UPMC Health Plan announces Medical
Commercial Group Rate Cap Program

 
UPMC Health Plan’s Medical Commercial Group Rate Cap Program is open to any new commercial group medical accounts that have 51 or more employees and effective dates of Oct. 1, 2021, to Dec. 31, 2022.­­ Below are some details about the program:

• The program provides a 9.5 percent cap on the first renewal. The rate cap excludes any federal or state-mandated benefit changes or additions, as well as any federal or state taxes, surcharges, or assessments.
  • At the time of the new business quote, the rate cap will be offered based on a projected medical expense ratio (MER) of no more than 90 percent.
  • The Broker Program will be permitted but must be requested by the broker.
  • The group must maintain coverage with UPMC Health Plan as a total replacement during any year throughout the guarantee period.
  • Guarantees apply only to groups with 51 or more enrolled contracts in the first month of the initial year and during each renewal year.  Groups in the Eastern Region must have 100 enrolled contracts at the time of enrollment to qualify for the rate cap program.
  • We reserve the right to re-evaluate the guarantee if the final enrollment fluctuates by more than 15 percent.
• On second renewal, the program provides a 12 percent cap on groups with an MER of less than or equal to 88 percent.
  • The MER calculation will include the standard application of actuarial completion factors in the medical loss ratio claim estimate, as well as annualization/seasonality adjustments.
  • The specified period for use with this calculation will include a minimum of six months of completed data in the current benefit year, with the exact dates to be outlined in the first renewal.