Medical Program

E.MAP and the ACA – Modified Community Rating and “Grandmothering” for Small Groups

Beginning on January 1, 2014, the Affordable Care Act (ACA) introduced a new method for rating small employers with 2 to 50 employees called modified community rating. Under ACA law, health insurance plans are no longer permitted to offer discounted medical rates or rate caps for small groups.

Fortunately, for many E.MAP members, an exception commonly referred to as “grandmothering,” was introduced and has continued to be extended over the years that has permitted many E.MAP member small groups to continue to purchase UPMC Health Plan plans that are rated according to rules that were in place prior to 2014 and to select plan designs that were part of the 2013 UPMC Health Plan portfolio of products.

Existing E.MAP small group members that are grandmothered continue to benefit by receiving rate guarantees for which they are qualified.

New E.MAP small group members are not eligible for discounted rates or rate guarantees under ACA law, but are eligible for significant savings on dental coverage through the E.MAP exclusive Medical and Dental Bundle for Small Groups preferred pricing arrangement with UPMC Health Plan.

Medical and Dental Bundle for Small Groups

E.MAP and UPMC Health Plan have collaborated on a “bundled” model that will drive exceptional savings. Any non-grandmothered group with 2 to 50 employees that purchases UPMC Health Plan medical plans through E.MAP will have the opportunity to purchase UPMC Dental Advantage coverage for their employees at a 60 percent discount. These savings rival the medical discounts that E.MAP groups in the small market enjoyed in the past.

E.MAP and the Affordable Care Act for Large Groups

The ACA does not restrict carriers from offering discounts and rate guarantees for groups with 51 or more employees. Consequently, E.MAP and UPMC Health Plan offer an excellent cost savings package for employers as defined in the exhibit below.

E.MAP Bundled Savings, Preferred Pricing, and Rate Caps*

The exhibit below presents the various savings opportunities for groups of all sizes through E.MAP and UPMC Health Plan. Together, we’ve got you covered!

Rates/Renewal Descirption
New E.MAP Groups and Existing E.MAP ACA Groups with 2 to 50 employees
UPMC Dental Advantage discount 60% off each UPMC Dental Advantage policy when group purchases UPMC Health Plan medical coverage**
Existing “Grandmothered” E.MAP Groups with 2-50 employees
Medical – Initial Rate  3% off standard UPMC Health Plan pricing
Medical – First Renewal Maximum rate increase of 14%
Medical – Second Renewal Maximum rate increase of 15%
New and Existing E.MAP Groups with 51 to 100 employees
Medical – Initial Rate 3% off standard UPMC Health Plan pricing
Medical – First Renewal Maximum rate increase of 14%
New and Existing E.MAP Groups with 101+ employees
Medical – Initial Rate 3% off standard UPMC Health Plan pricing
Medical – First Renewal Maximum rate increase of 14%
Medical – Second Renewal Maximum 15% trend factor applied to demographics and experience

*These offers are valid as of January 1, 2014, and are subject to change. Please note that due to limitations imposed by the Affordable Care Act (ACA), rate caps are not available to groups with 2 to 50 employees who are not qualified under the “grandmothering” exception.

**The discount is valid for these plans only: Basic 100/0/0/$0; Basic 100/0/0/$50; Basic 100/0/0/$75; Standard 100/50/50/$0/$1,500/No Ortho; Standard 100/50/50/$75/$2,000/No Ortho; Premium 100/80/50/$0/$1,500/No Ortho; Premium 100/70/50/$0/$1,000/No Ortho; Premium 100/70/50/$50/$1,000/No Ortho; Premium 100/70/50/$0/$1,500/No Ortho; Premium 100/70/50/$50/$1,500/No Ortho

About UPMC Dental Advantage

UPMC Dental Advantage offers members three plan models — Basic, Standard, and Premium — with a network of credentialed dentists. The plan is designed to encourage regular preventive care and foster open communication between patients and dentists regarding recommended treatment plans. The UPMC Dental Advantage network includes more than 1,900 providers in our 29-county service area.

How to Request a Quote

For more information about E.MAP’s cost-saving programs with UPMC Health Plan, or to request a quote, please contact one of the following:

  • Your insurance broker/producer
  • The E.MAP Hotline at 814-243-0012
  • UPMC Health Plan at 1-888-383-UPMC