Premier Health Will be Out-of-Network for United Healthcare Members In January

Premier Health in Southwest Ohio will be out-of-network starting Jan. 1, 2018. The following United Healthcare Medicare Solutions plans in the southwestern Ohio and Kentucky regions will be impacted:

  • AARP MedicareComplete (HMO) Plan 6 H5253-052
  • AARP MedicareComplete (HMO)  Plan 2 H5253-053
  • AARP MedicareComplete (HMO) Plan 3 H5253-054
  • Dual Complete® (HMO) H5253-059
  • Dual Complete (HMO-POS) H5322-028

 

Member information

  • Letters to impacted members will start arriving Oct. 23 alerting them to the network change.

 

Members in AARP Medicare Supplement Insurance Plans, insured by UnitedHealth care Insurance Company, will not be impacted by this change and may continue to access care from any doctor or hospital that accepts Medicare patients.

Updates to UHC Prescription Drug Lists

The following updates will take effect for the UnitedHealthcare Prescription Drug Lists (PDLs) Jan. 1, 2018. These updates apply to all UnitedHealthcare integrated commercial business. They do not apply to direct commercial business (OptumRx direct business without UnitedHealthcare medical coverage).

UnitedHealthcare Pharmacy Benefits

View UnitedHealthcare’s online, pre-recorded presentation of the pharmacy benefit strategies for Jan. 1, 2018.

Presentation for Clients

Click here to read more.

 

PDL Tracker

 

UnitedHealthcare 2018 Updates for Small Group Fully Insured

UnitedHealthcare’s Small Group fully insured business will have the following advantages in 2018, along with the full suite of UHC benefits:

  1. $0 Virtual Visits
    1. UHC’s telemedicine solution will now be included in all plans (except HSAs) at no cost, allowing your groups to save time and money for 70 percent of services they would seek at an Urgent Care or Emergency Room.
  2. RealAppeal: Embedded at no additional cost
    1. UHC’s state-of-the-art wellness solution, previously only available in Key Accounts, is now available for 2-50. Members will receive a Success Kit and have access to 1:1 coaching designed to lower BMI and lose weight.
  3. Increased Commissions
  Payment Per Enrolled Employee per Month
              Case Size First year commissions Renewal Commissions
1 to 4 enrolled employees $5 $5
5 or more enrolled employees $27 $24

Carriers with January 1 Effective Dates Available!

The following carriers have January 1, 2018, effective dates available for quoting as of October 4, 2017, this afternoon:

  • Aetna Funding Advantage
  • All Savers
  • Anthem (OH, KY, IN)
  • Anthem SOCA BP
  • Humana (OH, KY, IN)
  • UHC (IN, KY, OH)

 

For more information, contact your Cornerstone representative today!

Updates to UnitedHealthcare Preventive Care Services Coverage Determination Guidelines

The U.S. Preventive Services Task Force (USPSTF), the Advisory Committee on Immunization Practices including Bright Futures, which are part of the Centers for Disease Control and Prevention (CDC), and the Health Resources and Services Administration (HRSA) make recommendations regarding services that should be covered under the Affordable Care Act (ACA).

Based on recent recommendations, UnitedHealthcare is making several changes to the UnitedHealthcare Commercial Preventive Care Services Coverage Determination Guideline (CDG) for coverage at no cost share. These changes include medications for individuals at risk for cardiovascular disease (CVD), targeted age bands for lead and fluoride screening, and removal of coverage for prostate-specific antigen (PSA) and rubella screening. Please note that Preventive Services at no cost share are not required for grandfathered plans.

 

RESOURCES

Fourth Quarter 2017 and First Quarter 2018 Preventive Changes Announced

UnitedHealthcare 2018 PDL Updates Announced

The following updates will take effect for the UnitedHealthcare Prescription Drug Lists (PDLs), as well as the SignatureValue Formulary Jan. 1, 2018. These updates apply to all UnitedHealthcare integrated commercial business. They do not apply to direct commercial business (OptumRx direct business without UnitedHealthcare medical coverage).

UnitedHealthcare Pharmacy Benefits
You and your customers 
are invited to view our online, pre-recorded presentation of the pharmacy benefit strategies for Jan. 1, 2018 You can watch these presentations at any time that is convenient for you, with the opportunity to submit questions and feedback following the webcast.

Presentation for Clients

 

RESOURCES

January 1, 2018 PDL Updates Announced

UnitedHealthcare Introduces New EIN Functionality on Employer eServices

Employer eServices is adding functionality to allow fully insured clients that submitted aggregate forms to UnitedHealthcare to select the associated subscriber Employer Identification Number (EIN) when entering employee eligibility data.

Effective Sept. 25, 2017, aggregate small business clients will be prompted to select the associated subscriber EINs when entering employee eligibility data. This functionality was made available for large group clients March 20, 2017.

 

RESOURCES

New EIN Functionality on Employer eServices for Aggregate Clients

UnitedHealthcare Implementing Change to Child Age Bands

While, currently, there is only one age band where all premium rates are the same for children ages 0–20, per recent ACA guidance, insurers in states using the Federal uniform age curve must now have:

  • One age band for children 0–14; and
  • Separate single age bands for children 15 through 20.

UnitedHealthcare will be implementing these changes for rating purposes beginning with new and renewing at Small Business (including Oxford plans) and UnitedHealthOne, effective January 1, 2018.

Contact your Cornerstone representative for more information.

 

RESOURCES

Child Age Band Rating Change Small Business Reminder

UnitedHealthcare: MLR Premium Rebate Checks Mailing Begins

For benefit plan year 2016, the sixth Medical Loss Ratio (MLR) reporting year, UnitedHealthcare’s results show 49 aggregation sets (40 group and 9 individual combined) qualified to receive premium rebates totaling $114,954,917.

For a summary of which states, legal entities, and size of business (aggregation set) will be receiving a rebate, refer to the Final Rebate Summary Report.

 

RESOURCES

MLR Premium Rebate Checks Begin Mailing

Final Rebate Summary Report