Welcome to UnitedHealthcare Individual Exchange plans, also referred to as Individual and Family plans. These plans are offered through the Health Insurance Marketplace, or the Exchange, where individuals can research, compare, and purchase health plans.
Here, you can access a variety of resources to help you work with us as you care for members who have these state-specific plans.
Interactive guide
Access this self-paced guide for everything you need to know about our Individual Exchange plans
Quick reference guide
Get answers about working with the plans in our quick reference guide
Actions you can take in the Provider Portal
Sign in to the UnitedHealthcare Provider Portal to manage your account and complete tasks
Actions you can take in the Provider PortalVerify your participation
Check if you’re in-network for an Individual Exchange plan
Update patient information
Provide accurate patient information to help make claims processing faster
Submit a referral
Refer your patients to a specialist within minutes
Submit or check claims
Review a claim’s status or send us a new claim with ease
Check eligibility
Confirm patient eligibility and review information about their benefits
Helpful links
Guides and Resources
Policies
State-specific plan information
Find pharmacy information about clinical criteria and prior authorization forms.
Alabama
Pharmacy prior authorizations and exceptions
- Alabama Clinical Criteria
- Alabama Prior Authorization Form for Prescription Benefits
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective December 1, 2024
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective January 1, 2025
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria Effective February 1, 2025
Arizona
Pharmacy prior authorizations and exceptions
- Arizona Clinical Criteria
- Arizona Prior Authorization Form for Prescription Benefits
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective December 1, 2024
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective January 1, 2025
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria Effective February 1, 2025
Related links
Colorado
Pharmacy prior authorizations and exceptions
- Colorado Clinical Criteria
- Colorado Prior Authorization Form for Prescription Benefits
- Colorado Prior Authorization Form for Mental Health Step Therapy Exceptions
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective December 1, 2024
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective January 1, 2025
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria Effective February 1, 2025
Related links
- 2025 Individual Exchange Plans of Colorado Quick Reference Guide
- 2024 Individual Exchange Plans of Colorado Quick Reference Guide
- Colorado Referral Requirements Quick Reference Guide
- Colorado Rocky Mountain Health Plan Out-of-Network Request Form
- Colorado Rocky Mountain Health Plan Release of Information Form
- Colorado Rocky Mountain Health Plan Release of Information Form - Spanish
- Rocky Mountain Health Plans Administers Colorado Individual Exchange Plans
- Rocky Mountain Health Plans Medical Policies
Florida
Pharmacy prior authorizations and exceptions
- Florida Clinical Criteria
- Florida Prior Authorization Form for Prescription Benefits
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective December 1, 2024
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective January 1, 2025
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria Effective February 1, 2025
Related links
Georgia
Pharmacy prior authorizations and exceptions
- Georgia Clinical Criteria
- Georgia Prior Authorization Form for Prescription Benefits
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective December 1, 2024
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective January 1, 2025
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria Effective February 1, 2025
Illinois
Pharmacy prior authorizations and exceptions
- Illinois Clinical Criteria
- Illinois Prior Authorization Form for Prescription Benefits
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective December 1, 2024
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective January 1, 2025
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria Effective February 1, 2025
Indiana
Pharmacy prior authorizations and exceptions
Iowa
Pharmacy prior authorizations and exceptions
Kansas
Pharmacy prior authorizations and exceptions
- Kansas Clinical Criteria
- Kansas Prior Authorization Form for Prescription Benefits
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective December 1, 2024
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective January 1, 2025
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria Effective February 1, 2025
Louisiana
Pharmacy prior authorizations and exceptions
- Louisiana Clinical Criteria
- Louisiana Prior Authorization Form for Prescription Benefits
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective December 1, 2024
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective January 1, 2025
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria Effective February 1, 2025
Maryland
Pharmacy prior authorizations and exceptions
- Maryland Clinical Criteria
- Maryland Prior Authorization Form for Prescription Benefits
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective December 1, 2024
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective January 1, 2025
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria Effective February 1, 2025
Related links
- Maryland Health Connection administers Maryland Individual Exchange Plans
Massachusetts
Pharmacy prior authorizations and exceptions
Related links
- UnitedHealthcare Navigate® administers Massachusetts Individual Exchange Plans
- Massachusetts Navigate Quick Reference Guide
Michigan
Pharmacy prior authorizations and exceptions
- Michigan Clinical Criteria
- Michigan Prior Authorization Form for Prescription Benefits
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective December 1, 2024
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective January 1, 2025
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria Effective February 1, 2025
Mississippi
Pharmacy prior authorizations and exceptions
- Mississippi Clinical Criteria
- Mississippi Prior Authorization Form for Prescription Benefits
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective December 1, 2024
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective January 1, 2025
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria Effective February 1, 2025
Missouri
Pharmacy prior authorizations and exceptions
- Missouri Clinical Criteria
- Missouri Prior Authorization Form for Prescription Benefits
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective December 1, 2024
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective January 1, 2025
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria Effective February 1, 2025
Nebraska
Pharmacy prior authorizations and exceptions
Nevada
Related links
- Visit healthplanofnevada.com or sierrahealthandlife.com for plan options in Nevada
New Jersey
Pharmacy prior authorizations and exceptions
- New Jersey Clinical Criteria
- New Jersey Prior Authorization Form for Prescription Benefits
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective December 1, 2024
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective January 1, 2025
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria Effective February 1, 2025
New Mexico
Pharmacy prior authorizations and exceptions
- New Mexico Clinical Criteria
- New Mexico Prior Authorization Form for Prescription Benefits
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective December 1, 2024
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective January 1, 2025
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria Effective February 1, 2025
New York
Pharmacy prior authorizations and exceptions
Related links
North Carolina
Pharmacy prior authorizations and exceptions
- North Carolina Clinical Criteria
- North Carolina Prior Authorization Form for Prescription Benefits
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective December 1, 2024
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective January 1, 2025
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria Effective February 1, 2025
Ohio
Pharmacy prior authorizations and exceptions
- Ohio Clinical Criteria
- Ohio Prior Authorization Form for Prescription Benefits
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective December 1, 2024
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective January 1, 2025
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria Effective February 1, 2025
Oklahoma
Pharmacy prior authorizations and exceptions
- Oklahoma Clinical Criteria
- Oklahoma Prior Authorization Form for Prescription Benefits
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective December 1, 2024
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective January 1, 2025
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria Effective February 1, 2025
South Carolina
Pharmacy prior authorizations and exceptions
- South Carolina Clinical Criteria
- South Carolina Prior Authorization Form for Prescription Benefits
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective December 1, 2024
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective January 1, 2025
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria Effective February 1, 2025
Tennessee
Pharmacy prior authorizations and exceptions
- Tennessee Clinical Criteria
- Tennessee Prior Authorization Form for Prescription Benefits
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective December 1, 2024
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective January 1, 2025
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria Effective February 1, 2025
Texas
Pharmacy prior authorizations and exceptions
- Texas Clinical Criteria
- Texas Prior Authorization Form for Prescription Benefits
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective December 1, 2024
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective January 1, 2025
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria Effective February 1, 2025
Related links
Virginia
Pharmacy prior authorizations and exceptions
- Virginia Clinical Criteria
- Virginia Prior Authorization Form for Prescription Benefits
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective December 1, 2024
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective January 1, 2025
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria Effective February 1, 2025
Washington
Pharmacy prior authorizations and exceptions
- Washington Clinical Criteria
- Washington Prior Authorization Form for Prescription Benefits
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective December 1, 2024
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective January 1, 2025
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria Effective February 1, 2025
Related links
- Washington Healthplan Finder administers Washington Individual Exchange Plans
Wisconsin
Pharmacy prior authorizations and exceptions
- Wisconsin Clinical Criteria
- Wisconsin Prior Authorization Form for Prescription Benefits
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective December 1, 2024
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria - Effective January 1, 2025
- Notice of Changes to Prior Authorization Requirements and Coverage Criteria Effective February 1, 2025
Wyoming
Pharmacy prior authorizations and exceptions
Individual Exchange plan news
New 2025 Individual Exchange plans and prior authorization information
RMHP Individual Exchange plans to align with hospital reference lab protocol
Updates to Individual Exchange plans PDLs on Jan. 1, 2025
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