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NexusACO OAP Plan

With this health plan, you’ll 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 may choose services from an out-of-network provider. However, care services may likely cost you more.

To see a network specialist, you don’t need a 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.

View plan benefits

Our comparison chart helps you find your best fit by listing important plan benefits side-by-side.

Plan comparison

Plan highlights

Network coverage

Both network and out-of-network providers covered, including Tier 1 providers

Primary care provider

Primary care provider is required

Copays

Copay due for certain services and prescriptions

Savings account options

Savings account options not offered

Medical annual deductibles and out-of-pocket limits

Deductible amounts

	Tier 1 / Designated network	Network	Out-of-network
Individual	$1,650	$2,200	$4,400
Family	$3,300	$4,400	$8,800

Out-of-pocket limits

	Tier 1 / Designated network	Network	Out-of-network
Individual	$3,300	$5,000	$10,000
Family	$6,600	$9,200	$20,000

Deductible amounts

	Tier 1 / Designated network	Network	Out-of-network
Individual	$1,650	$2,200	$4,400
Family	$3,300	$4,400	$8,800

Out-of-pocket limits

	Tier 1 / Designated network	Network	Out-of-network
Individual	$3,300	$5,000	$10,000
Family	$6,600	$9,200	$20,000

Medical costs - copays ($) and coinsurance (%)

Doctors and specialists

	Tier 1 / Designated network	Network	Out-of-network
Preventive care visit	0%	0%	Not Covered
Primary care visit (illness or injury)	10%	30%	50%
Primary care kids visit	10%	30%	50%
Mental health visit (outpatient)	10%	30%	50%
Specialist visit	10%	30%	50%

Virtual, urgent and emergency care

	Tier 1 / Designated network	Network	Out-of-network
24/7 Virtual Visit (online doctor)	10%	30%	Not Covered
Urgent care visit	10%	30%	50%
Emergency room	10%	30%	50%

Doctors and specialists

	Tier 1 / Designated network	Network	Out-of-network
Preventive care visit	0%	0%	Not Covered
Primary care visit (illness or injury)	10%	30%	50%
Primary care kids visit	10%	30%	50%
Mental health visit (outpatient)	10%	30%	50%
Specialist visit	10%	30%	50%

Virtual, urgent and emergency care

	Tier 1 / Designated network	Network	Out-of-network
24/7 Virtual Visit (online doctor)	10%	30%	Not Covered
Urgent care visit	10%	30%	50%
Emergency room	10%	30%	50%

Pharmacy costs

Prescription drugs

	Tier level 1	Tier level 2	Tier level 3	Tier level 4
Retail - up to 31 day supply	$10	25% ($30 min, $90 max)	40% ($60 min, $120 max)	No Coverage
Out-of-network	$10	25% ($30 min, $90 max)	40% ($60 min, $120 max)	No Coverage
Home delivery - up to 90 day supply	$20	25% ($60 min, $180 max)	40% ($120 min, $240 max)	No Coverage
Important information	Tier level 1: $ - generic. Tier level 2: $$ - brand-name and generic. Tier level 3 $$$ - brand-name and generic. Tier level 4: $$$$ - mostly brand-name.

Prescription drugs

	Tier level 1	Tier level 2	Tier level 3	Tier level 4
Retail - up to 31 day supply	$10	25% ($30 min, $90 max)	40% ($60 min, $120 max)	No Coverage
Out-of-network	$10	25% ($30 min, $90 max)	40% ($60 min, $120 max)	No Coverage
Home delivery - up to 90 day supply	$20	25% ($60 min, $180 max)	40% ($120 min, $240 max)	No Coverage
Important information	Tier level 1: $ - generic. Tier level 2: $$ - brand-name and generic. Tier level 3 $$$ - brand-name and generic. Tier level 4: $$$$ - mostly brand-name.

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.

Spot the Tier 1 dot

Tier 1 providers are primary care provider and medical specialists typically affiliated with an ACO. Tier 1 hospitals are ACO hospitals and select facilities that have been evaluated and designated for quality and cost. These providers offer you the greatest value from your health care benefits.

Look for the hearts

UnitedHealth Premium® helps you make informed choices for your medical care. You’ll have access to doctors across multiple specialties who meet UnitedHealth Premium quality care criteria which includes safe, timely, effective, and efficient care.

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.

It's easy to find and choose a network Primary Care Provider
Click the provider network link above, or choose "Search for a Provider" in the main menu, and open the network provider directory website for your selected plan.

Then follow these steps:

Under “What type of Medical Care can we help you find near”, click Change Location, fill in your location information, and click Update Location.
Under “Find Health Care by Category”, select People > Primary Care > All Primary Care Providers to see a listing of PCPs.
Scroll through the listing and select the name of the network PCP you'd like to coordinate your care.
Click on the PCP’s name for the Provider ID number.

Important: For health plans requiring a PCP, a PCP will be selected for you and your covered family members if you don’t pick one by the enrollment deadline. You can 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.

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.

NexusACO OAP Plan

Compare to help find the right health plan

Plan highlights

Network coverage

Primary care provider

Copays

Savings account options

Medical annual deductibles and out-of-pocket limits

Deductible amounts Deductible amounts

Out-of-pocket limits Out-of-pocket limits

Deductible amounts Deductible amounts

Out-of-pocket limits Out-of-pocket limits

Medical costs - copays ($) and coinsurance (%)

Doctors and specialists Doctors and specialists

Virtual, urgent and emergency care Virtual, urgent and emergency care

Doctors and specialists Doctors and specialists

Virtual, urgent and emergency care Virtual, urgent and emergency care

Pharmacy costs

Prescription drugs Prescription drugs

Prescription drugs Prescription drugs

Network coverage

Are your providers in network?

Stay in the network

Spot the Tier 1 dot

Look for the hearts

The importance of a primary care provider (PCP)

Primary care provider

It's easy to find and choose a network Primary Care Provider It's easy to find and choose a network Primary Care Provider

The importance of a primary care provider (PCP)

Deductible amounts

Out-of-pocket limits

Deductible amounts

Out-of-pocket limits

Doctors and specialists

Virtual, urgent and emergency care

Doctors and specialists

Virtual, urgent and emergency care

Prescription drugs

Prescription drugs

It's easy to find and choose a network Primary Care Provider