Important Information from Oxford
Upcoming Changes to Your Oxford Health Plan – Effective Late 2025
As your trusted benefits partner, PrestigePEO is committed to keeping you informed of important plan changes. The following updates will take effect on your group’s next renewal and are designed to enhance compliance, improve access, and support the well-being of your employees.
- AbleTo Program Discontinued – Virtual therapy and coaching will be retired.
- Mental Health Wellness Exams (CT only) – Up to two no-cost visits per year with a mental health provider.
- Expanded Gender Dysphoria Coverage – Now includes medically necessary breast reduction surgery.
- Updated Behavioral Health Terminology –
- “Intensive outpatient treatment” is now “Intensive outpatient program”
- “Transitional living” is now “Supportive housing”
- Formulary Adjustments – The annual review is in place; changes are to be communicated in advance.
- Infertility Prescription Drug Limits Removed
- New Exclusions – OTC glucose monitors, repackaged medications, cosmetic-based prescriptions
- Step Therapy Updates – Now allows therapeutic equivalents for compliance.
- Expanded Child Eligibility (NY only) – Now includes children under legal custody or guardianship.
- Donor Breast Milk (NY only) – Covered if medically necessary.
- Colorectal Screenings (CT only) – No cost-share for multiple colonoscopies per year if recommended.
- HSA-Compatible Plan Requirements
- Minimum Deductibles: $1,700 (self-only), $3,300 (family)
- OOP Maximums: $8,500 (self-only), $17,000 (family)
- ACA OOP Max (2026):
- Individual: $10,150
- Embedded OOP max: $8,500 (individual), $17,000 (family)
- Non-embedded: $10,150 (family cap)
- HSA Contribution Limits
- $4,400 (self-only), $8,750 (family), $1,000 catch-up (age 55+)
- FSA Updates
- Contribution cap: $3,300
- Carryover max: $660
- Terminations: Full election access remains available if used before the plan’s end.
- One Pass Tier Changes:
- Effective August 1, 2025: Club Pilates and Picklr move to Elite Tier ($249/month)
- Action needed by July 31, 2025, to adjust or cancel.
- Calm Health App (NY only) – Replaces previous self-care tools with stress management features.
- Wellos Wellness Platform (NY only) – Digital nutrition, weight, and healthy habits tools.
- Ambulance Policy (NY only) – Expanded emergency/non-emergency transport coverage with clear reimbursement rules.
- Urgent Care – Broader definition includes mobile urgent care and alternative access locations.
myuhc.com Support Line Retired –
- As of June 5, 2025, members must use live chat or the UHC mobile app.
- Co-Browse allows agents to walk users through issues live.
Important Information for MetLife Dental and Solstice Dental
MetLife and Solstice Dental Rate Updates – Effective at Renewal
As part of our continued commitment to transparency and proactive benefits planning, we share essential updates to your dental benefit options for the upcoming renewal period.
MetLife Dental Rate Adjustments
The following MetLife Dental plans will see a 3.5% increase, effective at your next renewal:
- MetLife Dental DHMO
- MetLife Standard Plan – $1,000 Annual Max
- MetLife Premium Plan – $2,000 Annual Max
- MetLife Enhanced Plan – $5,000 Annual Max
These modest adjustments reflect updated market conditions while preserving your employees’ value and quality of coverage.
Solstice Dental National Rates
Solstice continues to offer competitively priced DHMO plans to support employee access to quality dental care nationwide. Below are the updated monthly rates for Solstice DHMO plans:
Solstice Dental National Rates |
Low PLan |
High Plan |
|---|---|---|
Solstice DHMO R1 |
11.67 |
19.40 |
Solstice DHMO R2 |
23.34 |
38.8 |
Solstice DHMO R3 |
26.52 |
44.09 |
Solstice DHMO R4 |
37.13 |
61.72 |
What's New This Year?
MetLife and Solstice Dental Rate Updates – Effective at Renewal
We’ve made several enhancements to the Renewal Portal to help make Open Enrollment faster, easier, and more transparent for you and your team. Here’s what you can expect:
Smarter Plan Comparison Tools
- Side-by-side benefit summaries: Easily compare your current plans with multiple renewal options.
- Clear change indicators: See exactly what’s new or different with color-coded highlights.
- Streamlined summaries: Focused, easy-to-read benefit breakdowns for quick decision-making.
Simplified Contribution Modeling
- Build and track your own models: Create, rename, or delete contribution models based on your needs.
- See who created what: Know whether a model was built by your team, broker, or internal PrestigePEO support.
- Submission record: Automatically get a copy of the final model submitted for your records.
Enhanced HSA Contribution Inputs
- Employer contribution tracking: Tell us whether you’re contributing to HSAs and how you want those contributions structured (annually, monthly, or per pay period).
- Custom rules for new hires: Choose whether new participants receive prorated or full contributions.
Improved User Experience
- Client name displayed clearly on all screens and downloadable menus.
- Access to employee census reports directly from the Open Enrollment Report Center (no PII included).
- Full visibility into your current and renewal employer/employee contributions for better budgeting.
These updates are designed to support your Open Enrollment planning from start to finish. As always, your dedicated Benefits Specialist is here to help if you have any questions!
New Voluntary Benefits
We’re introducing new voluntary benefits and programs that will enhance your overall well-being and provide unprecedented family-building and caregiving support.
BenExtnd
We’re proud to offer an exciting new benefit through Aflac:
BenExtend is a powerful, employer-paid plan that combines key features of accident, hospital indemnity, and critical illness coverage into one simplified policy.
If your employer offers BenExtend, you’ll have access to enhanced financial protection, with no restrictions based on your health history or pre-existing conditions. Its comprehensive coverage is made accessible for everyone.
Resources & Support for a Successful Open Enrollment
Your Open Enrollment Resource Center
Visit www.prestigepeo.com/openenrollment to access everything you need for a smooth and informed Open Enrollment season.
You’ll find valuable tools, plan information, FAQs, and resources tailored for you, your broker, and your employees. We encourage you to explore this site to prepare for important decisions ahead.
Need Help? We're Here for You
Our benefits specialists are ready to assist with any Open Enrollment questions, reach us at 833-PEO-BEN1 or oequestions@prestigepeo.com You can also connect directly with your assigned Benefits Specialist via the PrestigeGO mobile app for quick access and real-time support.
Your Role as a PrestigePEO Client Manager
As a key leader in your organization, you play a vital role in guiding your employees through Open Enrollment. Here’s how you can support your team:
- Reinforce our shared commitment to offering competitive, comprehensive benefits tailored to employee needs.
- Direct employees to the Open Enrollment Resource Center to explore benefit options and helpful tools.
- Encourage your team to evaluate their coverage needs, compare plans, and complete their elections during the Open Enrollment window.
- Remind employees that they can contact the Prestige Benefits Team at 833-PEO-BEN1 or oequestions@prestigepeo.com or use PrestigePRO to access their benefits portal.
Thank you for your continued trust in PrestigePEO. We’re proud to support you and your team and look forward to another successful year together.