Delaware UnitedHealthcare Dual Complete® Special Needs Plans

Health Maintenance Organization (HMO) plans use a network of contracted local physicians and hospitals to provide member care. Generally, members must use these care providers to receive benefits for covered services, except in emergencies. Some HMO plans do not require referrals for specialty care.

Point of Service (HMO-POS) plans include all the features of HMO plans plus the ability to go outside the contracted network for certain health care services - typically at a higher cost. Some POS plans do not require referrals for specialty care.

Preferred Provider Organization (PPO) plans work with a network of contracted local physicians and hospitals, but also allows members the flexibility to seek covered services from outside of the contracted network, usually at a higher cost. Members do not need a referral for specialty care.

PPO plans are available as either local PPO (certain counties within a state) or regional PPO (RPPO) offerings. RPPOs serve a larger geographic area - either a single state or a multi-state area. RPPOs offer the same premiums, benefits and cost-sharing requirements to all members in the region.

UnitedHealthcare Medicare Advantage Special Needs Plans (SNPs) combine the hospital and doctor coverage of Medicare Parts A and B with Part D prescription drug coverage, plus additional features and benefits designed to meet the unique needs of identified Medicare consumer populations.

Dual Special Needs Plans must:

  • Follow CMS regulations and cover all Medicare Part A (hospital stay) and Part B (doctor’s office) benefits, and must include Medicare Part D (pharmacy) coverage.
  • Offer clinical programs and special expertise to serve the target population.
  • UnitedHealthcare Dual Complete program will reimburse claims, according to your UnitedHealthcare contractual Medicare fee schedule.