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Available only in California, this plan is the Preferred/Default HMO Plan (Sharp/Sharp Rees-Stealy, UCSD, PCAMG, centric for SD country area).
This plan is designed to help you navigate the health care system more easily while providing access to doctors who can help guide you to better health and lower costs. With this plan, you can choose from providers within Southern California using the SignatureValue HMO network.
You won’t have coverage if you go out of the network or if you see a specialist without an electronic referral from your PCP.
Preventive care is covered 100 percent in the network. You don't have to pay any out-of-pocket costs for age-appropriate preventive care as long as you use a network doctor.
Plan highlights
Network coverage
Network coverage plays a big part in delivering you cost savings and quality care. With the network, you'll have access to a group of health care providers and facilities that have a contract with UnitedHealthcare.
Are your providers in network?
Stay in the network
To help save on costs, choose care and services from within our network.
The importance of a primary care provider (PCP)
Primary care provider
With this plan, you'll need to select a primary care provider (PCP) for yourself and each covered family member. Your PCP is your health guide - coordinating your care, helping you avoid cost surprises and supporting you in achieving your best health.
If you don't select a PCP by the deadline, one will be selected for you. But you can always change your PCP anytime at myuhc.com.
The importance of a primary care provider (PCP)
Having a PCP to help guide and coordinate your care is important whether or not the health plan you select requires one.
Copays and cost sharing
Most health plans share the same idea: there's how much you pay for the cost of care, when you pay for it, and what percentage of those costs you and your plan share. It can all be a little confusing, especially when you add in words like "deductible" and "copay".
To make it easier, here's an example of how health plans work.
At the start of your health plan year...
You're responsible for paying 100% of the costs for covered health care, up until you reach your deductible. The deductible is the amount you pay before the plan starts sharing costs. Age appropriate preventive care is covered 100% as long as you use a network provider.
About COPAYS...
Some health plans have a copay, which is a fixed amount you pay each time you see a provider or purchase a prescription. Because copays don't count toward your deductible, you're responsible for paying 100% of your copay up until you reach your out-of-pocket limit.
When you reach your DEDUCTIBLE
Coinsurance kicks in and your health plan starts sharing a percentage of these costs with you, up until you reach your out-of-pocket limit.
When you reach your OUT‑OF‑POCKET LIMIT
The most you'll have to pay for the costs of health care in a plan year is your out-of-pocket limit. Once this limit is reached, your health plan covers you at 100% for the rest of the plan year.
Services covered in the network
Here's a partial list of your coverage:
- Preventive Care Services
- Doctor Office Visits and Labs
- Emergency and Outpatient Care
- Mental Health and Substance Disorder Service
- Pregnancy and Newborn Care
- Health and Wellness
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