UnitedHealthcare requires response to data request

UnitedHealthcare (UHC) plan sponsors have until April 10 to provide data needed to complete the annual Prescription Drug Data Collection (RxDC) reporting. To comply with the Consolidated Appropriations Act (CAA), passed in December 2021, insurance carriers and employer-based plans must submit information regarding prescription and health care spending to the Centers for Medicare and Medicaid Services (CMS) by June 1 of each year.   

The majority of the data required is maintained by UHC, but the following input is needed from plan sponsors:

• group health plan name (Ex: ABC Employee Benefit Plan)
• Form 5500 status and plan number (may not apply to groups under 100 lives)
• average monthly member-paid premiums (total member-paid UHC premiums for 2023)
• average monthly employer-paid premium (total employer-paid UHC premiums for 2023)
• confirm UHC administers the majority of the plan’s benefits (yes/no)
• confirm prescription drug coverage is provided to members (yes/no)
• confirm if stand-alone behavioral health benefits are provided to members (yes/no)

Plan sponsors must login to UHC’s employer site to access the request for information. UHC recommends reviewing their instruction guide in advance of completing the request for information.

CMS instructions state the following should be included in the member-paid premium calculation:

• premium paid by members for medical and pharmacy coverage
• member payments for COBRA coverage, including the 2% administrative fee
• spousal and tobacco surcharges, if applicable

CMS defines member-paid premium for self-funded groups differently than fully insured groups. Click here for the CMS self-funded calculation.

Failure to meet this deadline may require employers to submit information on their own or be subject to a CMS penalty of $100 per day per affected individual.

Groups with non-calendar year renewals should expect a data request from other carriers for coverage in place in 2023.

Contact your Bukaty benefits consultant for additional information at 913.345.0440.