The following commercial health plans are offered in West Virginia. Open any section below to view more information.
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.
For a detailed description of MS.IPA benefits, exclusions and limitations, please refer to FEHB brochure #73-100 uhcfeds.com.
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.
If services are delivered outside of the local network, the plan will not cover the cost except in an emergency.
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.
Bind administers an innovative personalized health plan. It accesses UnitedHealthcare provider contracts through its partnership with UnitedHealthcare. While Bind leverages the UnitedHealthcare network, members must present a Bind ID card. The plan features no deductible and no coinsurance, providing members with fewer barriers to care. With the Bind plan, members are covered across numerous common conditions and events. They can also activate coverage during the year for less common, plannable treatments if and when they need them.
All claims for Bind members must be sent directly to the Bind Payer ID 25463 or the address listed on the member ID card. Claims sent to a different address or Payer ID for UnitedHealthcare will be denied.
The UnitedHealthcare Choice and Choice Plus health plans allow members to choose a physician or specialist from the UnitedHealthcare Choice networks but do not need a referral to receive benefits.
Preventive care, including immunizations and preventive exams and health screenings, is covered at 100 percent in our UnitedHealthcare Choice and UnitedHealthcare Choice Plus networks.
UnitedHealthcare Choice Advanced health plans allow members to choose a physician or specialist in the UnitedHealthcare Choice networks and do not need a primary care physician or referral to receive benefits. There is out-of-network coverage for emergency services only.
UnitedHealthcare Choice Advanced members have lower copays and/or greater coinsurance when they use UnitedHealth Premium® Tier 1 2-star care providers.
UnitedHealthcare Choice Advanced and UnitedHealthcare Choice Advanced Plus build on Choice and Choice Plus plans with additional features for both members and employers.
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.
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.
UnitedHealthcare Options PPO health plans allow members to choose a network physician or specialist without a referral (open-access).
UnitedHealthcare Options PPO offers two levels of coverage: a higher level of benefits for in-network services, and a lower level of benefits for non-network services, with somewhat higher deductibles and coinsurance.