Quoting and processing renewals has become significantly more complex. Carriers require Producers to process the renewal transaction in the proprietary carrier portal for certain market segments. Your time and talents should be used elsewhere, building stronger relationship with your groups and creating new sales opportunities.

Renewals are distributed by the General Agency within 48 hours of receipt.

Once you have reviewed the renewal with your client and a decision has been made for the new plan year, you can simply submit your client’s renewal decision directly to the NFP BNGA Support Team or through the NFP Secure Upload feature.

 

For carrier specific renewal guidance,  click the carrier logo below.


 

 

The following references Small Market 2-50. For specifics related Mid or Large Market clients, reach out to your NFP BNGA support team.

 

UPMC

Please refer to the appropriate Benefit Plan Summary Brochures of the applicable platform (non-ACA compliant vs. ACA) for compliance requirements and business rules on multiple plan offerings and participation.  If your group has a dual option in place currently, they may renew the dual offering with a maximum of two plan choices.   If you do not have a dual offering in place currently, depending on group size, you may still be eligible to put a dual offering in place.  Please call or email the NFP BNGA Support Team with these requests.

If a group is eligible and wishes to offer multiple plans, please indicate on the renewal rate sheet, the plans selected and the following information.

Small groups that do not submit renewal changes will be auto-renewed with their current medical (or mapped coverage if the current plan is unavailable to renew) plan design 30 days prior to renewal.  If a client will be making a change in plan design please notify us as soon as possible to request the group not be auto-renewed. UPMC will not permit any plan changes after the plan effective date.

Note: Exceptions to the above auto-renewal process:

  • If the group does not offer medical benefits and has stand alone supplemental benefits in place, a signed renewal copy is required. Stand-alone supplemental plans will not be auto-renewed.
  • Groups that are in audit status must submit audit documentation to receive a released renewal. Groups must submit a signed renewal copy for prior to the effective date for the renewal to be processed.

upmc docFor groups who may be considering an HMO plan: members must choose an in-network Primary Care Provider (PCP). Please have the members indicate their PCP here on the UPMC Benefit Election and Change Form

  • Note: If members do not choose a PCP for referrals, the health plan will assign one to them. Because out of network providers are not covered, it is important to make sure all providers and specialists are in-network. PCP Referrals will be required for Specialist Coverage (with exception of some specialties, such as Ob/gyn, Mental Health or Substance Abuse and Virtual Visits).

HSA Administration: At renewal clients will have an HSA option that waives maintenance fees for participants. This option is called the UPMC ConsumerAdvantage Debit Card.  If they wish to utilize UPMC ConsumerAdvantage please have the HSA Set Up Form completed by the company.

Clients utilizing an HSA will need to submit an updated HSA Set Up Form annually at renewal.

Non-ACA Renewal Process

UPMC does not automatically include their 100% Consumer Driven options as alternatives on the non-ACA compliant renewals. If you are seeking pricing for 100% Consumer Driven plans with a 2023 plan year, please outreach to our office to obtain rates on any of the following rates.

2023
HRA $1250 – 100% 15/3050Rx not subject to deductible
HRA $2500 – 100% 15/3050Rx not subject to deductible
HSA $1350 – 100% 15/3050Rx after deductible is satisfied
HSA $2500 – 100% 15/3050Rx after deductible is satisfied

Non-ACA plans utilize the National Pharmacy Network and either the Your Choice Pharmacy Formulary or Value Choice Pharmacy Formulary. Refer to renewal or plan agreement to confirm.

UPMC does not reprint or revise the Medically Underwritten Benefit Plan Summary Guide annually. Be aware that the Non-HRA & -HSA plan deductibles change per IRS contribution guidelines.

ACA Renewal Processrx

There is one pharmacy option available for UPMC’s ACA plans:

  • 2023 plan years: $15/$40/$75/$95
  • 2024 plan years: $15/$40/$75/$95

ACA plans will be transitioned to the Essential Pharmacy Network at their 2023 renewal and continue to utilize their Advantage Choice Pharmacy Formulary.

2024 ACA plans utilize the Essential Pharmacy Network and the Advantage Choice Pharmacy Formulary.

Please refer to the applicable product portfolio to match the year of policy start:

2024 Benefit Plan Summaries 2-50        2025 Benefit Plan Summaries 2-50


You will notice while reviewing the benefit summary guide the Small Business Advantage networks are Standard (HMO) and Partner or Premium (EPO & PPO). In addition, you will find creative products such Inside Advantage, MyCare Advantage, Virtual Care, and UPMC First Care.

Supplemental Coverage

If supplemental coverage is not currently offered and is selected at renewal, New Applications may be needed for participants to be enrolled. Use this UPMC Benefit Election and Change Form

dentalGroups that do not carry existing Dental coverage for their employees currently are only eligible to elect a plan that does not include Orthodontic coverage. Renewal rates include all of the non-ortho plans. Previously these groups were only eligible to enroll in a Basic dental offering for the first 12 months.

If your client does carry dental and is considering UPMC for replacement coverage, please let us know if you would like to see rates for the plans with Ortho coverage. These rates can be requested from the Underwriting department for your review.

Vision Care

UPMC has partnered with NVA to offer a competitively priced national network vision program. See UPMC Vision Care offerings by referring to the Benefit Plan Summary Guide.

Dental Advantage 

UPMC’s discount program is available for groups with either a standalone plan option or along with the Basic Dental Advantage offering. See the Dental Discount Brochure.

See UPMC Dental Advantage offerings by referring to the Benefit Plan Summary Guide.

 

Back to Top

Highmark

Small groups that do not submit renewal changes will be auto-renewed with their current plan (or mapped coverage if the current plan is unavailable to renew).  If a client will be making a change in plan design please utilize your Plan Advisor access or notify us as soon as possible to process the plan change. Highmark will not permit any plan changes after the plan effective date.

Please refer to the below for Highmark Small Group product portfolios:


Southeastern PA

Back to Top

Guardian

  • Any plan changes need to be submitted prior to the group’s renewal effective date.
  • If you are in need of alternate plan designs from those shown on the renewal package, please do not hesitate to reach out.
  • Please email signed renewals to the NFP BNGA Support Team.

 

Back to Top