Employer Information: Medicare Part D To help you address the immediate actions highlighted in the cover letter, please see the additional information that follows.
Action 1: Determine creditable coverage Creditable Coverage Prescription drug coverage is creditable if the actuarial value of the coverage equals or exceeds the actuarial value of standard prescription drug coverage under Medicare Part D, as demonstrated through the use of generally accepted actuarial principles and in accordance with CMS actuarial guidelines. In general, the actuarial equivalence test measures whether the expected amount of paid claims under the employer’s prescription drug coverage is at least as much as the expected amount of paid claims under the standard Part D benefit. Enclosed is a list of the standard benefit plan designs reviewed by Reden & Anders. You may use this information as a starting point for your determination whether your prescription drug plan satisfies the requirements of creditable coverage. Please consult your pharmacy plan document to determine your plan’s description of benefits. If your plan is creditable and you will make that plan available throughout 2006, you can tell your Medicare eligible actives and retirees that they do NOT have to drop their coverage with you and enroll in a Medicare prescription drug plan.
Simplified Determination of Creditable Coverage CMS has clarified that if an employer is not applying for the subsidy, the employer can determine that its prescription drug plan’s coverage is creditable if the plan design meets all four of the following criteria: 1. Provides coverage for brand and generic prescriptions; 2. Provides reasonable access to retail providers and, optionally, for mail order coverage; 3. Is designed to pay on average at least 60 percent of participants’ prescription drug expenses; and
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4. Satisfies the following: • For employers that have a stand-alone prescription drug plan, the plan must satisfy; o The prescription drug coverage has no annual benefit maximum benefit or a maximum annual benefit payable by the plan of at least $25,000; or o The prescription drug coverage has an actuarial expectation that the amount payable by the plan will be at least $2,000 per Medicare eligible individual in 2006. • For employers that have integrated health coverage, the integrated health plan has no more than a $250 deductible per year, has no annual benefit maximum or a maximum annual benefit payable by the plan of at least $25,000 and has no less than a $1,000,000 lifetime combined benefit maximum. Plans that meet these four criteria are deemed to be creditable. Your plan may be creditable even if it doesn’t meet the criteria. An actuarial gross value test of your claims experience would be required to determine your status.
Creditable Coverage Q&A Q: Are Part D eligibles required to enroll in Part D? A: Medicare beneficiaries who have other sources of drug coverage - through a current or former employer or union, for example may stay in that plan and choose not to enroll in the Medicare drug plan. If their other coverage is at least as good as the new Medicare drug benefit (and therefore considered "creditable coverage"), then beneficiaries may continue to get the high quality care they have now as well as avoid higher payments later if they later sign up for the Medicare drug benefit. Eligible members who forego Part D enrollment when first available and who do not have creditable prescription drug coverage for any period of 63 days or longer will likely have to pay a higher Part D premium of 1 percent per month for late enrollment.
Q: Do we have to engage an accredited actuary to judge our plan's creditable coverage status? A: No. CMS has created a simplified Creditable Coverage Determination that allows the employer to identify creditable coverage status without the attestation of an accredited actuary. However, you will require the services of an actuary if your company decides to apply for the subsidy.
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Action 2: Notify Medicare-eligible individuals of creditable or non-creditable coverage Employers must provide this notice to all Medicare-eligible individuals who are covered under, or who apply for, the entity’s prescription drug plan (Part D eligibles), whether active employees or retirees, before November 15, 2005. This notice need not be a separate mailing and may be included with other plan participant informational materials or through electronic means. Please remember, employers are required to provide this notice even if they choose not to apply for the subsidy.
Creditable Coverage Notification Q&A Q: When must we notify our members of our plan's creditable coverage status? A. Employer plan sponsors are required by CMS to provide creditable coverage status to Part D-eligible members prior to beginning of the Part D enrollment period on November 15, 2005 and on an ongoing basis at the following times: • Prior to the Medicare Part D Annual Coordinated Election Period beginning on November 15 of each year; • Prior to an individual's initial enrollment period; • Prior to the effective date of coverage for any Medicare-eligible individual that joins your plan; • Whenever prescription drug coverage ends or changes so that it is no longer creditable or becomes creditable; or • Upon the request of a beneficiary. Please see page 4 for CMS contact information. Q: What if I do not offer retiree health care coverage? A: Creditable coverage notification must be provided to all Part D-eligible individuals who are covered under or apply for your company's prescription drug benefits plan. This requirement applies to Medicare beneficiaries who are active employees and those who are retired, as well as Medicare beneficiaries who are covered as spouses under active or retiree coverage.
Q: Must we notify CMS of our plans’ creditable coverage status? A: Yes. You must provide a disclosure to CMS on an annual basis. Creditable coverage status may change from one year to the next because the standard Part D benefit may change in the future. CMS will provide future guidance relating to this disclosure requirement.
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Action 3 – Decide whether to pursue the subsidy If you have a retiree prescription drug plan and you have determined that your plan is creditable and you choose to apply for the 28 percent subsidy, you can work with our partner Reden & Anders or another actuarial firm to complete additional testing required to determine your eligibility for the subsidy and the actuarial attestation required for the subsidy application. The subsidy is available only for qualified retiree prescription drug plans and will be payable to the plan sponsor. An employer may receive an amount equal to 28 percent of allowable retiree drug costs between $250 and $5000 per qualifying covered retiree in 2006, net of any rebates or other price concessions. Original CMS estimates projected the value of the subsidy to be $668 per Medicare-eligible enrollee. Reden & Anders’ initial review of UnitedHealthcare data suggests an average value for the subsidy of $450 to $500 per Medicareeligible enrollee. Pursuit of the subsidy may require additional reporting and administrative effort on the part of the employer. Employers who choose to work with Reden & Anders should contact Reden and Anders to determine the fees for their services. Your contacts at Reden & Anders are: Corey Berger:
[email protected]
Herschel Reich:
[email protected]
CMS Guidance The CMS Web site provides complete text of the guidance and model disclosure templates published by CMS, and may be a helpful resource to both employers and their employees. Updates are made regularly, so please check back as implementation of Part D continues. http://www.cms.hhs.gov/medicarereform/Credcovrg.asp The creditable coverage model disclosure template: http://www.cms.hhs.gov/medicarereform/CredCov-BeneDsclsreNtc.pdf http://www.cms.hhs.gov/medicarereform/Non-CredCov-BeneDsclsreNtc.pdf
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Pharmacy Plans Tested for Creditable Coverage
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Pharmacy Plans Tested for Creditable Coverage Pass The benefit plan designs identified on the following list have been reviewed and determined by Reden & Anders to PASS the actuarial value test for creditable coverage. The employer retains ultimate responsibility for the assessment that the plan, as implemented, provides creditable coverage. You should make this determination by reviewing and performing the test for the Simplified Creditable Coverage Determination described on page one of the enclosed description of actions required or through consultation with your benefits counsel.
Plans with Copayments Only Single-Tier Copay
Two-Tier Copay
$3
$10
$ 5/10
$ 7/12
$10/24
$15/30
$5
$15
$ 5/12
$ 7/15
$10/25
$15/35
$7
$20
$ 5/15
$ 7/20
$10/30
$15/40
$ 5/20
$ 7/30
$10/35
$20/25
$ 5/30
$10/15
$15/25
$20/30
$9
$ 6/20
$00/15/25 $ 2/04/04 $ 2/05/05 $ 3/10/10 $ 5/05/05 $ 5/10/20 $ 5/15/15 $ 5/15/25 $ 5/15/35 $ 5/15/50 $ 5/20/30 $ 5/20/35 $ 5/20/40
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$ 5/20/45 $ 5/20/50 $ 5/30/50 $ 7/10/25 $ 7/12/25 $ 7/14/25 $ 7/15/25 $ 7/15/30 $ 7/15/35 $ 7/15/50 $ 7/17/40 $ 7/20/35 $ 7/20/40
$ 7/20/45 $ 7/20/50 $ 7/25/40 $ 7/25/45 $ 7/25/50 $ 7/30/40 $ 7/30/50 $ 8/20/35 $ 8/25/35 $ 8/25/40 $ 8/25/45 $ 8/25/50 $ 8/30/15
Three-Tier Copay $ 8/30/50 $10/20/45 $ 8/35/50 $10/20/50 $ 9/19/29 $10/25/35 $10/10/10 $10/25/40 $10/15/20 $10/25/45 $10/15/25 $10/25/50 $10/15/30 $10/28/40 $10/15/35 $10/30/40 $10/20/20 $10/30/45 $10/20/30 $10/30/50 $10/20/35 $10/30/60 $10/20/40 $10/35/50 $10/20/40* $10/35/60
6
$10/40/50 $10/40/60 $10/50/100 $12/25/50 $12/30/50 $15/15/15 $15/15/30 $15/20/25 $15/20/30 $15/20/50 $15/25/25 $15/25/35 $15/25/40
$15/25/50 $15/27/40 $15/30/40 $15/30/45 $15/30/50 $15/30/60 $15/35/50 $15/35/55 $15/35/60 $15/35/75 $15/40/75 $15/45/60 $20/20/20
$20/30/50 $20/35/50 $20/40/100 $20/40/60 $25/25/25 $30/30/30 $40/40/40
Creditable Coverage Pass The benefit plan designs identified on the following list have been reviewed and determined by Reden & Anders to PASS the actuarial value test for creditable coverage. The employer retains ultimate responsibility for the assessment that the plan, as implemented, provides creditable coverage. You should make this determination by reviewing and performing the test for the Simplified Creditable Coverage Determination described on page one of the enclosed description of actions required or through consultation with your benefits counsel.
Copayments and Deductible Four-Tier Copay Copayment Out-of-Pocket Maximum $10/25/40/100 $2,000 $10/30/50/100
$2,000
$10/30/50/100
$2,000
Shared Pharmacy Copayment $45/30/15 $10/25/40 & $75/75/75 $50/50/20
Out-of-Pocket Maximum $2,000 $2,500 $3,000
$10/25/40 & $60/40/30
$ 2,500
$10/30/50 & $60/40/30
$2,500
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Copayments and Deductible (cont.) CoPay with Deductible CoPay with Deductible CoPay with Deductible $15 $150 $ 7/20/50 $250 $10/25/40 $250 $ 5/10 $100/300 $ 7/25/40 $100 $10/25/45 $100 $10/20 $100 $ 7/25/40 $250 $10/25/50 $100 $ 5/05/05 $50 $ 7/25/45 $100 $10/25/50 $150 $ 5/10/10 $100 $ 7/25/50 $100 $10/25/50 $250 $ 5/10/10 $50 $ 7/30/50 $50 $10/25/50 $50 $ 5/10/20 $50 $ 7/30/50 $100 $10/25/50 $500 $ 5/10/25 $50 $ 7/35/50 $100 $10/30/45 $100 $ 5/15/15 $100 $ 7/35/50 $150 $10/30/45 $200 $ 5/15/15 $50 $ 7/35/50 $200 $10/30/50 $100 $ 5/15/25 $100 $ 8/25/40 $100 $10/30/50 $250 $ 5/15/25 $50 $ 8/25/45 $100 $10/30/50 $250** $ 5/15/35 $100 $ 8/25/50 $100 $10/30/60 $100 $ 5/15/35 $50 $ 8/25/50 $150 $10/30/60 $200 $ 5/15/50 $50 $ 8/25/50 $200 $10/30/60 $250 $ 6/20/35 $100 $ 8/25/50 $250 $15/20/30 $150 $ 7/10/25 $50 $ 8/30/50 $100 $15/20/30 $250 $ 7/15/25 $50 $10/15/30 $100 $15/25/40 $50 $ 7/15/30 $100 $10/20/20 $75 $15/25/50 $50 $ 7/15/35 $100 $10/20/30 $100 $15/25/50 $100 $ 7/15/35 $50 $10/20/35 $100 $15/25/50 $150 $ 7/15/50 $50 $10/20/35 $250 $15/25/50 $250 $ 7/20/20 $50 $10/20/35 $50 $15/30/40 $100 $ 7/20/20 $75 $10/20/35 $75 $15/30/40 $250 $ 7/20/20 $100 $10/20/40 $100 $15/30/40 $500 $ 7/20/40 $50 $10/20/40 $50 $15/30/60 $100 $ 7/20/40 $100 $10/20/40 $150* $15/30/60 $50 $ 7/20/40 $250 $10/20/40 $175* $15/35/60 $200 $ 7/20/40 $500 $10/20/40 $200* $15/35/60 $250 $ 7/20/50 $50 $10/20/50 $50 $15/35/75 $100 $ 7/20/50 $100 $10/20/50 $100 $15/35/75 $250 $ 7/20/50 $150 $10/25/40 $100 $10/25/50/100 $250** $10/20/20 $50*** $2/50/50 $50*** * $1,500 out-of-pocket maximum ** $2,000 out-of-pocket maximum *** Brand drug only deductibles UHC-05-006
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CoPayments and Coinsurance Two-Tier Copayment
Coinsurance
$ 7.50
50%
$10
40% Four-Tier
$10/25/50/50% w/ $150 minimum and $500 maximum; $2,000 out-of-pocket maximum Three-Tier $ 5/8/20% $ 5/15/35% $ 8/25/50% $10/8/20% $10/20/30% $10/35% w/ $25 minimum and $40 maximum/$50 copay $10/35% w/ $25 minim and $40 maximum/ 50% w/ $50 minimum and $250 maximum $10/30/50% ($50 minimum); $5,000 out-of-pocket maximum $15/30/50% ($50 minimum); $5,000 out-of-pocket maximum $ 5/15%/25% $ 5/20%/30% $ 5/25%/$40 $ 5/30%/40% $10/25%/$45 $10/35%/50%; $1,500 out-of-pocket maximum
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CoPayment, Coinsurance and Deductible Three-Tier $10/35% w/ $25 minimum and $40 maximum/50% w/ $50 minimum and $250 maximum;$100 Deductible $10/35% w/ $25 minimum and $40 maximum/50% w/ $50 minimum and $250 maximum; $100 Deductible $10/35% w/ $25 minimum and $40 maximum/$50; $100 Individual/$300 Family Deductible $10/35% ($25 minimum and $40 maximum) $50 copay; $100/300 $10/35% ($25 minimum and $40 maximum)/50% coinsurance ($50 minimum and $250 maximum); $100/300 $10/35% ($25 minimum and $40 maximum)/50% coinsurance ($50 minimum and $250 maximum); $250 Deductible $10/35%/50%; $150 Deductible; $1,500 out-of-pocket maximum $10/35%/50%; $200 Deductible; $1,500 out-of-pocket maximum $10/35%/50%; $250 Deductible; $1,500 out-of-pocket maximum $10/35%/50%; $500 Deductible; $1,500 out-of-pocket maximum
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Pharmacy Plans Tested for Creditable Coverage Pass The benefit plan designs identified on the following list have been reviewed and determined by Reden & Anders to PASS the actuarial value test for creditable coverage. The employer retains ultimate responsibility for the assessment that the plan, as implemented, provides creditable coverage. You should make this determination by reviewing and performing the test for the Simplified Creditable Coverage Determination described on page one of the enclosed description of actions required or through consultation with your benefits counsel.
Coinsurance One-Tier
Two-Tier
Three-Tier
10%
10%/20%
10%/20%/30%
20%
15%/30%
10%/20%/35%
30%
20%/20%
10%/20%/40%
35%
20%/30%
20%/20%/20%
30%/30%
20%/30%/45%
Plans Covering Pharmacy Under Medical Coverage Out-of-Pocket Maximum
Deductible
Coinsurance
$500
20%
$1500
$500
25%
$2000
$500
30%
$3000
$1000
20%
$1000
$1000
20%
$3000
$1000
20%
$4000
$1000
20%
$5000
$1000
40%
$3000
$1500
40%
$5000
$500
20%
$2000 plus $50 ER copay
$1000
40%
$3000 plus $50 ER copay
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Pharmacy Plans Tested for Creditable Coverage Pass The benefit plan designs identified on the following list have been reviewed and determined by Reden & Anders to PASS the actuarial value test for creditable coverage. The employer retains ultimate responsibility for the assessment that the plan, as implemented, provides creditable coverage. You should make this determination by reviewing and performing the test for the Simplified Creditable Coverage Determination described on page one of the enclosed description of actions required or through consultation with your benefits counsel.
Plans Covering Pharmacy Under Medical Coverage with in- and out-of-network benefits In-Network
Out-of-Network
$500 Deductible; 20% coinsurance; $2000 out-of-pocket maximum; $50 ER copay $500 Deductible; 20% coinsurance; $2000 out-of-pocket maximum; $50 ER copay $500 Deductible; 20% coinsurance; $2500 out-of-pocket maximum; $10 office copay $1000 Deductible; 20% coinsurance; $1000 out-of-pocket maximum $1000 Deductible; 20% coinsurance; $4000 out-of-pocket maximum; $50 ER copay $1500 Deductible; 30% coinsurance; $4500 out-of-pocket maximum; $20 office copay
$500 Deductible; 40% coinsurance; $2000 out-of-pocket maximum $1000 Deductible; 30%/50% coinsurance; $4000 out-of-pocket maximum $1000 Deductible; 40% coinsurance; $5000 out-of-pocket maximum $1500 Deductible; 40% coinsurance; $1500 out-of-pocket maximum $1000 Deductible; 40% coinsurance; $4000 out-of-pocket maximum $3000 Deductible; 50% coinsurance; $8000 out-of-pocket maximum
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Do Not Pass The benefit plan designs identified on the following list have been reviewed and determined by Reden & Anders to NOT PASS the gross value test for creditable coverage. You will need to determine whether your plan, as implemented, provides creditable coverage by reviewing and performing the test for the Simplified Creditable Coverage Determination described on page one of the enclosed description of actions required or through consultation with your benefits counsel. Your UnitedHealthcare representative can help you in your decisionmaking and planning should you wish to adjust your pharmacy benefit design.
DO NOT PASS – PHARMACY PLANS • No Pharmacy Coverage • Retail Not Covered • Diabetic Supplies Coverage Only • $50/50/50 • $15/50% w/$250 Deductible • $15/50% w/$500 Deductible • $200 Deductible; 20%; 2k CY max (AK plans 54G) • $200 Deductible; 50%; 2k CY max (AK plans 54A)
DO NOT PASS – PLANS COVERING PHARMACY UNDER MEDICAL COVERAGE • $2500 Deductible; 40% coinsurance; $7500 out-of-pocket maximum • $2500 Deductible; 50% coinsurance; $7500 out-of-pocket maximum • 50% Benefit in Medical Plan - No Card • $15/50% with $150 Deductible • $15/50% with $100 Deductible
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Pharmacy Plans Tested for Creditable Coverage Requires further analysis This list contains plans for which we are unable to make a determination at this time. These plans may or may not provide creditable coverage. The actuarial values of these plans are very close to the value of the standard Part D benefit, but they could fall above or below depending on the group’s experience. You will need to verify whether your plan, as implemented, provides creditable coverage. You should make this determination by reviewing the Simplified Creditable Coverage Determination described on page 1 of the enclosed description of actions required or through consultation with your benefits counsel.
Requires further analysis • 50% coinsurance • 50%/50%/50% • $15/50% • $15/50%/50% with $50 deductible • $15/50% with 100 deductible • $15/50% with 150 deductible • 50% benefit in medical plan - no card • $15/30/60 with $100 Brand deductible and $3000 annual brand limit • $5/15/15 with $3000 annual brand limit • $10/20/30 with $2000 annual brand limit • $10/20/30 with $3000 annual brand limit • $10/20/20 with $100 deductible (all drugs) and $3,000 limit.
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HSA High Deductible Plan – Small Business National Plans All plans feature combined medical and pharmacy deductible and out-of-pocket maximum. Medical In-Network Deductible
Medical Out-of-Network
OOP Max (incl ded)
Deductible
Rx Plan
OOP Max (incl ded)
Single
Family
Coins
Single
Family
Single
Family
Coins
Single
Family
$10/30/50
$1,100
$2,200
100%
$1,100
$2,200
$2,200
$4,400
80%
$4,400
$8,800
Pass
$1,100
$2,200
80%
$2,200
$4,400
$2,200
$4,400
60%
$4,400
$8,800
Pass
$2,000
$4,000
100%
$2,000
$4,000
$4,000
$8,000
80%
$8,000
$16,000
Pass
$2,000
$4,000
80%
$4,000
$8,000
$4,000
$8,000
60%
$8,000
$16,000
Requires further analysis
$2,850
$5,600
100%
$2,850
$5,600
$5,000
$10,000
80%
$10,000
$20,000
Requires further analysis
$2,850
$5,600
80%
$5,000
$10,000
$5,000
$10,000
60%
$10,000
$20,000
Fail
$2,850
$5,600
80%
$5,000
$10,000
$5,000
$10,000
60%
$10,000
$20,000
Fail
$3,500
$7,000
100%
$3,500
$7,000
$7,500
$15,000
80%
$10,000
$30,000
Fail
$3,500
$7,000
80%
$5,000
$10,000
$7,500
$15,000
60%
$10,000
$30,000
Fail
$3,500
$7,000
80%
$5,000
$10,000
$7,500
$15,000
60%
$10,000
$30,000
Fail
$5,000
$10,000
100%
$5,000
$10,000
$7,500
$15,000
80%
$10,000
$30,000
Fail
$5,000
$10,000
100%
$5,000
$10,000
$7,500
$15,000
80%
$10,000
$30,000
Fail
$1,100
$2,200
80%
$2,200
$4,400
n/a
n/a
n/a
n/a
n/a
Pass
$2,000
$4,000
80%
$4,000
$8,000
n/a
n/a
n/a
n/a
n/a
Requires further analysis
$2,850
$5,600
80%
$5,000
$10,000
n/a
n/a
n/a
n/a
n/a
Fail
$3,500
$7,000
80%
$5,000
$10,000
n/a
n/a
n/a
n/a
n/a
Fail
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HSA High Deductible Health Plan – Mid-Market Preferred Portfolio All plans feature combined medical and pharmacy deductible and out-of-pocket maximum. Medical In-Network Deductible
Medical Out-of-Network
OOP Max (incl ded)
Deductible
Available RX Plans
OOP Max (incl ded)
Single
Family
Coins
Single
Family
Single
Family
Coins
Single
Family
$1,100
2x Ind
90%
$4,400
2x Ind
$2,200
2x Ind
70%
$4,400
2x Ind
Pass
$1,100
2x Ind
80%
$4,400
2x Ind
$2,200
2x Ind
60%
$4,400
2x Ind
Pass
$2,000
1.5x Ind
80%
$4,000
2x Ind
$4,000
2x Ind
60%
$8,000
2x Ind
Requires further analysis
$2,000
2x Ind
100%
$2,000
2x Ind
$4,000
2x Ind
80%
$8,000
2x Ind
Pass
$2,000
2x Ind
90%
$4,000
2x Ind
$4,000
2x Ind
70%
$8,000
2x Ind
Requires further analysis
$2,000
2x Ind
80%
$4,000
2x Ind
$4,000
2x Ind
60%
$8,000
2x Ind
Requires further analysis
$2,000
2x Ind
70%
$4,000
2x Ind
$4,000
2x Ind
50%
$8,000
2x Ind
Requires further analysis
$2,500
1x Ind
90%
$4,500
2x Ind
$5,000
2x Ind
70%
$9,000
2x Ind
Requires further analysis
$2,500
2x Ind
90%
$4,500
2x Ind
$5,000
2x Ind
70%
$9,000
2x Ind
Requires further analysis
$2,500
2x Ind
80%
4,500
2x Ind
$5,000
2x Ind
60%
$9,000
2x Ind
Requires further analysis
$2,500
2x Ind
70%
$4,500
2x Ind
$5,000
2x Ind
50%
$9,000
2x Ind
Requires further analysis
$2,850
$5,600
100%
$2,850
$5,600
$5,000
2x Ind
80%
$9,000
2x Ind
Requires further analysis
$3,000
2x Ind
100%
$3,000
2x Ind
$6,000
2x Ind
80%
$10,000
2x Ind
Requires further analysis
$3,000
2x Ind
90%
$5,000
2x Ind
$6,000
2x Ind
70%
$10,000
2x Ind
Fail
$3,000
2x Ind
80%
$5,000
2x Ind
$6,000
2x Ind
60%
$10,000
2x Ind
Fail
$3,000
2x Ind
70%
$5,000
2x Ind
$6,000
2x Ind
50%
$10,000
2x Ind
Fail
$1,100
2x Ind
80%
$4,400
2x Ind
n/a
n/a
n/a
n/a
n/a
Pass
$2,500
2x Ind
80%
$4,500
2x Ind
n/a
n/a
n/a
n/a
n/a
Requires further analysis
$3,000
2x Ind
80%
$5,000
2x Ind
n/a
n/a
n/a
n/a
n/a
Fail
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$7/25/40
$10/30/50
HSA High Deductible Health Plan – Oxford Health Plans Portfolio Deductible Single $2,850 $2,850 $2,850 $2,850 $2,850 $2,850 $2,500 $2,500 $2,500 $2,500 $2,500 $2,500 $2,850 $2,850 $2,850 $2,850 $2,850 $2,850 $2,850 $2,850 $2,850 $2,850 $2,850 $2,850 $2,850 $2,850 $2,850 $2,850 $2,850 $2,850
Medical In-Network OOP Max (incl ded) Family Coins Single Family 2x Ind 100% $5,000 2x Ind 2x Ind 100% $5,000 2x Ind 2x Ind 100% $5,000 2x Ind 2x Ind 100% $5,000 2x Ind 2x Ind 100% $5,000 2x Ind 2x Ind 100% $5,000 2x Ind 2x Ind 100% $5,000 2x Ind 2x Ind 90% $5,000 2x Ind 2x Ind 100% $5,000 2x Ind 2x Ind 90% $5,000 2x Ind 2x Ind 100% $5,000 2x Ind 2x Ind 90% $5,000 2x Ind 2x Ind 90% $5,000 2x Ind 2x Ind 90% $5,000 2x Ind 2x Ind 90% $5,000 2x Ind 2x Ind 100% $5,000 2x Ind 2x Ind 100% $5,000 2x Ind 2x Ind 100% $5,000 2x Ind 2x Ind 100% $5,000 2x Ind 2x Ind 100% $5,000 2x Ind 2x Ind 100% $5,000 2x Ind 2x Ind 90% $5,000 2x Ind 2x Ind 90% $5,000 2x Ind 2x Ind 90% $5,000 2x Ind 2x Ind 100% $5,000 2x Ind 2x Ind 90% $5,000 2x Ind 2x Ind 100% $5,000 2x Ind 2x Ind 90% $5,000 2x Ind 2x Ind 100% $5,000 2x Ind 2x Ind 90% $5,000 2x Ind
UHC-05-006
Medical Out-of-Network OOP Max (incl Deductible ded) Single Family Coins Single Family n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a $2,500 2x Ind 70% $5,500 2x Ind $2,500 2x Ind 70% $5,500 2x Ind $2,500 2x Ind 70% $5,500 2x Ind $2,500 2x Ind 70% $5,500 2x Ind $2,500 2x Ind 70% $5,500 2x Ind $2,500 2x Ind 70% $5,500 2x Ind $2,850 2x Ind 70% $5,850 2x Ind $2,850 2x Ind 70% $5,850 2x Ind $2,850 2x Ind 70% $5,850 2x Ind $2,850 2x Ind 70% $5,850 2x Ind $2,850 2x Ind 70% $5,850 2x Ind $2,850 2x Ind 70% $5,850 2x Ind $2,850 2x Ind 70% $5,850 2x Ind $2,850 2x Ind 70% $5,850 2x Ind $2,850 2x Ind 70% $5,850 2x Ind $2,850 2x Ind 70% $5,850 2x Ind $2,850 2x Ind 70% $5,850 2x Ind $2,850 2x Ind 70% $5,850 2x Ind $2,850 2x Ind 70% $5,850 2x Ind $2,850 2x Ind 70% $5,850 2x Ind $2,850 2x Ind 70% $5,850 2x Ind $2,850 2x Ind 70% $5,850 2x Ind $2,850 2x Ind 70% $5,850 2x Ind $2,850 2x Ind 70% $5,850 2x Ind
17
Available RX Plans
$5/15/35 $10/25/50 $15/50%/50% $10/25/50 $15/50%/50% $15/30/60 $7/15/35 $7/15/35 $10/25/50 $10/25/50 $15/50%/50% $15/50%/50% $5/15/35 $10/25/50 $15/50%/50% $5/15/35 $10/25/50 $15/50%/50% $10/25/50 $15/50%/50% $15/30/60 $10/25/50 $15/50%/50% $15/30/60 $7/15/35 $7/15/35 $15/25/40 $15/25/40 $15/50%/50% $15/50%/50%
Fail Fail Fail Fail Fail Fail Fail Fail Fail Fail Fail Fail Fail Fail Fail Fail Fail Fail Fail Fail Fail Fail Fail Fail Fail Fail Fail Fail Fail Fail
Medical In-Network Deductible Single $1,100 $1,100 $1,100 $1,100 $1,100 $1,100 $1,100 $1,100 $1,100 $1,100 $1,100 $1,100 $1,100 $1,100 $1,100 $1,100 $1,100 $1,100 $1,100 $1,100 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $1,100 $1,100 $1,100 $1,100 $1,100 $1,100 $1,100 $1,100 $2,000 $2,000 $2,000
Medical Out-of-Network
OOP Max (incl ded) Family 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind
UHC-05-006
Coins 100% 100% 100% 80% 80% 100% 100% 100% 80% 100% 80% 100% 80% 100% 80% 100% 80% 100% 100% 100% 100% 100% 100% 100% 100% 100% 80% 100% 100% 100% 80% 80% 100% 80% 100% 100% 100%
Single $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000
Family 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind
Deductible Single n/a n/a n/a $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 n/a n/a n/a n/a n/a n/a n/a n/a n/a $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000
Available RX Plans
OOP Max (incl ded) Family n/a n/a n/a 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind n/a n/a n/a n/a n/a n/a n/a n/a n/a 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind
18
Coins
Single
N/a n/a n/a 60% 60% 70% 70% 70% 70% 70% 60% 70% 60% 70% 60% 70% 60% n/a n/a n/a n/a n/a n/a n/a n/a n/a 60% 70% 70% 70% 70% 70% 70% 60% 70% 70% 70%
n/a n/a n/a $6,000 $6,000 $5,000 $5,000 $5,000 $5,000 $5,000 $6,000 $5,000 $6,000 $5,000 $6,000 $5,000 $6,000 n/a n/a n/a n/a n/a n/a n/a n/a n/a $6,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $6,000 $5,000 $5,000 $5,000
Family n/a n/a n/a 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind n/a n/a n/a n/a n/a n/a n/a n/a n/a 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind
$5/15/35 $10/25/50 $10/25/50 $5/15/35 $10/25/50 $5/15/35 $10/25/50 $10/25/50 $10/25/50 $7/15/35 $7/15/35 $10/25/50 $10/25/50 $7/15/35 $7/15/35 $15/25/40 $15/25/40 $15/50%/50% $15/50%/50% $15/30/60 $5/15/35 $10/25/50 $15/50%/50% $10/25/50 $15/50%/50% $15/30/60 $15/50%/50% $15/50%/50% $15/50%/50% $15/30/60 $15/50%/50% $15/30/60 $15/50%/50% $15/50%/50% $5/15/35 $10/25/50 $15/50%/50%
Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Pass Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis
Medical In-Network Deductible Single $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $1,100 $1,100 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000
Medical Out-of-Network
OOP Max (incl ded) Family 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind
Coins 100% 100% 100% 90% 90% 90% 100% 90% 100% 80% 90% 90% 90% 100% 90% 100% 90% 100% 90% 100% 90% 100% 90%
Single $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000
Family 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind
Deductible Single $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000 $2,000
Available RX Plans
OOP Max (incl ded) Family 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind
Coins
Single
70% 70% 70% 70% 70% 70% 70% 70% 70% 60% 70% 70% 70% 70% 70% 70% 70% 70% 70% 70% 70% 70% 70%
$5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $6,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000 $5,000
Family 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind 2x Ind
$10/25/50 $15/50%/50% $15/30/60 $10/25/50 $15/50%/50% $15/30/60 $15/50%/50% $15/50%/50% $15/50%/50% $15/50%/50% $5/15/35 $10/25/50 $15/50%/50% $7/15/35 $7/15/35 $10/25/50 $10/25/50 $7/15/35 $7/15/35 $15/25/40 $15/25/40 $15/50%/50% $15/50%/50%
Health Reimbursement Arrangement (HRA): If your plan provides a HRA for your employees, the value of the HRA should be included in the creditable coverage testing of your plan, and may be large enough to allow your plan to be considered creditable coverage. HRAs were not included in Reden & Anders’ testing of plans on this list, because the testing was not employer-specific. If your plan design is not on any of the lists enclosed, it may not have been tested. Contact your UnitedHealthcare representative for additional information.
UHC-05-006
19
Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis Requires further analysis
