Applicable to all states except North Carolina
We create new commercial products and networks to meet member needs for affordable and quality care. We offer a variety of fully insured and self-funded commercial products for small and large groups. We also have individual benefit plans. These products vary by network size and make-up, gated or non-gated requirements, and benefit structure.
We offer commercial products on the Individual or Small Business Health Options Program (SHOP) Exchange in some states. Commercial products on the Individual and SHOP Exchange follow the same policies and protocols within this guide, unless otherwise stated in your Agreement.
For Individual Exchange in AL, AZ, FL, GA, IL, LA, MD, MI, NC, OK, TN, TX, VA and WA, refer to Chapter 4: Individual Exchange Plans.
You are contracted to see all commercial members (including Exchange), unless your Agreement excludes you. This includes new benefit plans brought into your market after the effective date of your Agreement. UnitedHealthcare Individual Exchange Benefit Plans require you to be located in a limited geographic market called the Individual Exchange Benefit Plans network service area. Verify the current Individual Exchange Benefit Plans network service area at UHCprovider.com/plans.
Each commercial product has a network of health care providers we work with to provide more affordable, quality health care. Our commercial benefit plans include a subset of our commercial network providers: Navigate, Charter, Core, Compass, Doctors Plan and NexusACO. A list of participating health care providers by benefit plan is on UHCprovider.com/findprovider. Your Agreement requires you to coordinate care with other participating network providers. Do not engage non-network providers in a member’s care.