UnitedHealthcare

Details and requirements specific to UHC Level Funded quoting

Overview

Subject	Detail
Ideon's Internal Issuer ID	110006
Quoted Rates Policy	Illustrative
Available States	34 total: AK, AL, AR, AZ, CA, CO, CT, IA, ID, IL, IN, KS, KY, ME, MI, MN, MO, MS, MT, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SD, UT, WA, WY
Plan Inventory	UHC has an extensive plan catalogue, supporting around 5,000 plans nationally. There are typically 200-800 plans available in each state.
Quote Effective Date Restrictions	UHC requires quote effective dates to be the 1st day of the month; any effective dates quoted in Ideon's API that do not satisfy this requirement will be automatically pushed to the 1st day of the following month. Quote effective dates must be no greater than 2 weeks prior to and 4 months in advance of the current date.
Additional Notes	UHC Level Funded SBCs are auto-generated with arbitrary coverage periods. Most plans will show 1/1/YY - 12/31/YY in the top-right of the SBC, where YY reflects the most current available year for quoting.

Quoting Details

Coordination of Benefits

For Level Funded quoting, UHC requires a coordination of benefits parameter to be passed. To support this, Ideon's API expects the coordination_of_benefits parameter to be included in the Create Quote request. This enum parameter expects one of two values: plan or medicare, representing the which insurance plan pays first when there are multiple overlapping coverages for a member.

Stop Loss Amounts

In level funded plans, stop loss coverage limits an employer’s financial exposure to high or unexpected claims. Specific stop loss sets a per-member claims threshold, while aggregate stop loss caps total claims for the group. Together, these amounts define the risk protection built into the plan and are a key factor in determining overall costs.

UnitedHealthcare quotes plans with specific per-member stop loss amounts, pre-configured by state. Each state allows for 2-5 different stop loss amounts. Ideon's API automatically quotes all available plans for each stop loss amount. For example, if there are 100 plans available and 3 stop loss amounts, then 300 results would be expected in the Show Rates endpoint (GET /quotes/{quote_id}/rates). In this endpoint response for UHC Level Funded, it is important to account for a single plan (unique by plan_id) being returned multiple times, with different stop_loss_amount values per the state's configuration.

Claims Surplus

Claims surplus fractions describe how unused claims funds are handled at the end of a level funded plan year. The fraction indicates what portion of any surplus may be returned or credited to the employer, with the remainder retained by the carrier. This structure helps balance predictable monthly costs with the potential for shared savings.

UnitedHealthcare defines a single, consistent claims surplus fraction for each state, returned in the claims_surplus_fraction field in the Show Rates endpoint response (GET /quotes/{quote_id}/rates). Values are structured as a string - "1/1" or "1/2", for example.