Catheters soon to be a standard benefit for UnitedHealthcare

UnitedHealthcare will be adding catheters as a standard benefit as part of an employer’s medical plan. Coverage details, including timing and related supplies that fall under the coverage, are included below.

Members in Medicaid, Medicare, commercial health plans in the small group market where mandated by state regulations, and certain self-funded plans that have chosen to add coverage already cover intermittent and indwelling urinary catheters.

Coverage and timing

Coverage for intermittent and indwelling urinary catheters will be available for members in commercial health plans upon the first renewal of the plan on or after:

Fully insured:

  • Coverage begins Jan. 1, 2020 ― for Small Group states: Alabama, Arkansas, Connecticut, Delaware, Georgia, Indiana, Kansas, Louisiana, Maine, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, West Virginia, Wisconsin and Wyoming.
  • Coverage begins Jan. 1, 2021 ― for remaining Small Group states.
  • Coverage begins July 1, 2020 ― for all Large Group states.

Self-funded:

  • Coverage begins July 1, 2020 (unless clients are already covered) ― Clients with standard benefits will automatically have coverage for catheters added at this time unless they choose to opt out.

UnitedHealthcare Global is excluded at this time.

Urinary catheters along with specific supplies will be covered when a physician writes a prescription for the member. The supplies include urinary drainage bag and insertion tray (kit), anchoring device and an indwelling irrigation tubing set. Other supplies, like lubricant, are not covered. Urinary catheters will be covered at the same level DME is covered under the policy, which is typically deductible/coinsurance.

Small, fully insured group customers are being sent communications beginning in late November that mention coverage for urinary catheters is available for their employees based on the availability noted above.

Contact your UnitedHealthcare representative for more information.