Commercial Master

Version below is for Mid Atlantic UHC M.D.IPA and Optimum Choice Plans (Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, West Virginia)

Mid-Atlantic Health Plan

UnitedHealthcare® Maryland Independent Physician Association (M.D.IPA) Plan

The UnitedHealthcare Maryland Independent Physician Association (M.D.IPA) health plan encourages members to use their primary care provider (PCP) to coordinate care across a wide spectrum of health services and enter electronic referrals to network specialists.

  • Members must receive a referral from their PCP to see a network specialist for benefits to be covered. There is out-of-network coverage for emergency services only.
  • This health maintenance organization (HMO) individual practice plan emphasizes preventive care, including immunizations and preventive exams and health screenings.

For a detailed description of MS.IPA benefits, exclusions and limitations, please refer to FEHB brochure #73-100 uhcfeds.com.

Optimum Choice®, Inc. (OCI)

The Optimum Choice, Inc. (OCI) health plans encourage members to use their primary care provider (PCP) to coordinate care across a wide spectrum of health services and enter electronic referrals to network specialists.

  • An optional health savings account (HSA) can pay for qualifying medical expenses, including the annual deductible.
  • An optional health reimbursement arrangement (HRA) can offer a type of employer-funded health benefit plan that reimburses employees for out-of-pocket medical expenses.

If services are delivered outside of the local network, the plan will not cover the cost except in an emergency. 

Forms, Tools & Resources

These resources are available to care providers with members in M.D.IPA, M.D.IPA Preferred, Optimum Choice, Inc., and Optimum Choice Preferred health plans unless otherwise noted.

Version below is for All Saver's plan in all states except AK, CA, HI, MT, NY,VT, NH, WV. Contact is Stephanie Rower, Jodie Glish and Shannon Ristow.

All Savers®

The All Savers® Alternate Funding Plans are self-funded health plans that can help employees pay everyday health care expenses before they meet their deductible. Employers can also purchase UnitedHealthcare dental and vision plans and fully insured group life insurance.

  • A health savings account (HSA) may be available to pay for qualifying medical expenses, including the annual deductible.
  • The UnitedHealthcare Motion™ program provides a financial reward (in the form of a reimbursement for out-of pocket medical expenses or an HSA deposit) for meeting daily activity goals. The UnitedHealthcare Motion program is not available in all states.

Members with All Savers Plans have access to the UnitedHealthcare® Choice, UnitedHealthcare Choice Plus and UnitedHealthcare Core networks with the exception of Mayo Clinic facilities.

All Savers Insurance Company (ASIC) is a UnitedHealthcare company.

To check member eligibility and claims status for a patient enrolled in an All Savers Plan, go to provider-allsavers.optum.com/.

Version below shows in all states except AK, MT, NH, VT, WY, HI, and VI. Limited availability in MI, ME and MO per Michelle Zack for 2019. 

UnitedHealthcare® NexusACO®

The UnitedHealthcare NexusACO suite of products offers cost-saving opportunities to members when they seek care providers from a select group of Accountable Care Organizations (ACO) nationwide. There is out-of-network coverage for emergency services only.

UnitedHealthcare NexusACO Plans – Open Access

  • UnitedHealthcare NexusACO OA plans offer network-only coverage for care providers.
  • UnitedHealthcare NexusACO OAP plans offer both network and non-network coverage.

UnitedHealthcare NexusACO Plans – Referral Required

  • UnitedHealthcare NexusACO R plans offer network-only coverage for care providers.
  • UnitedHealthcare NexusACO RB plans offer network coverage when the PCP refers a member to a network specialist, and lower coverage applies when there is no referral.
  • UnitedHealthcare NexusACO RP plans offer network coverage when the PCP refers a member to a network specialist, and lower coverage applies when there is no referral or with an out-of-network specialist.

All UnitedHealthcare NexusACO members are required to select a primary care provider (PCP) within the network to provide their preventive care, treat chronic conditions, manage medications and enter specialist referrals.

Changes to PCP selection are permitted once per month. Changes submitted on or before the 31st of the month will be effective on the first day of the following month.

Tools & Resources

UnitedHealthcare Navigate®

The UnitedHealthcare Navigate health plans encourage members to use their primary care provider (PCP) to coordinate care across a wide spectrum of health services and enter electronic referrals to network specialists. The UnitedHealthcare Navigate network is narrowed in some states.

  • UnitedHealthcare Navigate members must receive a referral from their PCP to see a network specialist for benefits to be covered. There is out-of-network coverage for emergency services only.
  • UnitedHealthcare Navigate Balanced members may see a network specialist at a reduced benefit level when there is no referral.   There is out-of-network coverage for emergency services only.
  • UnitedHealthcare Navigate Plus members may see a network specialist at a reduced benefit level when there is no referral.  Navigate Plus also provides out of network coverage.

Changes to PCP selection are permitted once per month. Changes submitted on or before the 31st of the month will be effective on the first day of the following month.

Tools & Resources

UnitedHealthcare Navigate®

The UnitedHealthcare Navigate health plans encourage members to use their primary care provider (PCP) to coordinate care across a wide spectrum of health services and enter electronic referrals to network specialists. The UnitedHealthcare Navigate network is narrowed in some states.

  • UnitedHealthcare Navigate members must receive a referral from their PCP to see a network specialist for benefits to be covered. There is out-of-network coverage for emergency services only.
  • UnitedHealthcare Navigate Balanced members may see a network specialist at a reduced benefit level when there is no referral.   There is out-of-network coverage for emergency services only.
  • UnitedHealthcare Navigate Plus members may see a network specialist at a reduced benefit level when there is no referral.  Navigate Plus also provides out of network coverage.

Changes to PCP selection are permitted once per month. Changes submitted on or before the 31st of the month will be effective on the first day of the following month.

Tools & Resources

UnitedHealthcare® Core and Core Essential

UnitedHealthcare Core health plans allow members to choose a network physician or specialist without a referral (open access). The UnitedHealthcare Core network is narrowed in some states.

  • UnitedHealthcare Core Essential members must receive care from network providers for benefits to be covered.
  • UnitedHealthcare Core plans cover out-of-network providers at a lower benefit level.

An array of health and wellness resources are available to members including the Online Health Assessment, Personal Health Record and Online Health Coaching modules.

Tools & Resources