May 24, 2023
UnitedHealthcare has announced new participation rules, effective June 1, 2023, for level funded cases in the 31 states listed below.
Participation requirements are now as follows:
| Market Size | Level Funded Participation Guidelines |
|---|---|
| Small Group 2-4 (No Change) |
2 Eligible: 2 Must Enroll 3-4 Eligible: 3 Must Enroll Waiver Forms Not Required |
| Small Group 5-50 | Participation Requirements Are the Same as for Fully Insured Groups |
| 51+ and Key Accounts (No Change) |
50% of Eligible Waivers Not Required |
As a result of these new rules, medical waiver reasons will now be required when submitting requests for initial underwritten rates for level funded groups in the below states:
- Alabama (AL)
- Alaska (AK)
- Arkansas (AR)
- Colorado (CO)
- Connecticut (CT)
- Florida (FL)
- Georgia (GA)
- Illinois (IL)
- Iowa (IA)
- Kansas (KS)
- Louisiana (LA)
- Maine (ME)
- Massachusetts (MA)
- Michigan (MI)
- Minnesota (MN)
- Mississippi (MS)
- Missouri (MO)
- Montana (MT)
- Nevada (NV)
- New Hampshire (NH)
- New Mexico (NM)
- North Carolina (NC)
- Oklahoma (OK)
- Oregon (OR)
- Rhode Island (RI)
- Tennessee (TN)
- Texas (TX)
- U.S. Virgin Islands (VI)
- Washington (WA)
- Wisconsin (WI)
- Wyoming (WY)
Providing the list of waiving employees, along with their waiver reasons, helps solidify the final enrollment census should the group elect to move forward. This reduces the risk of drastic changes in enrollment, which could ultimately affect final rates.
Contact your Amwins Connect Regional Sales Manager with questions or if you are in need of further assistance.
