Broker Broadcast
Dental Groups: 2-9 Eligible Employees
Portfolio Changes for Groups with 2 to 9 Eligible Lives
- Effective July 1 (in-market June 18), plans with a $2,000 annual maximum will no
longer be available.
- All voluntary plans will require a waiting period. However,
this waiting period may be waived with proof of prior coverage.
Waiving Waiting Period Process for New Business Groups
The waiting period can be
waived for all initial enrollees – regardless of whether they had prior coverage
– if dental coverage included Class III (and Class IV, if applicable) services
for the 12 consecutive months prior to becoming effective with UnitedHealthcare
Dental.
Required documentation for submission:
- Certificate of Coverage or
Summary Plan Description
- Renewal from prior carrier validating coverage over the
past year or prior carrier bill (with effective date showing 12 consecutive
months of coverage for enrollee/group)
- Sales document or prior carrier bill
indicating which Class III and Class IV services were covered
Installation
Guidelines and Form Requirement Updates
Stand-alone Dental, Vision, and Life and
Disability cases can use a current or prior carrier bill in lieu of wage and tax
or payroll documentation.
Adjusted Guideline When Offering Dual Option Dental
Plans
Dual Option plans with a Dental HMO and PPO combination can be offered to
groups with five or more eligible lives.
Underwriting Guidelines
- A minimum of
three eligible lives must enroll overall, whether voluntary or employer-paid.
- The combination of plans must be logical, e.g., high and low options, network
and non-network options.
- A minimum of eight enrollees is required for any PPO
plan that includes orthodontic services.
Dual Option plans with two PPO plans
require a combined minimum of 10 subscribers (not eligible employees).
Underwriting Guidelines
- Plans must differ by more than just orthodontia on one
plan, e.g., deductibles, coinsurance, annual maximum, major services, freedom of
provider choice.
- The combination of plans must be logical, e.g., high and low
options, network and non-network options, with a 30 percent differential target.
Installation Process
- Submit Dual Option Dental plans following the standard
process.
- The health plan will indicate Dual Option Plans on the New Business
Cover Sheet.
- The health plan Employee Enrollment Form will include the Dental
Plan Option.
- Rates are unaffected by enrollment distribution (full census was
used to determine original rates).
- Sales and Account Management will install the
case following their normal process.
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