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



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.



New EIN Functionality on Employer eServices for Aggregate Clients

What is Going on With the 48-Hour Scope of Appointment Rule?

By now, you’ve almost certainly heard about changes to the Medicare Marketing Guidelines and the 48-hour Scope of Appointment (SOA) rule. So what does it mean for agents, and why hasn’t Cornerstone shared this news sooner?

Let’s start at the beginning:

On July 20, 2017, the Centers for Medicaid and Medicare Services (CMS) published their updated Medicare Marketing Guidelines.

That’s when we first spotted there was a BIG change for the 2018 SOA section:

While this was great news, it didn’t mean much without the carriers (plan sponsors) updating their agent guidance. Typically, carriers update their policies to align closely with any changes in the MMG. However, with the late release of such a significant change, many carriers were not prepared to provide official guidance on the updated marketing guidelines. Some carriers and trade associations believed the change to MMG was a mistake and would soon be reversed. Other carriers informally indicated that they would no longer require SOAs to be obtained 48 hours in advance.

We’ve finally started to get some official clarification from our carrier partners, and it is good news for brokers. See the chart below for updates on which carriers will no longer require the SOA to be obtained 48 hours in advance beginning on October 1, 2017:

Carriers no longer requiring the SOA to be obtained 48 hours in advance beginning October 1, 2017

Caution: We expect most carriers will update their policies to reflect the new MMG guidance. However, if you are writing business for a carrier that has not updated their policies to remove the 48-hour requirement, you should continue to obtain an SOA according to that carrier’s policies or risk possible sales conduct violations. We’ll continue to update the chart as we receive additional information.

Contact your broker advisor or local market director for more information.

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.



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.



MLR Premium Rebate Checks Begin Mailing

Final Rebate Summary Report

CBO Predicts Cheap ACA Subsidies Through 2026

Due to low enrollment in ACA exchange plans, the Congressional Budget Office (CBO) predicts that federal spending on subsidies for three major ACA individual health insurance subsidy programs could amount to just $729 billion from 2017 to 2026, which is 16 percent lower than the CBO estimate published in March 2016.

Looking ahead 10 years, analysts also made cuts to the ACA premium tax credit, the ACA cost-sharing reduction subsidy program, and the total for the tax revenue lost to the employer group health coverage cost tax exclusion.

The CBO also expects 18 million people to have individual coverage in 2026, lower than the total of 25 million predicted in March 2016.



ACA Subsidies Are Much Cheaper Than Expected: CBO

Be Proactive: Identity Theft Protection with LifeLock

With events like the Equifax cybersecurity breach that exposed the personal information of 143 million U.S. consumers, its important to protect your personal information. According to LifeLock, “you are 11 times more likely to be a victim of identity fraud if you are notified of a breach.”

Don’t wait to protect your identity.


Contact your Cornerstone representative with any questions about LifeLock.



Hackers Accessed The Personal Data Of 143 Million People, Equifax Says

Dental Care Plus Enrollment Confirmation Emails

Dental Care Plus Group brokers will be notified via email with each new enrollment associated with a broker code or personalized link (PURL).

The email will contain the subscriber’s name, plan type, plan tier, monthly premium amount, effective date, and member ID.

DCPG Individual Dental Plans and Medicare AEP

Due to the fact that many Medicare plans don’t include coverage for routine procedures like cleanings and fillings, dental plan from Dental Care Plus Group may complement Medicare plans and help fill gaps for individual clients.

Contact your Cornerstone representative today with questions.

DCPG 2018 Individual Plan Rates

DCPG’s 2018 individual dental plan rates for Ohio, Kentucky and Indiana are below:

  • Ohio HMO (for residents of Butler, Clermont, Hamilton and Warren counties)
  • Ohio PPO  (for residents OUTSIDE of Butler, Clermont, Hamilton and Warren counties)
  • Kentucky HMO (for residents of Boone, Campbell, Kenton and Pendleton counties)
  • Kentucky PPO (for residents OUTSIDE of Boone, Campbell, Kenton and Pendleton counties)
  • Indiana PPO