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

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Verify 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

State-specific plan information

Find pharmacy information about prescription drug lists, clinical criteria and prior authorization forms.

A Prescription Drug List (PDL) or a formulary is a list of covered prescribed medications, other pharmacy care products or supplies. Use the PDL Booklet to learn more about the drug list, tier information and definitions of prior authorization and utilization management edits. For real-time coverage information, search for medications using the Medication Search.

States can have multiple PDLs. To access member specific PDLs, use PreCheck MyScript.

Pharmacy Benefit Coverage Updates

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Individual Exchange plan news

You may see more Individual Exchange members

Updated process for prior authorization requests

New oral oncology prior authorization process

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