UPMC Health Plan Double Play

Rate Cap Program

What Employer Groups Qualify:

• Groups in 51-100 market segment with 51 employees or more enrolled
• 100 + market segment with 100 or more employees enrolled

Time Period:

• July 2017 - January 2018 Effective Dates

Two Rate Cap Options to Choose From!

• Option 2: Add dental and vision at first renewal along with HealthyU and reduce rate cap by an additional 1% in first renewal year.
• Option 2: If group does not add dental and vision or renew their HealthyU / Take A Healthy Step Benefit Program in second year, rate cap reverts to 12% second year renewal cap in Option 1.
• UPMC Health Plan, may, at its sole discretion, cancel, amend, terminate, or suspend the Rate Cap program at any time.
• Program applies to new business only. Groups must be full replacement on each applicable product to qualify.
• Market segment is based upon total average employee count from the preceding calendar year. Enrolled employee count is based on currently enrolled employees at time of sale/renewal.
• This Rate Cap Program applies to Pennsylvania-issued fully insured employer group business only.
• Rate Caps are exclusive of PPACA taxes and any new taxes or assessments that may be imposed by an applicable regulatory or taxing authority in the future.
• Terms and Conditions are subject to change without prior notice as may be necessary to comply with applicable law, regulation, or other governmental authority. Rate Cap Program may be subject to the approval of Pennsylvania Insurance Department.
• Enrolled employee count is based on currently enrolled employees at time of sale/renewal.
• Monthly: Enrolled employee count must be maintained at least 80% of qualifying enrollment threshold during each month of the contract year prior to capped renewal.
• Average over full year: Enrolled employee count must average at least 80% of qualifying enrollment threshold during the contract year prior to capped renewal.