Virginia 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 Virginia we will be offering plans in 16 counties.
In Virginia 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 are tailored for each market. There are three metal levels in Virginia, including the following options:
- Value Gold
- Balance Silver
- Balance Plus Silver
- Value Silver
- Balance Bronze
- Value Bronze
Exchange Plan Policies
- UnitedHealthcare Value and Balance Exchange Coverage Determination Guidelines for Virginia (Effective 4/1/2021)
- UnitedHealthcare Value & Balance Exchange Medical & Drug Policies and Coverage Determination Guidelines
Prior Authorization:
Pharmacies/Drug/Formularies