Commercial product overview table - Chapter 3, 2022 UnitedHealthcare Administrative Guide

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Product Name1:

UnitedHealthcare Choice and Choice Plus

How do members access physicians and health care professionals?2

Members can choose any Choice network physician or health care professional without a referral and without designating a PCP.

UnitedHealthcare Choice Plus provides out-of-network benefits. UnitedHealthcare Choice does not cover out- of-network services (except for emergency services).

Is a referral required from the member’s PCP to the network specialist?

No, members have open access to a national network of Choice health care providers.

Is the treating network physician and/or facility required to give notification when providing certain services?

Yes, on selected procedures as described in Chapter 7: Medical management of this guide.

Product Name1:

UnitedHealthcare Doctors Plan and Doctors Plan Plus

How do members access physicians and health care professionals?2

Members choose, or are assigned, a Doctors Plan network PCP for each family member. Members are encouraged to see their PCP to coordinate their care, but are not required to see that PCP, or to obtain a referral from a PCP when accessing a Doctors Plan network specialist or facility for care.

UnitedHealthcare Doctors Plan Plus provides out- of-network benefits. UnitedHealthcare Doctors Plan does not cover out of-network services (except for emergency services).

Is a referral required from the member’s PCP to the network specialist?

No, members have open access to a limited network of Doctors Plan health care providers available nationally.

Is the treating network physician and/or facility required to give notification when providing certain services?

Yes, on selected procedures as described in Chapter 7: Medical management of this guide.

Product Name1:

UnitedHealthcare Select and Select Plus

How do members access physicians and health care professionals2?

Members choose, or are assigned, a Select network PCP for each family member. Members are encouraged to see their PCP to coordinate their care, but are not required to see that PCP, or to obtain a referral from a PCP when accessing a Select network specialist or facility for care.

UnitedHealthcare Select Plus provides out-of-network benefits. UnitedHealthcare Select does not cover out- of-network services (except for emergency services).

Is a referral required from the member’s PCP to the network specialist?

No, members have open access to a national network of Select health care providers.

Is the treating network physician and/or facility required to give notification when providing certain services?

Yes, on selected procedures as described in Chapter 7: Medical management of this guide.

Product Name1:

UnitedHealthcare Options PPO

How do members access physicians and health care professionals?2

Members can choose any network physician or health care professional without a referral and without designating a PCP.

Options PPO provides out-of-network benefits.

Is a referral required from the member’s PCP to the network specialist?

No, members have open access to a national network of Options PPO health care providers.

Is the treating network physician and/or facility required to give notification when providing certain services?

Members are responsible for notifying us using the phone number on their health plan ID card, as described under the member’s benefit plan.

Product Name1:

UnitedHealthcare Indemnity

How do members access physicians and health care professionals?2

Members can choose any physician or health care professional.

Is a referral required from the member’s PCP to the network specialist?

No, members have open access to any health care provider.

Is the treating network physician and/or facility required to give notification when providing certain services?

No, members are responsible for notifying us using the phone number on their health plan ID card.

Product Name1:

UnitedHealthcare Core and Core Essential

How do members access physicians and health care professionals?2

Members can choose any Core network physician or health care professional without a referral and without designating a PCP.

Core provides out-of-network benefits. Core Essential does not (except for emergency services).

Is a referral required from the member’s PCP to the network specialist?

No, members have open access to a limited network of health care providers available nationally.

Is the treating network physician and/or facility required to give notification when providing certain services?

Yes, on selected procedures as described in Chapter 7: Medical management of this guide.

Product Name1:

UnitedHealthcare Freedom Plans

How do members access physicians and health care professionals?2

Members can choose any physician or health plan, however they must choose a PCP for the EPO plan.

Is a referral required from the member’s PCP to the network specialist?

No, referrals are not required.

Is the treating network physician and/or facility required to give notification when providing certain services?

Yes, on selected procedures as described in Chapter 7: Medical management of this guide.

Product Name1:

UnitedHealthcare Navigate®, Navigate Balanced®, Navigate Plus®

How do members access physicians and health care professionals?2

Members must see their PCP and have electronic referrals submitted to UnitedHealthcare by their PCP before seeing another Navigate network physician. Navigate Balanced and Plus benefit plans provide additional network coverage, at a higher member cost-share, for services from a Navigate network physician other than the member’s PCP without a referral.

Navigate Plus provides out-of-network benefits3. Navigate and Navigate Balanced do not (except for emergency services).

Is a referral required from the member’s PCP to the network specialist?

Yes, an electronic referral from the member’s PCP is required prior to receiving services from a Navigate physician participating in this limited Navigate network. See Chapter 6: Referrals of this guide.

Is the treating network physician and/or facility required to give notification when providing certain services?

Yes, on selected procedures as described in Chapter 7: Medical management of this guide.

Product Name1:

UnitedHealthcare NavigateNOW,  NavigateNOW Balanced, NavigateNOW Plus

How do members access physicians and health care professionals?2

Subject to specific benefit designs, a member in NavigateNOW must choose a care team/PCP at the time of their enrollment. If not, we assign one. NavigateNOW members must see their virtual care team or selected PCP, and have electronic referrals submitted to UnitedHealthcare by their care team or PCP before seeing another Navigate network physician.

NavigateNOW Balanced and Plus benefit plans provide additional network coverage, at a higher member cost-share, for services from a Navigate network physician other than the member’s PCP without a referral.

NavigateNOW Plus provides out-of-network benefits3. NavigateNOW and NavigateNOW Balanced do not (except for emergency services).

Is a referral required from the member’s PCP to the network specialist?

Yes, an electronic referral from the member’s PCP is required prior to receiving services from a Navigate physician participating in this limited Navigate network. See Chapter 6: Referrals of this guide.

Is the treating network physician and/or facility required to give notification when providing certain services?

Yes, on selected procedures as described in Chapter 7: Medical management of this guide.

Product Name1:

UnitedHealthcare Charter®, Charter® Balanced, Charter® Plus

How do members access physicians and health care professionals?2

Members must see their PCP and have electronic referrals submitted by their PCP before seeing another Charter network physician to receive the highest level of coverage. Charter Balanced and Charter Plus benefit plans provide additional network coverage, at a higher member cost-share, for services from a Charter network physician other than the member’s PCP without a referral.

Charter Plus provides out-of-network benefits. Charter and Charter Balanced do not (except for emergency services).

Is a referral required from the member’s PCP to the network specialist?

Yes, an electronic referral from the member’s PCP is required prior to receiving services from a Charter health care provider participating in this limited Charter network. See Chapter 6: Referrals of this guide.

Is the treating network physician and/or facility required to give notification when providing certain services?

Yes, on selected procedures as described in Chapter 7: Medical management of this guide.

Product Name1:

UnitedHealthcare Compass, Compass Balanced, Compass Plus

How do members access physicians and health care professionals?2

Members must see their PCP and have electronic referrals submitted by their PCP before seeing another Compass network physician within the Compass network service area to receive the highest level of coverage4. Compass Balanced and Plus benefit plans provide network coverage at a higher member cost- share for services from a network physician other than the member’s PCP without a referral.

Compass Plus provides out-of-network benefits. Compass and Compass Balanced do not (except for emergency services).

Is a referral required from the member’s PCP to the network specialist?

Yes, an electronic referral from the member’s PCP is required prior to receiving services from a health care provider participating in this limited Compass network. See Chapter 6: Referrals of this guide.

Is the treating network physician and/or facility required to give notification when providing certain services?

Yes, on selected procedures as described in Chapter 7: Medical management of this guide.

Product Name1:

Individual Exchange Plans

How do members access physicians and health care professionals?2

Plans are sold on the Exchange marketplace. Members choose, or are assigned, a network PCP for each family member. Members must see their PCP to coordinate care. In most states, members must obtain a referral from a PCP when accessing a network specialist for care.

Individual exchange plans do not provide out-of- network benefits (except for emergency services) and members must stay within a defined service area to access care.

Is a referral required from the member’s PCP to the network specialist?

Referrals are required in most states.

Is the treating network physician and/or facility required to give notification when providing certain services?

Yes, on selected procedures as described in Chapter 7: Medical management of this guide.

Product Name1:

UnitedHealthcare NexusACO OA®, NexusACO OAP®

How do members access physicians and health care professionals?2

NexusACO OA is a tiered benefit plan where members choose, or are assigned, a network PCP for each family member. The member is encouraged to see their PCP to coordinate their care but is not required to see that PCP or obtain a referral when accessing other network providers.

NexusACO OAP is a tiered benefit plan and provides out-of-network benefits. NexusACO OA does not cover out-of-network services (except for emergency services).

Is a referral required from the member’s PCP to the network specialist?

No, members have open access to a national network of health care providers.

Is the treating network physician and/or facility required to give notification when providing certain services?

Yes, on selected procedures as described in Chapter 7: Medical management of this guide.

Product Name1:

UnitedHealthcare NexusACO R®,  UnitedHealthcare NexusACO RB®, NexusACO RP®

How do members access physicians and health care professionals?2

NexusACO® is a tiered benefit plan where members must see their assigned network PCP and have electronic referrals submitted by their PCP before seeing another network specialist to receive the highest level of coverage.

NexusACO RP provides out-of-network benefits.3

NexusACO R and RB do not (except for emergency services).

All NexusACO benefit plans are tiered.

Is a referral required from the member’s PCP to the network specialist?

Yes, an electronic referral from the member’s PCP is required prior to the member receiving specialist services. See Chapter 6: Referrals of this guide.

Is the treating network physician and/or facility required to give notification when providing certain services?

Yes, on selected procedures as described in Chapter 7: Medical management of this guide.

1 The UnitedHealthcare Network may be different among commercial products in your local market. Refer to your contract to determine whether you are part of that local network.
2 Physicians and health care professionals must be licensed for the health services provided and the health care services provided must be covered under the member’s benefit contract.
3 The benefit level for non-emergency services from out-of-network physicians and other health care providers is generally less than that for services from network physicians and other health care providers.
4 For more information about the Compass service area, go to uhcprovider.com/plans.