New NY 51+ COC and NJ Product Offering

The new UnitedHealthcare Certificate of Coverage (COC) will be launched for new large groups (51+) in the New York market. Beginning July 1, 2012, all new UnitedHealthcare business inNew York will be written on the 2011 COC. Some of the key changes in the 2011 COC include:

• Medical necessity:  Prior authorization
• Pharmacy: Prior authorization, Retail before mail
• Benefit updates to the following categories:

               Durable Medical Equipment (DME)
               Physicians office services  - sickness and injury
               Rehabilitation services, Outpatient Therapy & Manipulative Treatment
               Surgery  - Outpatient
               Therapeutics Treatments  - Outpatient

Please view the documents below for more detailed information on the 2011 COC.

UnitedHealthcare Certificate of Coverage 2007 to 2011 Comparison

2011 Certificate of Coverage Prior Authorization Overview

2011 Certificate of Coverage New York Product Grid

UnitedHealthcare Navigate Plus^®: Patient-Centered Health Care for New Jersey Groups (51+)

UnitedHealthcare Navigate Plus is a health insurance product built on the fundamentals of patient-centered care, with the goal of enhancing the patient-doctor relationship and promoting better health and lower costs. Navigate Plus focuses on the primary care physician (PCP) gatekeepers' role in making referrals and coordinating care. This active physician involvement is designed to promote quality and efficient care for members by helping them get the appropriate care at the appropriate time, which may result in benefits that are at a more budget-friendly price-point than most non-gated products. 

Upon enrollment in a Navigate Plus plan, members who do not already have a network PCP will be required to select a PCP from the existing UnitedHealthcare Choice Plus network. With a Navigate Plus plan, PCPs will be responsible for the majority of the member's health care needs  - regular and routine care, as well as care for sickness or injury. And, because the PCP has the benefit of history with the member and will understand the member's health needs, he or she is in the best position to refer the member to other network physicians and specialists when additional care is necessary.

Navigate Plus provides the highest level of benefits when the member has a PCP referral prior to receiving services from another network physician, and a lower level of benefits if there is no referral. The lowest level of benefit applies if a non-network provider is used.

Reference Materials
UnitedHealthcare Navigate Plus Sell Sheet

 Timing
The 2011 COC and Navigate Plus will be available for quoting to new and renewing New York UnitedHealthcare large groups (51+) beginning May 1, 2012, with an effective date of July 1, 2012.