Small Business Health Coverage for Memphis

Level Funded plans let your small business make the same monthly claims funding payment throughout the plan year. Stop-loss insurance, which protects your company from unexpectedly high medical claims, is already built into your monthly payment. If your covered claims are lower than expected, your plan gets a surplus refund at the end of the year. And don't forget that members of the Greater Memphis Chamber receive a 2% discount off of their monthly costs.

With traditional plans, the business pays a fixed premium to the insurance company, and then the insurance company pays the health care claims as well as the administrative costs, sales commissions and taxes. If the actual health care claims are higher than expected, the insurance company covers them. But if the claims are lower than expected, the insurance company keeps the difference. This means your company doesn’t get anything back if your plan participants have lower-than-expected claims.

With Level Funded, if the covered medical claims are lower than expected, your plan shares the savings with a potential surplus refund at the end of the year (where allowed by state law). And if the covered medical claims are higher than expected, your stop-loss insurance policy covers them.

A couple of additional benefits:

• The plan is a “level-funded” plan, so your company will make the same monthly claims funding payment throughout the plan year; you won’t have to pay any more for medical claims at the end of the plan year, even if your medical claims are higher than expected
• Self-funded medical plans are not subject to most state insurance mandates or state insurance premium taxes, which may mean lower costs throughout the year (your stop loss coverage is still subject to premium tax, however)

Choose from a variety of plan designs to get the best fit for your business and plan participants. Get more details here.

Traditional, split copay and HSA plans

• $0 primary care physician (PCP) network copays for kids (EPO/PPO)
• Deductible range: $500 to $6,350
• Coinsurance options: 80% or 100%
• Network only (EPO) options
• Embedded/non-embedded deductibles
• Individual stop-loss limits: $15K–$50K (varies by state)
• Primary care physician (PCP) gated EPO plans with specialist referral required (not available in all markets)
• Featuring a new virtual-first EPO plan in select markets
• Real Appeal® online weight loss program available with all benefit plans
• Savings with hearing benefit offering device discounts
• Survivorship Benefit included with all medical plans — continued coverage available for dependents when a plan participant passes away

Tiered benefit plans

• Specialist tiering (not available in all markets)
• Advanced—deductible range $1,000–$5,000, 50% coinsurance
• Premier performance — deductible range $1,000–$5,000, 80% coinsurance; $0 PRO PCP copays for kids, $10–$15 PCP copay for adults

 Flex Focus plans

• Deductible range: $1,000–$3,000, 80% coinsurance
• $0 copay for the first 3 PCP/specialist combined visits
• $0 copay for the first 2 urgent care visits

National networks

• Choice Plus (PPO)
• Core Network

Best case: Low medical claims

Your company’s monthly payments include the estimated health care claims plus fixed-cost items (administrative fees and stop-loss insurance premium). This is called your plan’s “maximum liability,” which means you won’t get stuck at the end of the year with unexpected costs.

Part of your monthly payments will go into an account that pays for your covered plan participants’ eligible claims. At the end of the year, the monthly claims funding payments will be compared with the actual claims costs.

In the best-case scenario, if actual claims costs for the year are less than what was estimated, your plan has a surplus. After plan reconciliation, any surplus is sent back to your plan to use for the following year (where allowed by state law).

Worst case: High medical claims

In the worst-case scenario, the actual claims would be higher than expected. But because your plan would have already paid the maximum liability, your plan won’t pay more for covered claims at the end of the plan year. Your plan is protected by the stop-loss insurance that is already built into your monthly payments. Of course, each year could be somewhere in between. But in any case, many businesses may save with a Level Funded plan.

Get anywhere, anytime answers about prescription drugs. OptumRx® makes it easy to get prescriptions, cost estimates and savings on medications.

• PreCheck MyScript® — real-time plan costs and benefit information
• Dx2Rx — streamlines the Prior Authorization process
• Refill and Save — 30- to 90-day retail or mail-order pharmacy supplies
• Advantage Prescription Drug List (PDL) or Essential PDL (unique benefit designs; not available in all markets)
• Opioid management
• Point-of-sale discounts

As part of your benefit plan, and at no additional cost, we provide your plan participants with ways to help manage their care and get healthier.

UnitedHealthcare Motion

With UnitedHealthcare Motion®, participants can get rewarded for something they do every day: walk. They simply sign up, slip on a wearable activity tracker and get moving, no gym required. Participants get a wearable activity tracker and may earn rewards every day — up to $1,095* a year— for meeting 3 daily walking goals.**

Goal Potential Benefits Reward

• Frequency Six 5-minute walks, minimum of 300 steps, 1 hour apart May reduce risk factors for metabolic and cardiac health $1
• Intensity One brisk walk of 3,000 steps within 30 minutes or 30 minutes performing other eligible activities
• May reduce risk factors for cardiovascular, metabolic, mental and bone health, as well as cancer $1
• Tenacity 10,000+ total steps May increase energy (weight control) $1
• Total Possible per Day $3
• Participants and eligible spouses may be reimbursed up to $1,095* or 30% of the plan participant only annual payment (or family annual payment if dependents are covered), whichever is less, each calendar year
• Quarterly reimbursements for expenses are applied to the out-of-pocket limit calendar year spend
• 50% calendar year rollover of unreimbursed rewards for those on a non-HSA plan
• A $55 registration credit can be used toward purchase of an activity tracker or saved for quarterly reimbursements

To learn more, visit unitedhealthcaremotion.com.