Mar 18, 2025
UnitedHealthcare has announced the following rate updates for Q3 2025 in California:
Quarterly Rate Change:
- HMO: 1.8% Statewide
- PPO: 3.5% Statewide
- Navigate: Rate Pass
Quoting Availability: April 1, 2025
Plan/Portfolio Changes: There are no changes to the plan portfolio; however, the optional infertility benefit will continue at the same premium percentage loads without change (HMO plans at 3.4% and PPO Select Plus/Core plans at 4.9%). Additional information noted below for reference on SB729.
- Fertility and Infertility Services: UnitedHealthcare is working diligently with regulators to validate the effective date and coverage requirements for CA SB729, treatment for fertility and infertility services. Consistent with the Governor's ask to the legislature, it is possible that this bill's effective date may be delayed from 7/1/2025 to 1/1/2026. However, if there is no delay, UnitedHealthcare is prepared to offer the mandated coverage to small groups upon renewal effective 7/1/2025 and after.
- Note: UHC small business product team is in the process of updating the optional benefit language for SB729.
Network/Zip Code Updates: There are updates in Los Angeles, Orange, and Sacramento Counties (rating areas 3, 15, 16, and 18). Contact your Amwins Connect Regional Sales Manager for details.
Underwriting Guidelines: For small group fully insured, continue to use the version dated September 1, 2024. Note that an extension of the relaxed participation guidelines for Choice Simplified+Staff Model (currently scheduled to end 07/31/2025) is under discussion.
For small group level funded, UnitedHealthcare is reducing the participation to 25% of total eligible, regardless of waivers, effective July 1, 2025. Revised underwriting guidelines will be posted when received.
Marketing Materials/Forms: A revised PBSF/GAF has been posted and will be added to the Easy Enrollment Kit. The employee flyer for One Pass Select has also been updated to reflect 2025 pricing tiers.
Contact your Amwins Connect Regional Sales Manager today to learn more about how UnitedHealthcare plans can benefit your clients!
