2024 Product Grids (ACA and Level Funded) are available
- We are switching back to the “Broad” pharmacy network. You’ll see the prefix “B” at the end of the LF plan codes to connotate it. That means for new business effective 1/1/24. CVS will be back in the pharmacy network. This is for both ACA and LF.
- We are replacing Motion with a program called “UHC Rewards”. It will be similar to Motion in that you can earn credits by meeting health goals. Those on co-pay plans will have “Core Rewards” and those on HSAs will have “Premium Rewards”. One important note is that for those on HSA plans, members will need to use Optum as the bank for the credit deposits.
A few notes on plan designs/categories:
- Choice is our nationwide in-network only plans; no referrals needed
- Choice+ is the same as Choice, but adds out of network benefits
- Navigate utilizes a PCP that a member selects at the time of enrollment and all specialists visits require a referral from that PCP
- Premier plans tier out specialists visits; if a member sees a premium designated Tier 1 specialist they will have a lower co-pay than just an in network specialist
- Assured plans not only tier out specialists visits, but also PCP visits; if you don’t see a premium designated provider your visit is subject to deductible, after deductible has been met a co-pay would apply
- Nexus (Indiana only) utilizes the American Health Network instead of Choice for PCPs; members will have to declare a PCP from the American Health Network at the time of enrollment; this is only available in the Indianapolis metro area; it also tiers out specialists as premium designated Tier 1 vs in-network
- Charter (Indiana only) utilizes the Select Health Network in South Bend; for the Indianapolis metro area it eliminates IU Health and Ascension St. Vincent from the network otherwise it mirrors Choice; members will have to declare a PCP from the Charter network at the time of enrollment; this is only available in South Bend and the Indianapolis metro area
UHC LF Surplus Change/Default PEPM Revisions
We are changing how UHC LF groups receive their LF surplus beginning with 9/1/23 new business (renewals on or after 9/1/23 as well). We will no longer be distributing surplus refund checks in month 16; rather we will apply a credit to the plan sponsor’s future invoice. Remember, to receive a surplus refund, the group needs to be active with UHC LF in month 15.
Additionally, we are increasing the default PEPM amount for UHC LF. For IN, the default $34 will increase to $50. For KY, the default $28 will increase to $45. You are still free to set that amount whatever you prefer though.