Iowa Commercial Health Plans

The following commercial health plans are offered in Iowa. 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 and 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 Provider Portal: Sign In With Your One Healthcare ID 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.

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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 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®.

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.