Refunds

When medical claims costs are lower than expected, your health plan receives a surplus refund. Because this is level funded, you’ll have a fixed monthly claims payment throughout the plan year. And in cases where medical claims are higher than expected, there’s an automatic stop-loss reimbursement.

Quality

UnitedHealthcare offers access to a nationwide network of quality health care providers, dedicated expert service, and 24/7 website access and detailed reports to manage your plan effectively. It also offers programs like UnitedHealthcare Motion®, which allows participants to earn more than $1,000 in HSA deposits at no additional cost to your company.

Advantages

UnitedHealthcare level-funded health plans give your company a talent recruitment advantage. Our plans guarantee 15-month introductory rates, tiered administrative credits that start at $2,500 for plans for plans with at least 10 members, introductory discounts and rate caps on life, dental and vision products — and more!

Meredith Hennessy

Q&A

Principal & Practice Leader

Consilience Group, LLC

“Memphis small businesses don’t have to choose between quality and affordability. With UnitedHealthcare plans, we can have both. It’s a tremendous relief to know you’re taking care of your employees as well as your bottom line.”

1

What are level-funded plans?

Level-funded plans let your small business make the same monthly claims funding payment throughout the plan year. Stop-loss insurance, which protects your company from unexpectedly high medical claims, is already built into your monthly payment. If your covered claims are lower than expected, your plan gets a surplus refund at the end of the year. And don't forget that members of the Greater Memphis Chamber receive a 2% discount off of their monthly costs.

2

How is this different from traditional plans?

With traditional plans, the business pays a fixed premium to the insurance company, and then the insurance company pays the health care claims as well as the administrative costs, sales commissions, and taxes. If the actual health care claims are higher than expected, the insurance company covers them. But if the claims are lower than expected, the insurance company keeps the difference. This means your company doesn’t get anything back if your plan participants have lower-than-expected claims. With level funded, if the covered medical claims are lower than expected, your plan shares the savings with a potential surplus refund at the end of the year (where allowed by state law). And if the covered medical claims are higher than expected, your stop-loss insurance policy covers them.

3

A couple of additional benefits:

The plan is a “level-funded” plan, so your company will make the same monthly claims funding payment throughout the plan year; you won’t have to pay any more for medical claims at the end of the plan year, even if your medical claims are higher than expected. Self-funded medical plans are not subject to most state insurance mandates or state insurance premium taxes, which may mean lower costs throughout the year (your stop loss coverage is still subject to premium tax, however).

$0 primary care physician (PCP) network copays for kids (EPO/PPO)
Deductible range: $500 to $6,350
Coinsurance options: 80% or 100%
Network only (EPO) options
Embedded/non-embedded deductibles
Individual stop-loss limits: $15K–$50K (varies by state)
Primary care physician (PCP) gated EPO plans with specialist referral required (not available in all markets)
Featuring a new virtual-first EPO plan in select markets
Real Appeal® online weight loss program available with all benefit plans
Savings with hearing benefit offering device discounts
Survivorship Benefit included with all medical plans — continued coverage available for dependents when a plan participant passes away

Specialist tiering (not available in all markets)
Advanced — deductible range $1,000–$5,000, 50% coinsurance
Premier performance — deductible range $1,000–$5,000, 80% coinsurance; $0 PRO PCP copays for kids, $10–$15 PCP copay for adults

Deductible range: $1,000–$3,000, 80% coinsurance
$0 copay for the first 3 PCP/specialist combined visits
$0 copay for the first 2 urgent care visits

Choice Plus (PPO)
Core Network

What are my Best - and Worst - Case Scenarios?

1

Best Case: Low Medical Claims

Your company’s monthly payments include the estimated health care claims plus fixed-cost items (administrative fees and stop-loss insurance premium). This is called your plan’s “maximum liability,” which means you won’t get stuck at the end of the year with unexpected costs. Part of your monthly payments will go into an account that pays for your covered plan participants’ eligible claims. At the end of the year, the monthly claims funding payments will be compared with the actual claims costs. In the best-case scenario, if actual claims costs for the year are less than what was estimated, your plan has a surplus. After plan reconciliation, any surplus is sent back to your plan to use for the following year (where allowed by state law).

2

Worst Case: High Medical Claims

In the worst-case scenario, the actual claims would be higher than expected. But because your plan would have already paid the maximum liability, your plan won’t pay more for covered claims at the end of the plan year. Your plan is protected by the stop-loss insurance that is already built into your monthly payments. Of course, each year could be somewhere in between. But in any case, many businesses may save with a level-funded plan.

What’s included with prescription drugs?

Get anywhere, anytime answers about prescription drugs. OptumRx® makes it easy to get prescriptions, cost estimates and savings on medications.

PreCheck MyScript® — real-time plan costs and benefit information
Dx2Rx — streamlines the Prior Authorization process
Refill and Save — 30- to 90-day retail or mail-order pharmacy supplies
Advantage Prescription Drug List (PDL) or Essential PDL (unique benefit designs; not available in all markets)
Opioid management
Point-of-sale discounts

UnitedHealthcare Motion
Goal Potential Benefits Reward

With UnitedHealthcare Motion®, participants can get rewarded for something they do every day: walk. They simply sign up, slip on a wearable activity tracker and get moving, no gym required. Participants get a wearable activity tracker and may earn rewards every day — up to $1,095 a year— for meeting 3 daily walking goals.

Frequency Six 5-minute walks, minimum of 300 steps, 1 hour apart May reduce risk factors for metabolic and cardiac health $1
Intensity One brisk walk of 3,000 steps within 30 minutes or 30 minutes performing other eligible activities
May reduce risk factors for cardiovascular, metabolic, mental and bone health, as well as cancer $1
Tenacity 10,000+ total steps May increase energy (weight control) $1
Total Possible per Day $3
Participants and eligible spouses may be reimbursed up to $1,095* or 30% of the plan participant only annual payment (or family annual payment if dependents are covered), whichever is less, each calendar year
Quarterly reimbursements for expenses are applied to the out-of-pocket limit calendar year spend
50% calendar year rollover of unreimbursed rewards for those on a non-HSA plan
A $55 registration credit can be used toward purchase of an activity tracker or saved for quarterly reimbursements

UnitedHealthcare Health Plans