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Illinois Commercial Health Plans

The following commercial health plans are offered in Illinois. Open the section below to view more information.

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The Heritage and UnitedHealthcare of the River Valley family of health plans allow members to go to any network provider. The member will pay two different copayment amounts based on the services received.

  • One copayment is used for a visit to a primary care physician (family practice, internal medicine, or pediatric physician).
  • A higher copayment is used for a visit to a specialist.

There is out-of-network coverage for emergency services only.

Tools & Resources

Surest, a UnitedHealthcare company, administers a health plan without a deductible or coinsurance. Members have access to the nationwide UnitedHealthcare and Optum Behavioral Health networks and can check costs and care options in advance.

Some members have the Surest Flex plan, which includes the feature of flexible coverage. For a small number of plannable tests, procedures or treatments, the member must activate coverage at least 3 business days in advance of the service.

Claims: All claims must be sent directly to the Surest Payer ID 25463 or by mail to P.O. Box 211758, Eagan, MN 55121. Please include the subscriber ID and rendering address on the claim to help us confirm the copay/member price.

Eligibility and benefits: To check member eligibility and benefits, visit the UnitedHealthcare Shared Services (UHSS) Provider Portal or call UHSS Provider Services at 844–368–6661. You’ll need to provide the subscriber ID if you’re requesting information about a dependent.

For more information, please visit UHCprovider.com/surest.

UnitedHealthcare Charter 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 Charter network is narrowed in states where the product is sold.

  • UnitedHealthcare Charter members must receive a referral from their PCP to see a network specialist for services to be covered. There is out-of-network coverage for emergency services only.
  • UnitedHealthcare Charter Balanced members may see a network specialist at a reduced benefit level when there is no referral. There is out-of-network coverage for emergency services only.
  • UnitedHealthcare Charter Plus members may see a network specialist at a reduced benefit level when there is no referral.  Charter 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

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 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.