UHC Specialty Updates: Dental Plan Codes, Deductibles & Annual Maximums, Rate Methodology

UHC provided the following important updates on their Specialty products.

Dental Plan Codes

By offering different types of dental plan designs, you can connect employees to a higher quality of care! You can easily identify certain types of dental plans according to their plan code.

UHC Dental Plan Type by Codes

P Plans: Traditional PPO offering

• In- & out-of-network coverage
• MAC, 70% to 95% UCR
• Most common plans sold

A Plans: Gateway Plans

• Operates like traditional PPO plan
• Ideal for group sizes 2-9
• Full mouth & panoramic X Rays shift from Class I to Class II
• Lowest Pricing

H Plans: FlexAppeal Preventive MaxMultiplier

• Operates like traditional PPO plan
• Preventive & Diagnostic services DO NOT apply to Annual Max
• Down to 5 Eligible

X Plans: FlexAppeal Enhanced

• Operates like traditional PPO plan
• Includes posterior composites
• Includes dental implants
• No missing clause (unless there is a wait period)
• Down to 5 eligible in some markets

Consumer MaxMultiplier rewards members for regular checkups — available on many of the dental plans offered by UHC!

Dental Deductible & Annual Max

UHC dental plans run on a calendar year. This means that any applicable deductible and annual maximum will reset on January 1st.

UHC can "credit" the following items:

• Deductibles
• Annual Maximum
• Unused Roll-over account (CMM) dollars

In order to credit these items, UHC would require a report from the prior carrier showing which employees fulfilled deductibles and other plan balances. These reports almost always include the members annual maximum and how much was used. If this is the case, UHC will also "debit" the annual max.

It is almost always in the favor to start with a fresh annual max, deductible and rollover account.

Note:

• P, A, and X Plans: Preventive & Diagnostic Services count towards the Annual Maximum
• H Plans: Preventive & Diagnostic Services DO NOT count towards the Annual Maximum

How are Rates determined?

2-50:

1. SIC code
2. Zip code
3. Effective Date
4. Number Eligible Employees —NOT enrolling

Number Eligible Dental Rate Bands

• 2-4: EEs
• 5-9EEs
• 10-20 EEs
• 21-25 EEs
• 26-50 EEs

51-99:

1. SIC code
2. Zip code
3. Effective Date
4. EE Census (DOB/Age & Gender)
5. EE Elections

Rating Factors Estimates (approximations and will vary by market)

• Shifting Endo/Perio/Oral from Class II to Class I = 11% decrease in relativity
• Shifting Passing to Incentive = 11% decrease UCR to MAC in relativity
• Including a wait period = 3% decrease in relativity
• Including ConsumerMaxMultiplier = 1.3% increase in relativity
• Voluntary to ER Paid plan = 5% decrease in relativity

For questions or help with a UHC Specialty quote, please contact a member of your B&P Sales Team - 888.722.3373.

Some of this information may vary by region and state-specific laws or regulations.