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