District of Columbia Commercial Health Plans

The following commercial health plans are offered in the District of Columbia. Click the "+" sign to view more information on each.

UnitedHealthcare Catalyst is a high deductible health plan that uses a pre-deductible allowance to help employees pay everyday health care expenses before they meet their deductible, including physician office visits or urgent care. The pre-deducible allowance is the amount the plan will pay per member before the deductible applies. Each family member has their own pre-deductible allowance.

Preventive care, including immunizations and preventive exams and health screenings, is covered at 100% percent in our UnitedHealthcare Choice and UnitedHealthcare Choice Plus networks.

UnitedHealthcare Catalyst is a UnitedHealthcare Choice or UnitedHealthcare Choice Plus with the addition of a UnitedHealthcare Catalyst pre-deductible allowance plan.

The UnitedHealthcare Choice and Choice Plus health plans allow members to choose a physician or specialist from the UnitedHealthcare Choice networks but do not need a referral to receive benefits.

  • UnitedHealthcare Choice members must receive care from network care providers for benefits to be covered. There is out-of-network coverage for emergency services only.
  • UnitedHealthcare Choice Plus members are covered at a lower benefit level for services provided by out-of-network care providers.

Preventive care, including immunizations and preventive exams and health screenings, is covered at 100 percent in our UnitedHealthcare Choice and UnitedHealthcare Choice Plus networks.

UnitedHealthcare Choice Advanced health plans allow members to choose a physician or specialist in the UnitedHealthcare Choice networks and do not need a primary care physician or referral to receive benefits. There is out-of-network coverage for emergency services only.

  • UnitedHealthcare Choice Advanced members must receive care from network care providers for benefits to be covered. Members are encouraged to choose lower cost, freestanding network health care facilities rather than hospitals for radiology services and outpatient surgery.
  • UnitedHealthcare Choice Advanced Plus members are encouraged to seek care from the network care providers but don’t need a referral to receive benefits; members are covered for out-of-network care provider visits at a lower benefit level.

UnitedHealthcare Choice Advanced members have lower copays and/or greater coinsurance when they use UnitedHealth Premium® Tier 1 2-star care providers.

UnitedHealthcare Choice Advanced and UnitedHealthcare Choice Advanced Plus build on Choice and Choice Plus plans with additional features for both members and employers.

UnitedHealthcare Core health plans allow members to choose a network physician or specialist without a referral (open access). The UnitedHealthcare Core network is narrowed in some states.

  • UnitedHealthcare Core Essential members must receive care from network providers for benefits to be covered.
  • UnitedHealthcare Core plans cover out-of-network providers at a lower benefit level.

An array of health and wellness resources are available to members including the Online Health Assessment, Personal Health Record and Online Health Coaching modules.

Tools & Resources

UnitedHealthcare EDGE health plans allow members to choose a network physician or specialist but don’t need a referral (open-access).

Some UnitedHealthcare EDGE plans provide access to network and non-network care providers so members can seek care from any care provider they choose, but at a lower co-insurance/deductible level for network care providers.

By seeking care from Tier 1 care providers, members can maximize their in-network benefits based on UnitedHealthcare’s evaluation.

UnitedHealthcare EDGE plans provide medication benefit coverage through a four-tier pharmacy plan. UnitedHealthcare EDGE plans include health and wellness programs, services and discounts from UnitedHealth Wellness®.

The UnitedHealthcare MD-IPA health plan encourages members to use their primary care provider (PCP) to coordinate care across a wide spectrum of health services and enter electronic referrals to network specialists.

  • Members must receive a referral from their PCP to see a network specialist for benefits to be covered. There is out-of-network coverage for emergency services only.
  • This health maintenance organization (HMO) individual practice plan emphasizes preventive care, including immunizations and preventive exams and health screenings.

For a detailed description of MS-IPA benefits, exclusions and limitations, please refer to FEHB brochure #73-100 uhcfeds.com.

Mid-Atlantic Health Plans

These resources are available to care providers with members in M.D.IPA, M.D.IPA Preferred, Optimum Choice, and Optimum Choice Preferred health plans.

Forms, Tools & Resources

Radiology Vendors

The UnitedHealthcare Navigate health plans encourage members to use their primary care provider (PCP) to coordinate care across a wide spectrum of health services and enter electronic referrals to network specialists. The UnitedHealthcare Navigate network is narrowed in some states.

  • UnitedHealthcare Navigate members must receive a referral from their PCP to see a network specialist for benefits to be covered. There is out-of-network coverage for emergency services only.
  • UnitedHealthcare Navigate Balanced® members must receive a referral from their PCP to see a network specialist for benefits to be covered. Lower network coverage applies when there is no referral. There is out-of-network coverage for emergency services only.
  • UnitedHealthcare Navigate Plus® members must receive a referral from their PCP to see a network specialist for benefits to be covered. Lower network coverage applies when there is no referral. Navigate Plus also provides out of network coverage.

Changes to PCP selection are permitted once per month. Changes submitted on or before the 31st of the month will be effective on the first day of the following month.

Tools & Resources

UnitedHealthcare Options PPO health plans allow members to choose a network physician or specialist without a referral (open-access).

  • It is the member's responsibility to obtain prior approvals for both network and non-network services. No referral is required to see a specialist.
  • If a non-network physician is chosen, out-of-pocket member costs will be higher and it is the member’s responsibility to obtain approvals and submit claims.

UnitedHealthcare Options PPO offers two levels of coverage: a higher level of benefits for in-network services, and a lower level of benefits for non-network services, with somewhat higher deductibles and coinsurance.

The Optimum Choice (OCI) health plans encourage members to use their primary care provider (PCP) to coordinate care across a wide spectrum of health services and enter electronic referrals to network specialists.

  • An optional health savings account (HSA) can pay for qualifying medical expenses, including the annual deductible.
  • An optional health reimbursement arrangement (HRA) can offer a type of employer-funded health benefit plan that reimburses employees for out-of-pocket medical expenses.

If services are delivered outside of the local network, the plan will not cover the cost except in an emergency.

Mid-Atlantic Health Plans

These resources are available to care providers with members in M.D.IPA, M.D.IPA Preferred, Optimum Choice, and Optimum Choice Preferred health plans.

Forms, Tools & Resources

Radiology Vendors