UnitedHealthcare benefit plans for Individual Exchanges - Chapter 4, 2022 UnitedHealthcare Administrative Guide

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Plan Names:

  • UHC Gold Advantage+Extra
  • UHC Gold Value+
  • UHC Silver Advantage+
  • UHC Silver Value+
  • UHC Silver Value+Saver
  • UHC Bronze Essential+
  • UHC Bronze Value+

PCP Required: Yes

Referral Required: No, not required for member to have coverage.

Prior Auth Required: Yes

Out-of-Network/Area Coverage: No1

Plan Names:

  • UHC Gold Value+
  • UHC Gold Advantage+
  • UHC Gold Advantage+Extra
  • UHC Silver Value+Saver
  • UHC Silver Value+
  • UHC Silver Value+Base
  • UHC Silver Advantage+Extra
  • UHC Silver Advantage+
  • UHC Bronze Value+
  • UHC Bronze Value+Saver
  • UHC Bronze Essential+

PCP Required: Yes

Referral Required: Yes, for the member to have coverage

Prior Auth Required: Yes

Out-of-Network/Area Coverage: No

Plan Names:

  • UHC Gold Advantage+
  • UHC Gold Advantage+Extra
  • UHC Gold Value+
  • UHC Silver Value+
  • UHC Silver Virtual First
  • UHC Silver Value+Saver
  • UHC Silver Value+Base
  • UHC Silver Value+
  • UHC Silver Virtual First Saver
  • UHC Silver Advantage+Saver
  • UHC Silver Advantage+Base
  • UHC Silver Advantage+Extra
  • UHC Silver Advantage+Extra Saver
  • UHC Bronze Essential+
  • UHC Bronze Value+
  • UHC Bronze Value+Saver
  • UHC Bronze Virtual First

PCP Required: Yes

Referral Required: Yes, for the member to have coverage

Prior Auth Required: Yes

Out-of-Network/Area Coverage: No2

Plan Names:

  • UHC Gold Advantage+Extra
  • UHC Gold Advantage+
  • UHC Gold Value+
  • UHC Gold Value+Saver
  • UHC Silver Virtual First
  • UHC Silver Advantage+
  • UHC Silver Advantage+Extra
  • UHC Silver Value+
  • UHC Silver Value+Saver
  • UHC Bronze Value+
  • UHC Bronze Essential+
  • UHC Bronze Virtual First

PCP Required: Yes

Referral Required: Yes, for the member to have coverage

Prior Auth Required: Yes

Out-of-Network/Area Coverage: No*

Plan Names:

  • UHC Gold Value+
  • UHC Gold Advantage+
  • UHC Gold Advantage+Extra
  • UHC Silver Value+
  • UHC Silver Advantage+
  • UHC Silver Advantage+Extra
  • UHC Silver Virtual First

PCP Required: Yes

Referral Required: Yes, for the member to have coverage

Prior Auth Required: Yes

Out-of-Network/Area Coverage: No*

Plan Names:

  • UHC Gold Value+
  • UHC Gold Advantage+
  • UHC Gold Advantage+Extra
  • UHC Silver Value+
  • UHC Silver Advantage+
  • UHC Silver Advantage+Extra 
  • UHC Bronze Value+
  • UHC Bronze Essential+

PCP Required: Yes

Referral Required: No, not required for the member to have coverage

Prior Auth Required: Yes

Out-of-Network/Area Coverage: No*

Plan Names:

  • UHC Gold Value+ 
  • UHC Gold Base+ 
  • UHC Gold Saver+
  • UHC Gold Advantage+Extra
  • UHC Silver Value+
  • UHC Silver Base+
  • UHC Silver Saver+
  • UHC Silver Extra+
  • UHC Bronze Value+
  • UHC Bronze
  • UHC Bronze Saver+
  • UHC Bronze Essential+

PCP Required: Yes

Referral Required: Yes, for the member to have coverage

Prior Auth Required: Yes

Out-of-Network/Area Coverage: No3

Plan Names:

  • UHC Gold Advantage+Extra
  • UHC Gold Value+
  • UHC Gold Advantage+
  • UHC Gold Advantage+Extra 
  • UHC Silver Value+
  • UHC Silver Advantage+
  • UHC Silver Advantage+Extra
  • UHC Bronze Value+
  • UHC Bronze Essential+
  • UHC Bronze Essential+Saver

PCP Required: Yes

Referral Required: Yes, for the member to have coverage

Prior Auth Required: Yes

Out-of-Network/Area Coverage: No*

Plan Names:

  • UHC Gold Value+ 
  • UHC Gold Advantage+
  • UHC Gold Advantage+Extra
  • UHC Silver Value+
  • UHC Silver Value+Saver 
  • UHC Silver Advantage+ 
  • UHC Bronze Value+ 
  • UHC Bronze Essential+

PCP Required: Yes

Referral Required: No, not required for the member to have coverage

Prior Auth Required: Yes

Out-of-Network/Area Coverage: No*

Plan Names:

  • UHC Gold Value+
  • UHC Gold Advantage+Extra
  • UHC Silver Value+
  • UHC Bronze Value+
  • UHC Bronze Value+Saver
  • UHC Bronze Essential+
  • UHC Bronze Value+

PCP Required: Yes

Referral Required: Yes, for the member to have coverage

Prior Auth Required: Yes

Out-of-Network/Area Coverage: No*

Plan Names:

  • UHC Gold Value+
  • UHC Gold Advantage+Extra
  • UHC Silver Value+
  • UHC Silver Value+Saver
  • UHC Silver Advantage+Extra
  • UHC Bronze Value+
  • UHC Bronze Essential+

PCP Required: Yes

Referral Required: Yes, for the member to have coverage

Prior Auth Required: Yes

Out-of-Network/Area Coverage: No4

Plan Names:

  • UHC Gold Value+ 
  • UHC Gold Advantage+
  • UHC Gold Advantage+Extra
  • UHC Silver Value+
  • UHC Silver Virtual First
  • UHC Silver Advantage+
  • UHC Silver Advantage+Extra
  • UHC Bronze Value+
  • UHC Bronze Essential+ 
  • UHC Bronze Virtual First

PCP Required: Yes

Referral Required: Yes, for the member to have coverage

Prior Auth Required: Yes

Out-of-Network/Area Coverage: No*

Plan Names:

  • UHC Gold Value+
  • UHC Gold Advantage+Extra
  • UHC Silver Value+
  • UHC Silver Value+Saver
  • UHC Silver Virtual First
  • UHC Bronze Value+Saver
  • UHC Bronze Value+
  • UHC Bronze Virtual First
  • UHC Bronze Essential+

PCP Required: Yes

Referral Required: Yes, for the member to have coverage

Prior Auth Required: Yes

Out-of-Network/Area Coverage: No5

Plan Names:

  • Cascade Select Gold
  • Gold Value+
  • Silver Value+
  • Cascade Select Silver
  • Cascade Select Bronze 
  • Bronze Value+

PCP Required: Yes

Referral Required: Yes, for the member to have coverage

Prior Auth Required: Yes

Out-of-Network/Area Coverage: No*

*Except for emergency services and related authorized admissions.
1    Alabama Individual Exchange members located in Limestone and Madison counties will have access to participating providers in the following counties in the state of Tennessee: Giles and Lincoln. In addition, Alabama Individual Exchange members located in Baldwin and Mobile counties will have access to participating providers in Escambia County, Florida. However, they must select a PCP in the state of Alabama.
2    Florida Individual Exchange members located in Escambia County will have access to participating providers in the following counties in the state of Alabama: Baldwin and Mobile. However, they must select a PCP in the state of Florida.
3    Maryland Individual Exchange members located in Frederick, Montgomery and Prince George counties will have access to participating providers in the following counties in the state of Virginia: Fairfax, Fairfax City, Loudoun and Arlington. However, they must select a PCP in the state of Maryland.
4    Tennessee Individual Exchange members located in Giles and Lincoln counties will have access to participating providers in the following counties in the state of Alabama: Limestone and Madison. However, they must select a PCP in the state of Tennessee.
5    Virginia Individual Exchange members will have access to participating providers in the following counties in the state of Maryland: Frederick, Montgomery and Prince Georges. However, they must select a PCP in the state of Virginia.