Coverage for Midsize and Large Businesses
What’s New for 2023*
- Univera Healthy Baby Connection - Univera Healthy Baby Connection is a comprehensive case management program offered to pregnant women and their children. Embracing a proactive outreach strategy, our Care Management team will help them navigate the health care system – with a focus on early intervention, prenatal education, and personalized support before, during, and after pregnancy.
- Signature Suite Updates - We’re focused on catering to the needs of businesses in an ever-changing market; that’s why we’re enhancing our popular Signature Suite with increased plan flexibility, providing even more ways to balance cost control and out-of-pocket expenses.
- Acupuncture at PCP Cost Share - An additional PCP cost share option to help make acupuncture care more accessible and affordable will now be available across our Signature Suite of plans (subject to deductible, where applicable).
- Active&Fit ExerciseRewardsTM - We will be updating our Active&Fit ExerciseRewards program to count a fitness center visit as two points. Members that track their steps will continue to earn one point for 10,000+ steps in a day. Members are rewarded once they earn 100 points each 6-month period for working out at a qualifying fitness center or on their own** through their tracked steps. Maximum of two points per day will be allowable.
* Subject to DFS approval.
** At-home workouts will not count as a workout; only the steps tracked during a workout may count toward rewards.
Medicare Plans
With multiple plan types and options, we have coverage that’s right for every group and every member. Our network gives you access to more of the best doctors, specialists, and hospitals in your neighborhood and around the globe than any other. We’ve also negotiated great rates with these providers, which means everyone pays less for a higher quality of care.
- Local 39-County Network: More than 98% provider participation within these counties, including all major hospitals and strategic physician groups
- National Network: In-network benefits with more than 1,200,000 practitioners and 5,600 hospitals throughout the United States through the PHCS/Multiplan system
Also, we know that going to the doctor’s office isn’t always an option, so our plans allow employees to access care and support right from home through telehealth, telemedicine, and the Wellframe® app. Learn more about these convenient tools in Tools & Resources.
Univera Clear Options
The clarity and predictability of a copay plan—without the higher premiums.
For groups looking for a fresh new way to keep expenses in check while still providing a simple plan employees love, there’s Univera Clear Options. It works just like a traditional copay plan, only with additional copay levels. The result? An easy-to-understand and predictable copay plan with lower premiums than you might normally expect.
The many benefits of Univera Clear Options include:
- Six copay levels so costs are always transparent and predictable
- No deductible or coinsurance to figure out
- Copays go toward the out-of-pocket max
- Preventive care is covered in full from day one
- All plans are FSA and HRA compatible
Medicare Solutions
We can also help you with Medicare Advantage, Part D, and Supplement Plans for retirees and employees working past age 65. View Group Medicare Options.
Member Health Management
When your team is healthier, your business runs more smoothly. That’s why our comprehensive approach to Member Health Management is essential. With our system of clinical programs, reminders, and education, we surround your employees with the help they need to stay on track with their health goals, live better, and work harder.
Whether someone on your team is dealing with a chronic or complex condition, or just needs a reminder to go to the doctor once in a while, you can feel confident knowing someone is looking out for them—at no additional cost*.
Some highlights of our comprehensive roster of Member Health Management services include:
- Utilization management
- Care management
- Disease management
- Behavioral health management
- Wellbeing and incentive programs
*Included for Fully Insured. Buy-up for Self-Funded.
Tools & Resources
We’re dedicated to making health care more convenient for greater employee engagement. That’s why we offer free self-service support tools that make it easier than ever to get care.
- Online Member Accounts: From viewing their member card and benefits to viewing claims, tracking their deductible and out-of-pocket spending, and more, members have more visibility into their plan than ever before.
- Calm® App: Members receive a 12-month premium subscription to the Calm app, a digital experience to help members build resilience and manage stress through better sleep, mindfulness, and meditation.*
- Telemedicine: For non-emergency conditions and emotional wellbeing needs, telemedicine gives members convenient access to medical and behavioral health care 24/7/365 from the comfort of their home. In-network telemedicine services provided by a member’s physician or our partner, MDLIVE®, are covered in full (subject to deductible where applicable).
- Wellframe® App: Wellframe is a convenient way for members to receive confidential, text-based, one-on-one outreach from our care managers using a smartphone or tablet. Members can receive guidance, support, and tips to help achieve their health care goals and reduce costs.
- 24/7 Nurse Call Line: Members can contact a nurse by phone anytime—24 hours a day, seven days a week—with general health questions. If ongoing support is needed, members may be referred to a member care manager so they’ll have the support that best fits their needs.
- Find a Doctor & Estimate Medical Costs Tool: Members are more in control of their care with the ability to quickly and easily find their most affordable local and national care options with our online tools.
*Included in Fully Insured Large Group plans; Buy-up for Self-Funded and Minimum Premium groups. Calm is an independent company that provides a mobile app for sleep, meditation, and relaxation to Univera Healthcare members.
Voluntary Benefits Services
When you integrate services like dental, administrative services and stop loss with medical benefits, Univera Healthcare can support employees with a more complete view of their health. Leading to more proactive support to help keep employees healthy and costs of care down.
Large Group Dental Packages (more than 50 eligible employees)
With Univera Dental Select, groups get comprehensive dental coverage with the flexibility of choosing from a variety of coinsurance, deductible, and annual maximum options. Emphasizing on preventive care, Univera Dental Select helps employees maintain their complete oral health, reducing the need for more costly dental care in the future.
With Univera Healthcare, members get:
- One-stop shop for comprehensive medical and dental coverage
- Flexible benefit options at competitive rates
- Easy access to a broad network of providers
- Rewarded for regular dental care through Dental Rewards, a program offering monetary incentives for getting dental exams and cleanings
- 100% employee-paid options available
Dental Annual Maximum Rollover:
Regular dental visits can greatly reduce the occurrence of major oral health issues, saving money for both employers and employees. The Dental Annual Maximum Rollover from Univera Healthcare incentivizes preventive care by rewarding employees with funds they can roll over to use as needed in the future.
NEW! Groups new to enrolling in our dental plan will now be able to keep any accrued rollover account funds from another plan when they enroll in a dental plan that includes the annual maximum rollover benefit. We will match the funding members have with a competitor up to the Rollover Account Maximum.*
* Subject to DFS approval. Proof of rollover account funds will be required upon enrollment.
When you help employees take care of their eye health, they can enjoy a better quality of life, lower costs, and peace of mind in knowing they’re taking care of their whole health. That’s why group vision plans with low out-of-pocket costs are now available from Univera Healthcare.
All vision plans include:
- Low-cost eye exams
- Fully covered and low-cost on-trend frames options through the Exclusive Collection
- Competitively priced plan options and multiple contribution options
- Access to great discounts on lens add-ons, additional pairs of eyeglasses, LASIK services and other great extras*
Through our partner, Davis Vision, employees have access to a large network that includes 350 provider locations in the 8-county Western New York region and 100,000+ points of access nationwide, including independent eye care professionals, 4 of the top 5 eyewear retailers and online retailers.
*Not all providers participate in Davis Vision Discounts, including the fixed lens option pricing. Members should contact their provider prior to scheduling an appointment to confirm if discount and fixed lens options are offered.
Davis Vision is an independent company providing vision benefit management services and access to their network.
We oversee every aspect of pharmacy care on a member-by-member basis to keep costs low and keep businesses and their employees safe. Plus, we regularly connect with local physicians to stay current on new medications that can lower costs even further.
- With integrated benefits from Univera Healthcare, you get the complete package:
- One member card
- Zero claims integration fees, hidden costs for utilization management, or reporting fees
- Local, dedicated pharmacy, sales, and customer service team for more responsive service
- Real-time formulary management to identify the most effective drugs at the lowest cost —based on real member data (not national statistics)
- Access to 28 on-staff pharmacists and 16 medical directors
- 4-6% reduction in overall medical costs*
*Health Plan Data
We’re in the business of protecting local businesses from catastrophic claims.
We treat stop loss as an important part of our business, not a commodity. So you get the timely support and payments you need, when you need them most.
- An Integrated Approach to Care
By rolling stop loss in with medical and pharmacy coverage, we can use real-time member data to help prevent catastrophic events. The result: pricing consistently below the industry’s average stop loss trend.
- Reimbursements When They Matter Most
With wire transfer availability, we can make deposits directly into health plan accounts — with funds immediately available. We can also provide credit to claim billing for extraordinary, large reimbursements.
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Administration Without the Frustration
One point of contact for billing and customer service. Direct access to underwriters. And one consolidated bill for ASO administrative fees and stop loss payments when you also have medical through us — with no need to verify enrollment between carriers.
Health insurance administration is complicated. We can help connect you with workplace management solutions to help ensure regulatory compliance while improving efficiencies and bottom lines. Meaning your business can save more by focusing on other business priorities.
You can get administrative support for things like:
- Fully integrated reimbursement accounts
- Compliance services
- Full COBRA administration
- Nondiscrimination testing
Talk to a Univera Healthcare sales representative to learn more.
Univera for Business
Infographics, videos and more: See how we can help keep your team healthy and costs under control.
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