages by bringing together the resources of top notch carriers, local benefit advisors, and expert employment counsel provided by the United Employers Association. A few of these advantages include the following:

UnitedHealthCare / Kaiser Permanente
Pricing / Large group rating model creates pricing advantages & stability for employers / Large group rating model creates pricing advantages & stability for employers
Designs / The in-network benefits are consistent for ease of use across the 3 networks. / A complete and comprehensive array of different plans and network options
Choice / Any combination of benefit designs and networks up to 5 plans / Up to a total of 3 medical plans available with or without alternative care
Service / Plans include several “no cost” features and services including Wellness, FSA and EAP / Services are managed under one team staffed by senior benefit professionals
Membership / Expert employment law and human resource advice through United Employer Association / Expert employment law and human resource advice through United Employer Association

Q: What types of medical plans are underwritten by UnitedHealthCare?

UHC offers 6 medical plan designs, 3 provider networks, and allows each employer to offer any combination up to 5 plans. Each plan design and each network is considered a medical plan. For instance, offering the $1,500 medical plan and the 3 available networks = 3 plans.

UHC Medical Plans

Deductible / Out of Pocket / Virtual / Primary / Specialty
$500 / $3,000 / $0 / $15 / $50
$1,500 / $4,500 / $0 / $15 / $50
$2,500 / $5,500 / $0 / $15 / $60
$3,500 / $7,000 / $0 / $15 / $60
$5,500 / $7,150 / $0 / $40 / $80
$3,500 HSA / $6,550 / n/a / 20% / 20%
Network / Description / PCP Designation / Specialty Referrals / Out of Network
Choice Plus / Comprehensive PPO / Not required / Not required / Reduced Coverage
Navigate / Legacy based EPO / Required / Required / No Coverage
Charter / Providence based EPO / Required / Required / No Coverage
UHC product and UHC network grid, click here

Q: What types of medicals plans are underwritten by Kaiser Permanente?

Kaiser offers 5 deductible plans (DHMO), 4 Added Choice Plans (POS), and allows each employer to offer up to 3 medical plans. Pairing restrictions apply when an employer offers both DHMO plans (Kaiser Network) and Added Choice plans (Kaiser and First Choice network).

DHMO Plans: Kaiser Network

Deductible / Out of Pocket / Primary / Specialty / Pairing Option
$500 / $3,000 / $20 / $30 / DF, DX, DR, DK
$1,500 / $5,000 / $25 / $35 / DR,DK
$2,500 / $6,000 / $25 / $35 / DK
$4,000 / $5,000 / $30 / $40 / DK
$5,000 / $6,850 / $30 / $40 / None

Added Choice Plans: 3 Benefit Tiers (Kaiser, PPO, and out of network)

Plan & Deductible / Out of Pocket / Primary / Specialty / Pairing Option
DF: $500/$1,000/$1,500 / $3,000/$5,500/$7,500 / $30 / $40 / $500
DX: $1,500/$3,000/$4,500 / $5,000/$6,850/$8,400 / $25 / $35 / $500
DR: $2,000/$4,000/$6,000 / $5,000/$6,850/$8,400 / $25 / $35 / $500 + $1,500
DK: $4,000/$6,350/$8,400 / $5,000/$6,850/$8,400 / $30 / $40 / All except $5,000
Kaiser Permanente product grid, click here

Q: What are the quoting parameters on prospective new groups?

There are a few considerations based on size, carrier, and requested effective date:

UnitedHealthCare / Kaiser Permanente
Rolling Renewals / Yes. 12-month rate guarantee / No. Kaiser groups renew 1/1
Quote Existing Customers / Yes, under 49. No, over 50 / No.
New Groups 49 and under / Yes, will quote / Yes, will quote
New Groups 50 to 99 / Yes, will quote / No, will not quote UEA
Groups over 100 / Yes, will quote with claim data / Yes, will quote with claim data

Thursday, April 20, 2017