Brokers' Frequently Asked Questions about the UniCare PPO Health Plan

The topics below contain a broad list of brokers' Frequently Asked Questions. Please use the links below to refine your search, or simply scroll down to locate the subjects of most relevance to you. The answers are only general descriptions of coverage.Please refer to certificates of coverage for more complete details about the plan including benefits, limitations and exclusions


About UniCare

1. Who is UniCare?

UniCare is a national organization dedicated to the delivery of quality health care plans working together with its customers, brokers, providers and employers. Providing managed care and specialty health care services throughout the United States, UniCare is an operating subsidiary of WellPoint, Inc. (NYSE:WLP), one of the nation's largest publicly traded managed care companies serving the health care needs of more than 13 million members.There are several separate UniCare entities.

UniCare offers a comprehensive array of managed care health plans and specialty products that preserve member choice at competitive prices. UniCare currently serves 1.8 million medical members and currently employs over 3,400 employees with 38 locations in 13 states.

UniCare is committed to redefining the industry through a new generation of consumer friendly products that put individuals back in control of their health and financial future.

2. What is your mission statement?

Our mission and vision statement is as follows:

WellPoint Mission
The WellPoint Companies provide health security by offering a choice of quality branded health and related financial services designed to meet changing expectations of individuals, families and their sponsors throughout a lifelong relationship.

WellPoint Vision
WellPoint will redefine our industry through a new generation of consumer friendly products that put individuals back in control of their health and financial future. The result will be:

  • Significant increase in member satisfaction and enrollment;
  • Superior returns to shareholders;
  • Excellent opportunities for associates;
  • A highly respected national organization.

Click here to read recent news about WellPoint, our parent company.

3. What differentiates UniCare's services from other organizations?

UniCare recognizes that what works for one company doesn't necessarily work for another. That's why our full portfolio of health, pharmacy, dental, life and disability benefits products can be tailored to meet the specific needs of your organization.

Our focus is on putting our clients and their associates back in control of their health care and financial future. Through exceptional sales and account management staff who listen to our clients, we can create benefits that evolve over time to meet the changing needs of our clients and add the most value to you and your organization.

4.What do you view as UniCare's strengths?

In addition to our broad based product portfolio, patient focused care management, and service excellence, one of our core operational strengths is our Strategic Market Business Unit (MBU) approach. The MBU's concentrate on each unique customer segment and geography as a single entity with its own special needs. Through this unique customer-centered structure, innovative products and services are developed and delivered that meet the specific needs of each segment for choice, quality and cost efficiency. This approach serves as the foundation for all our activities and assures our products and services meet the diverse needs of your clients.

5. Please describe your member services organization?

Through our customer-focused approach, UniCare sees things from the customer's vantage point. To meet the needs of our clients, UniCare has assembled a team of highly qualified professionals dedicated to managing client accounts. This perspective enables us to consistently meet the needs of employers nationwide.

Account Management:

Our experienced account managers can help you design a plan that meets your managed care objectives. Your dedicated account team is always ready to make sure that your plan runs smoothly.

Client Service:

UniCare's state of the art Regional Service Centers combine sophisticated technology, highly-trained employer service representatives (ESRs), claims and customer service teams and proven processes to provide our clients with comprehensive and coordinated benefits administration. ESRs are your single point of contact for your group administrators and assist account management by monitoring the service of your account.

Information Management:

UniCare understands that the ability to manage benefit plan administration on a timely basis is powerful tool in helping our customers meet their benefits plans objectives. UniCare's Client Information Services unit offers superior technology and a staff of information processing, analysis and consulting professionals dedicated exclusively to our customers.

Technological Advances:

UniCare is committed to maximizing the use of technology throughout our organization. In order to provide prompt and accurate client service, UniCare has created the CallCare system. CallCare allows ESRs and customer service representatives to quickly access client and member information - resulting in one call resolution.

In our quest to provide online features that benefit both you, your group administrators and your associates, we are committed to making technological advances that make a difference in our industry, including Internet enrollment maintenance capabilities.

[Back to top]

Products

6. What products and services do you offer?

UniCare understands that offering a variety of products is essential in developing a competitive associate benefits program. We offer an array of benefits products that address aspects of health care, prescription drug, dental, life and disability management, while satisfying the diverse needs of employers and associates. Our national network management program is an evaluation program of managed care guidelines and performance outcome measures that monitor each network and network provider for quality and cost-efficiency. Our Healthcare Quality Assurance (HQA) program maximizes Plan Performance by managing the health care costs of the people who use it the most. UniCare's line of diverse products are designed to meet the needs of your organization. We pride ourselves on being an innovative organization that anticipates changing health care benefits dynamics and employer needs. We constantly research, plan and develop new solutions that respond to employers' evolving objectives

7. What is the focus of your managed care products?

The primary focus of UniCare's managed care products is to deliver programs and networks that are well designed and administered for the purpose of producing cost effective delivery of care while not jeopardizing the quality of that care. These programs seek to maintain the integrity of the employer's risk pool and avoid the service problems and lack of integration commonly associated with many managed care programs available in the market today.

We also believe that the dynamic nature of health care requires a broad portfolio of health care products to deal with the various problems employers' face. While we feel that a network environment is often the best approach for dealing with the issue of rising health care costs, a single model or solution will not address all problems or meet all circumstances. We believe that an analysis of a customer's particular circumstances should form the basis of action and that the programs employed should address the problems that are uncovered through this analysis.

[Back to top]

Pharmacy

8. Does UniCare offer a managed pharmacy network?

WellPoint Pharmacy Management1, a UniCare affiliate, currently serves over 27 million members, and provides pharmacy benefit administrative services to many UniCare plans. The network is national in scope and includes over 52,000 pharmacies, representing 85% of all pharmacies in the nation.

UniCare makes prescription plan costs easier to manage and control while enhancing employee satisfaction. Our prescription plans and our broad Pharmacy network offer all the key elements today's employer's demand in a prescription drug program.

Because the UniCare Prescription Drug Plan uses the WellPoint Pharmacy Management network, UniCare has the flexibility to develop programs that meet the diverse needs of your client. These strengths enable UniCare to develop innovative pharmacy management strategies that strive to maximize the quality of the pharmaceutical benefit in the most cost-effective manner.

1Professional Claim Service, Inc. d.b.a. WellPoint Pharmacy Management.

9. Does a group or a subscriber within a group have to take prescription drug coverage?

A client (group) does not have to offer drug coverage. However, if the client has both medical and drug coverage, UniCare requires that each subscriber within a group take both medical and drug coverage. UniCare does offer plan options that are medical only.

[Back to top]

Provider Network

10. Describe your provider networks.

MEDICAL:
UniCare's Platinum PPO2 network includes coverage throughout the country. UniCare's Platinum PPO network includes many of the leading physicians, hospitals and other health care providers in the nation. This includes coverage both at home and when our members are traveling. Location specific information is available via the Provider Finder feature on our home page or by contacting your local UniCare Representative.

DENTAL:
Broad Network Access - Our large dental provider network offers members wide access to care. We are able to maintain our network size because of our flexibility. We have broad access to networks in our large metropolitan areas.

PHARMACY:
WellPoint Pharmacy Management 3, a UniCare affiliate, currently serves over 27 million members and provides pharmacy benefit administrative services to many UniCare plans. The network is national in scope and includes over 52,000 pharmacies, representing 85% of all pharmacies in the nation.

2 Platinum Network is subject to applicable program terms and conditions and availability.
3 Professional Claim Service, Inc. d.b.a. WellPoint Pharmacy Management.

11. How often are your paper and online directories updated?

Directories are updated annually. Provider information is available online via our website, www.unicare.com. Through our online provider finder feature, members have the ability to print a listing of providers in their area. In addition, employees may also call Customer Service at anytime for questions regarding a physician's participation.

[Back to top]

Coverage/Benefits

12. Will UniCare send out detailed benefit information to employees?

Yes. The employer receives a supply of EOCs (evidence of coverage booklets) to issue to employees enrolled in the plan.

13. What are pre-existing conditions and how do they impact coverage?

Please reference your plan booklet for information on any applicable pre-existing condition limitations on coverage and/or other pre-existing condition provisions.

14. What type of wellness or health promotion programs do you offer to your members?

HealthyExtensionsSM is a personal path toward creating a healthier lifestyle. UniCare believes there are many components to a member's health and well-being. Through independent vendors 4, HealthyExtensions builds on existing UniCare prevention and wellness benefits by providing members with access to a large selection of materials, services and products for health and fitness at special discounted rates, including: - fitness club memberships,
- health and wellness products,
- weight loss programs,
- nutritional supplements,
- skin care products,
- parenting advice,
- prescription eyewear,
- laser vision correction,
- hearing aids,
- alternative health care information,
- massage therapy,
- and much more.

UniCare'S MedCall® puts the power of information at our member's fingertips whenever and wherever they need it so they can become better-informed health care consumers. This telephone information service puts the member in touch with nurse counselors who can answer any health care questions toll-free. This service includes an audio library with over 200 audio tapes covering a wide range of health topics as well the Healthwise Knowledgebase. Healthwise is a comprehensive resource of decision-making information created for medical consumers.

UniCare's Employee Assistance Program offers members and their families confidential help provided by professional consultants. Help is available for difficulties relating to relationships, substance abuse, stress and emotional problems. Also, the EAP website offers quick tips on life balancing issues.

UniCare offers a free glucose monitoring system through our Glucometer Program, at no charge to our members. Because routine monitoring of blood glucose levels is essential in minimizing the risk of complications and in maintaining the good health of our members.

4The HealthyExtensionsSM independent vendors are not affiliated with UniCare, its affiliates or parent companies.

15. Do you issue policies to minors?

UniCare's large group policies are issued to the employer not to individuals.

16.When does coverage begin?

The contract defines the date coverage will begin.

[Back to top]

Enrollment and Renewals

17.What documentation is necessary for enrolling a group?

The following documentation is necessary for enrolling a group: application, binder check, must offer forms, new case installation paperwork and enrollment forms.

18. Does the renewal paperwork require signatures from the broker and/or the group, if there are no changes other than the renewal rates?

Yes, the renewal paperwork will require signatures from the broker and/or the group.

19.What are the enrollment deadlines for a new group?

Enrollment deadlines depend on how the information is provided, i.e., electronic, paper. The standard is 15 days from effective date (and all paperwork is submitted).

20. How do I submit enrollment files to the plan?

You may submit enrollment files to the plan on paper or electronically (tape 750+ employees). After the case is initially enrolled we would accept online eligibility maintenance through myunicareonline.com.

21. Can I e-mail enrollment files to the plan?

Although enrollment files cannot be accepted via email, we would accept online eligibility maintenance through myunicareonline.com after the case is initially enrolled.

22. When can I get the renewal for a company enrolled with your plan?

You may obtain the renewal for a company enrolled in a UniCare plan sixty days before the renewal effective date.

[Back to top]

Eligibility

23. What is the average turnaround time required to determine a group or a subscriber's eligibility or underwriting status?

The client determines if a member is eligible. Standard processing time, once enrollment is received, is 3 days.

[Back to top]

Notification of Changes

24. Who must be notified of a change of address or other administrative change?

From a contractual standpoint, the UniCare Account Manager should be notified of any changes. The Account Manager completes the applicable paperwork needed to facilitate the change.

25. How do I change the waiting /elimination/probationary period on a group's policy?

Request for amendment (signed by the contract holder) can be submitted to the account manager who will work with underwriting to determine if the change is approved and determine effective date of change.

26. What is the maximum waiting /elimination/probationary period a group can impose?

The maximum period is six months to a year, depending on the employer's human resource policies.

[Back to top]

HIPAA

27. What is HIPAA?

HIPAA, or Health Insurance Portability and Accountability Act is a federal health benefits law passed in 1996, effective July 1, 1997, which restricts pre-existing condition exclusion periods to ensure portability of health care coverage between plans, group and individual; require guaranteed issue and renewal of insurance coverage; prohibit plans from charging individuals higher premiums, copayments, and/or deductibles based on health status. The legislation also establishes a four-year medical savings account (MSA) demonstration project. The Act mandates standards for electronic data interchange (EDI) transactions and code sets, establishes uniform health care identifiers for providers, health plans, and employers.. Compliance to HIPAA requires the use of ANSI ASC X12N (Version 4010) transaction standards and implementation guides. The final rules for transactions , code sets, privacy and security were published in the Federal Register on August 17, 2000. The compliance date of this rule is October 16, 2002. Compliance may be delayed for one year. Under the terms of HIPAA, the rules and regulations apply to covered entities defined to include health plans, health care clearinghouses and health care providers, who transmit any health information in any electronic form in connection with transactions covered under HIPAA and who receive, maintain or disclose individually identifiable health information in any form. All covered entities must comply with the standards adopted by HIPAA by the applicable compliance dates. The modes of electronic transmission covered under HIPAA include the Internet, Extranet, leased lines, dial-up lines, private networks and those transmissions that are physically moved from one location to another using magnetic tape, disk, or compact disk media.

28 Who is eligible for HIPAA?

The provisions of HIPAA generally apply to group health plans and group health insurance issuers offering group health insurance coverage. This means that both the plan itself and the insurer (if any) are required to comply. HIPAA contains many exceptions, including exceptions for the following types of plan:

  • Plans with fewer than 2 employees;
  • Plans providing only certain incidental types of coverages, including accident, disability income, liability insurance, and workers compensation;
  • Plans providing limited scope dental or vision benefits if provided under separate insurance policy or if coverage is elected by participants separately from the medical coverage;
  • And health FSAs, if certain requirements are met.

29. How does crediting for preexisting condition waiting periods work under HIPAA?

Many plans use the "standard method" to credit coverage. The individual receives credit for previous coverage that occurred without a break in coverage of 63 days or more. Coverage prior to a 63 day break or more is not credited against a preexisting condition exclusion period.

A plan or issuer may elect the "alternative method" for crediting coverage for all employees. The plan or issuer determines the amount of an individual's creditable coverage for any of the five specified categories of benefits which are mental health, substance abuse treatment, prescription drugs, dental care and vision care. The standard method is used to determine an individual's creditable coverage for benefits other than the five categories that a plan or issuer may use. (The plan or issuer may use some or all of these categories.)

With the alternative method, the plan or issuer looks to see is an individual has coverage within a category of benefits (regardless of the specific level of benefits provided within that category).

If your employer's plan requests information from your prior plan regarding any of the categories of benefits under the alternative method, your former plan must provide such information.

30. How will the latest HIPAA requirements regarding security, privacy, etc. affect the products your plan offers?

The requirements do not affect the products offered, however, they do affect the way UniCare does business. UniCare's practices and procedures are in compliance with HIPAA requirements.

31. What qualifies as creditable coverage?

Most health coverage is creditable coverage, such as coverage under a group health plan (including COBRA continuation coverage), HMO, individual health insurance policy, Medicaid or Medicare.

Coverage consisting solely of "excepted benefits," such as coverage solely for limited-scope dental or vision benefits is not included as creditable coverage.

Days in a waiting period during which you have no other coverage are not creditable coverage under the plan, nor are these days taken into account when determining a significant break in coverage (generally a break of 63 days or more). This 63-day break period may be extended under state law if your coverage is insured through an insurance company or offered through an HMO.

32. How does an employer-imposed waiting period affect a break in coverage?

A period of creditable coverage shall not be counted if it is before a significant break in coverage if, after such period and before the enrollment date, there was a 63 day period during all of which the individual was not covered under any creditable coverage. A waiting period is not treated as a break in coverage. Any period that an individual is in a waiting period for any coverage under a group health plan (or for group health insurance coverage) or is in an affiliation period shall not be taken into account in determining the continuous period.

33. How does a new employer or insurance carrier know that an employee had prior group coverage?

Group health plans and health insurance issuers are required to provide a certificate of coverage to an individual for documentation of prior creditable coverage. A certificate of creditable coverage shall be provided automatically by the plan or issuer when an individual either loses coverage under the plan or becomes entitled to elect COBRA continuation coverage and when an individual's COBRA continuation coverage ceases and shall also be provided, if requested, before the individual loses coverage or within 24 months of losing coverage.

34. How does HIPAA legislation affect individual coverage?

In general when leaving group coverage eligible individuals with prior group coverage can receive guaranteed individual coverage. Each state may implement statutes and regulations to modify the requirements but the modifications must be at least as favorable as the requirements pursuant to HIPAA.

HIPAA portability, special enrollment and nondiscrimination rules generally apply to group health plan and health insurance issuers offering group health insurance coverage. In contrast, individual polices of health insurance are subject to HIPAA' s individual insurance market rules, which include guaranteed availability, guaranteed renewability and certificate of creditable coverage requirements.

Group to individual conversion coverage, is considered individual health insurance coverage. Consequently, the individual market rules generally will apply to such conversion coverage. However, an insurer that offers conversion coverage to former group plan participants but does not otherwise offer coverage in the individual market will not, for the purposes of guaranteed-availability requirement, be considered to be and an insurer offering coverage in the individual market.

[Back to top]



Premiums/Rates and Quotes

35. Is payment required at the time of application?

Yes, payment equal to one month of premium is required at the time of application

36. How do I obtain a small group quote? (less than 50 employees)

For a more information on UniCare small group plans, please call 1(800)UniCare..

37. How do I obtain a large group (51+ employees) quote?

To obtain a large group quote, please call 1(800)UniCare.

38. What percentage of premium does the employer have to contribute?

The employer would typically contribute 75% of the premium.

[Back to top]

Claims

39. How are claims handled for employees with more than one health insurance plan?

UniCare's plans contain coordination of benefits language to allow group health plans to reduce their financial liabilities when their enrollees are covered under two or more group health plans.

[Back to top]

Broker Eligibility/Commissions

40 How do I become a broker for your company?

Please contact Sarah Tatum-Bourbeau at 1(800) 922-7302 for details.

41. How and when will I receive commission payments?

Commissions are generated on the last day of the month. Statements and checks are mailed to the brokers within 2-3 days of the statements and checks being generated.

42. Can I have my commission deposited directly to my bank account?

Yes, direct deposit is being offered to new brokers to UniCare. If you are an existing UniCare broker, please contact Sarah Tatum-Bourbeau at 1(800) 922-7302 for details.

[Back to top]