2014 UnitedHealthcare Plan Design Changes as a Result of the Patient Protection and
Affordable Care Act (PPACA)
- Medical copays will apply to the Out of Pocket Maximum.
- Addition of a Clinical Trials provision.
- Essential Health Benefits provision updated (includes benefit enhancements to durable
medical equipment and other categories).
- Elimination of vision hardware discounts. Eye exams will still be available and unchanged.
- BRCA testing: Effective October 1, 2013 - The BRCA test, as well as screening and
counseling, will be covered without cost share for members age 18 years and older
with a family history of ovarian and/or breast cancer and who do not have a personal
history or current diagnosis of ovarian and/or breast cancer. *note: UnitedHealthcare
will continue covering BRCA testing for members at risk with a history of cancer who
meet other testing guidelines. UnitedHealthcare also currently covers the genetic
counseling and evaluation without cost share.
- Over The Counter (OTC) Drugs: Implementation of a pharmacy point-of-sale solution
at network retail pharmacies as of November 1, 2013, and mail-order pharmacy beginning
January 1, 2014. UnitedHealthcare will cover certain OTC drugs and OTC contraceptives
for women. OTC drugs include: aspirin, folic acid supplements for women, fluoride
and iron supplements for children and vitamin D supplements for older adults. OTC
contraceptives for women include female condoms, emergency contraceptives and contraceptive
film, foam and gel. These are covered without cost share when age and gender appropriate,
prescribed by a health care professional and filled at a network pharmacy with the
appropriate physician orders.
- Addition of medical necessity language.
- Pharmacy Programs – Retail before Mail is a new program that will be implemented.
Open Enrollment Meetings
All Open-Enrollment Meetings have been completed