Sep 28, 2021
Rate Update
UnitedHealthcare rates for Q1 2022 will experience the following decreases. Quoting is expected to release on Fri. October 1st.
- HMO -3.8%
- Northern CA PPO -0.1%
- Southern CA PPO -2.7%
Network Updates
Termination
The Advantage network will terminate Jan 2022. Members currently enrolled in Advantage network plans will transition to new plans at their 2022 renewal. Members will be allowed to choose the network they transition to.
Expansion
Effective January 2022, Harmony will expand into Northern CA regions 2 and 4-9. With this expansion, and the Advantage network termination, Canopy providers will be available under the Harmony network.
Portfolio Updates
The existing plans have received minor benefit changes to meet AV and most plans (excludes multi-choice state) have new plan codes. All benefit materials and forms are pending from UHC and are expected to be available in October.
Infertility
PPO plans will no longer have infertility built into the standard plan design. PPO plans will now have the option to elect an infertility rider, just like HMO plans currently offer.
Select Plus PCP Selection
For new and renewing groups in 2022, members enrolling on Select Plus plans must elect a PCP. It is important to understand this change is strictly to help members with a point-of-care contact, which will show on their ID card. The PCP is not a gatekeeper and plans will still function like a traditional PPO, allowing members their choice in the provider they see.
Members are not required to contact their PCP for access to care.
Specialty Medication Cost Sharing
All plans will now have 2 levels of Rx copays, each level will have a 4-tier copay structure. The 2 levels are separated for standard prescriptions and specialty prescriptions. Example below, exact copays will vary by plan design:
| TIER | NON-SPECIALTY COST SHARE |
SPECIALTY COST SHARE |
|---|---|---|
| 1 | $10 | $10 |
| 2 | $35 | $150 |
| 3 | $70 | $250 |
| 4 | 25% | 25% |
All non-Bronze plans subject to maximum of $250 copay per script, while Bronze plans are maximum $500.
Value Add Update - One Pass Membership
One Pass is a new gym membership program that will be available to all UnitedHealthcare members. This is a new program added to their existing portfolio of value-added options, it does not replace any existing gym/fitness program.
Members can choose to enroll in 1 of 4 subscription-based fitness programs. Members will pay a monthly fee based on the level they enroll in (ranging from $25-$139/month). The base level provides access to a core network of 8000 locations, while each additional buy up level includes the core network plus additional premium locations.
Materials
- New PBSF coming for 2022 (ER and EE forms remain unchanged)
- Brochures and benefit summaries are expected around the 2nd week of October.
- One Pass flyer coming soon, which includes a directory of the gyms available in each level.
