Manuals and benefit plans referenced in the guide - Chapter 1, 2021 UnitedHealthcare Administrative Guide
Some benefit plans included under your Agreement may be subject to requirements found in other health care provider guides or manuals or to the supplements found in the second half of this guide.
This section provides information about some of the most common UnitedHealthcare products. Your Agreement may use “benefit contract types”, “benefit plan types” or a similar term to refer to our products.
If a member presents a health plan ID card with a product name you are not familiar with, use Link’s self-service tools to quickly find information on the plan. You may also call us at 1-877-842-3210.
You are subject to the provisions of additional guides when providing covered services to a member of those benefit plans, as described in your Agreement and in the following table. We may make changes to care provider guides, supplements and manuals that relate to protocol and payment policy changes.
We may change the location of a website, a benefit plan name, branding or the member health plan ID card. We inform you of those changes through one of our care provider communications resources.
Benefit plans subject to this guide
Plan Name:
All Savers Insurance Company
Location of most members subject to additional guides:
All markets
Location of plan information:
All Savers Supplement to this guide myallsaversconnect.com
Location of most members subject to additional guides:
All markets outside of NY* and national care providers; Primary concentrations in: AZ, CA, CT, DE, FL, GA, MA, MD, NC, NJ, NV, PA, SC, TN, TX, VA
Health plan ID card indicates NYSHIP The Empire Plan and references UnitedHealthcare logo on the back
*In the NY markets, there are a limited number of care providers with the Empire Plan specifically added to their UnitedHealthcare Agreement. Otherwise, we have a separate care provider network for Empire Plan members in NY.
Location of plan information:
Location of most members subject to additional guides:
AZ, MD, NC, OK, TN, VA, WA
Location of plan information:
Chapter 4: Health Insurance Marketplace (Exchanges) to this guide.
Plan Name:
MD Individual Practice Association, Inc.
Location of most members subject to additional guides:
DC, DE, MD, VA, WV
Some counties in: Southeastern PA
Location of plan information:
Mid-Atlantic Regional Supplement to this guide.
Location of most members subject to additional guides:
FL counties: Broward and Miami-Dade
Location of plan information:
Medica HealthCare Supplement to this guide.
Location of most members subject to additional guides:
All markets
Location of plan information:
Capitation and/or Delegation Supplement to this guide.
Location of most members subject to additional guides:
Florida
Location of plan information:
Neighborhood Health Partnership Supplement to this guide.
Location of most members subject to additional guides:
DC, DE, MD, VA, WV
Some counties in: PA
Location of plan information:
Mid-Atlantic Regional Supplement to this guide.
Location of most members subject to additional guides:
DC, DE, FL, GA, MD, NC, PA, SC, TN, VA, WV
Location of plan information:
OneNet PPO Supplement to this guide.
Plan Name:
- Oxford Health Plans, LLC
- Oxford Health Insurance, Inc.
- Investors Guaranty Life Insurance Company, Inc.
- Oxford Health Plans (NY), Inc.
- Oxford Health Plans (NJ), Inc.
- Oxford Health Plans (CT), Inc.
- Oxford Level Funded Plans (NJ, CT)
Location of most members subject to additional guides:
CT, NJ, NY (except upstate) Some counties in: PA.
Location of plan information:
Oxford Commercial Supplement to this guide.
For commercial benefits: oxhp.com or UHCprovider.com
For Medicare benefits: UHCprovider.com
Location of most members subject to additional guides:
FL counties: Broward, Miami-Dade and Palm Beach
Location of plan information:
Preferred Care Partners Supplement to this guide.
Plan Name:
- UnitedHealthcare Services Company of the River Valley, Inc.
- UnitedHealthcare Plan of the River Valley, Inc.
- UnitedHealthcare Insurance Company of the River Valley
Location of most members subject to additional guides:
Parts of AR, GA, IA, IL TN, WI, VA
Your UnitedHealthcare contract specifically references River Valley or John Deere Health protocols or guides; and
You are located in AR, GA, IA, TN, VA, WI or these counties in Illinois: Jo Daviess, Stephenson, Carroll, Ogle, Mercer, Whiteside, Lee, Rock Island, Henry, Bureau, Putnam, Henderson, Warren, Knox, Stark, Marshall, Livingston, Hancock, McDonough, Fulton, Peoria, Tazewell, Woodford, McLean, and
You are providing services to a River Valley Commercial member and not a River Valley Medicare Advantage, Medicaid or CHIP member.
Note: River Valley also offers benefit plans in LA, NC, OH and SC, but the River Valley Additional Guide does not apply to those benefit plans.
Location of plan information:
River Valley Entities Supplement to this guide.
Plan Name:
- Sierra Health and Life Insurance Co., Inc.
- Health Plan of Nevada, Inc.
- Sierra Healthcare Options, Inc.
Location of most members subject to additional guides:
Outside NV only:
The health plan ID card identifies the Sierra or Health Plan of Nevada members who access the UnitedHealthcare network outside of Nevada, and includes the following reference:
UnitedHealthcare Choice Plus Network Outside Nevada.
Location of plan information:
Services rendered outside of Nevada to Sierra or Health Plan of Nevada members with the health plan ID card reference described in this row are subject to your UnitedHealthcare Agreement and to this guide unless you are in Arizona or Utah and have a contract directly with Sierra or Health Plan of Nevada.
Plan Name:
- UMR
- UnitedHealthcare Shared Services (UHSS)
Location of most members subject to additional guides:
All markets
Location of plan information:
Plan Name:
(previously sold under the name All Savers® Alternate Funding)
Location of most members subject to additional guides:
December 2020: AL, SD, ND, DE
September 2021: All markets
Location of plan information:
UnitedHealthcare Level Funded supplement to this guide.
Plan Name:
(Formerly referenced in this guide as “PacifiCare”)
- UHC of California dba UnitedHealthcare of California (hereinafter referred to as UnitedHealthcare of California)
- UnitedHealthcare Benefits Plan of California
- UnitedHealthcare of Oklahoma, Inc.
- UnitedHealthcare of Oregon, Inc.
- UnitedHealthcare Benefits of Texas, Inc.
- PacifiCare of Arizona, Inc.
- PacifiCare of Colorado, Inc.+
- PacifiCare of Nevada, Inc.
+ Medicare Advantage benefit plans only.
Location of most members subject to additional guides:
AZ, CA, CO, NV, OK, OR, TX, WA
Location of plan information:
UnitedHealthcare West Supplement to this guide.
Plan Name:
- Golden Rule Insurance Company Group #705214
- Oxford Health Insurance, Inc. Group #908410
Location of most members subject to additional guides:
All markets New Jersey
Location of plan information:
UnitedHealthOne Individual Plans Supplement to this guide.
UHCprovider.com and myUHOne.com
Benefit plans not subject to this guide
Location of most members subject to additional guides:
Colorado
Location of plan information:
Plan Name:
- Sierra Health and Life Insurance Co., Inc.
- Sierra Healthcare Options, Inc.
- Health Plan of Nevada, Inc.
- Health Plan of Nevada Medicaid/ Nevada Check Up
Location of most members subject to additional guides:
Nevada
Location of plan information:
Benefit plans for Sierra Health and Life Insurance Company, Inc.: sierrahealthandlife.com/provider
Benefit plans for Sierra Healthcare Options, Inc: sierrahealthcareoptions.com
Benefit plans for Health Plan of Nevada, Inc.: healthplanofnevada.com/provider myhpnmedicaid.com/provider
Location of most members subject to additional guides:
Multiple states
Location of plan information:
UnitedHealthcare Community Plan Physician, Health
Care Professional, Facility and Ancillary Administrative Guide for Medicaid, CHIP, or Uninsured.
UHCprovider.com/communityplan and UHCprovider.com
Plan Name:
including references to older brand names such as AmeriChoice, Great Lakes Health Plan, Unison, Arizona Physicians IPA (APIPA)
Location of most members subject to additional guides:
Multiple states
Location of plan information:
UnitedHealthcare Community Plan Physician, Health
Care Professional, Facility and Ancillary Administrative Guide for Medicare UHCprovider.com/communityplan and UHCprovider.com