North Carolina UnitedHealthcare Exchange Plans

Effective January 1, 2021, UnitedHealthcare will be expanding options for members in to purchase health insurance using a Health Insurance Marketplace, otherwise known as an Exchange.  These new plans will be offered on the Individual Marketplace where individuals and families can shop for a health plan and apply for federal subsidies. In North Carolina we will be offering plans in 36 counties in the Charlotte, Greensboro/Piedmont, Raleigh/Triangle,  Asheville/Western, Fayetteville, and Wilmington areas.

In North Carolina the UnitedHealthcare Exchange plans will utilize the Compass network of providers. These plans:

  • Are specifically designed for Exchanges.
  • Utilize a customized, more focused network of care providers.
  • Require the member to be assigned a PCP to manage their health care needs.
  • Require the PCP to submit electronic referrals for members to see a network specialist.
  • Require prior authorization and notifications.

Out of Network / Out of Area Benefit Coverage

It is important to note that Exchange members have NO OUT-OF-NETWORK or OUT-OF-AREA benefit coverage, except for emergency services and related admissions, unless specifically approved by UnitedHealthcare.  Members must receive eligible services at participating provider locations within the service area if they are to be considered as covered.

2021 Health Plans include standard product designs tailored for each market.  There are three metal levels in North Carolina, including the following options:

  • Balance Gold
  • Balance Plus Silver
  • Balance Silver
  • Value Silver
  • Balance Bronze
  • Value Bronze