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With this health plan, you need to select a Primary Care Physician (PCP) from the NexusACO® network to help you manage your care. Our national Tier 1 network includes select Accountable Care Organization (ACO) providers and UnitedHealth Premium® physicians who have been evaluated and have met benchmarks for quality and cost-efficiency. Choosing Tier 1 providers and hospitals in an ACO, supplemented with the UnitedHealth Premium Provider program, will help you get the most out of your health plan benefits.
Where you go for care can make a difference. You will pay less by using Tier 1 providers so it’s important to check your doctor’s Tier 1 status before you access care to be sure their Tier 1 status hasn’t changed. You won’t have coverage if you go out of the network.
Benefits are reduced if you see a network 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.
Compare to help find the right health plan
Our comparison chart helps you find your best fit by listing important plan benefits side-by-side.
Plan highlights
Medical annual deductibles and out-of-pocket limits
Medical costs - copays ($) and coinsurance (%)
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
The UnitedHealth Premium® designation program is a resource for informational purposes only. Designations are displayed in UnitedHealthcare online physician directories at myuhc.com®. You should always visit myuhc.com for the most current information. Premium designations are a guide to choosing a physician and may be used as one of many factors you consider when choosing a physician. If you already have a physician, you may also wish to confer with him or her for advice on selecting other physicians. You should also discuss designations with a physician before choosing him or her. Physician evaluations have a risk of error and should not be the sole basis for selecting a physician. Please visit myuhc.com for detailed program information and methodologies.
Tier 1 providers may be subject to change, visit myuhc.com® for the most current information or call the number on your health plan ID card.
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