UnitedHealthcare Updates for Q4

UnitedHealthcare (UHC) is now quoting for Q4 and is making some plan and coverage changes effective 11/1/2018.

Here’s an overview:

  • PPO rate pass: current rates are valid for coverage with an October through December effective date.
  • HMO rates: statewide, UHC is implementing an average increase of 1.5%; increase varies by HMO network, as shown below:

-Full: 2%

-Advantage: 2%

-Alliance: 0%

-Focus: 5%

  • Benefits/Plans/Packages: There are no benefit changes for existing plans; however, new HMO plans and an additional package are available effective 11/1/2018:

-HMO 20-40: $500 deductible paired with existing HMO Rx plan 407

-HMO 30-60: $1,00 deductible paired with new HMO Rx plan 859

-Choice Simplified III: New package expands choices to four options


New Underwriting Guidelines Now in Effect

UHC has implemented a variety of underwriting changes, which were effective 7/1/2018:

  • A minimum of 60% participation is required for contributory groups, excluding COBRA *
  • Groups offering UHC Choice Simplified Package and a staff model: There must be at least 60% participation between the participating carriers with a minimum of five California employees enrolling with UnitedHealthcare, excluding COBRA participants.*
  • Groups offering UHC Multi-Choice® State Package and a staff model: There must be at least 60% percent participation with UHC, excluding COBRA
  • Additional participation guidelines for all groups applying for coverage
    • When the employer contributes 100% toward the employee premium, 100% of Eligible Employees must enroll.
    • COBRA participants and employees in waiting period are not considered Eligible Employees and are not included when determining the participation requirement.

*A complete copy of the most recent billing statement from the current carrier(s) reflecting employee census and applications/waivers from any employees not reflected in the billing statement is required. Excluding valid waivers for spousal group coverage through another employer’s plan, parental group coverage through another employer’s group plan for a dependent up to age 26, spousal COBRA/state continuation, Medicare (Parts A and B required), TRICARE or at-no-cost, government-sponsored plans including an Exchange Individual waivers are considered valid waivers for non-grandfathered groups beginning January 2014. This does not apply to groups written or renewed in 2013.


NOTE: UHC coverage may be written alongside two other carriers; both must be a staff-model carrier. Eligible staff models include Chinese Community Health Plan, Kaiser Permanente, MediExcel, Sharp Health Plan, SIMSA, Sutter Health Plus, and Western Health Advantage. UHC may not be written alongside CaliforniaChoice or Covered California for Small Business. 


Click here for UHC’s Dental Simplified options for California small businesses with 1-100 employees, or here for the UHC Dental Benefit Grid.


If you have questions, contact your Word & Brown representative.

How Much Can You Earn as an Insurance Broker?

Find out what you can be earning as an insurance agent in our handy, up-to-date salary guide. Produced by our in-house experts, this resource is bound to help you in advancing your career.

Word & Brown Salary Guide