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New York Commercial Health Plans

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

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.

  • 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 need a referral from their PCP to see a network specialist for services to be covered. Lower network coverage applies 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 Choice Advanced health plans allow members to choose a physician or specialist in the UnitedHealthcare Choice networks and do not need a primary care physician or referral to receive benefits. There is out-of-network coverage for emergency services only.

  • UnitedHealthcare Choice Advanced members must receive care from network care providers for benefits to be covered. Members are encouraged to choose lower cost, freestanding network health care facilities rather than hospitals for radiology services and outpatient surgery.
  • UnitedHealthcare Choice Advanced Plus members are encouraged to seek care from the network care providers but don’t need a referral to receive benefits; members are covered for out-of-network care provider visits at a lower benefit level.

UnitedHealthcare Choice Advanced members have lower copays and/or greater coinsurance when they use UnitedHealth Premium® Tier 1 2-star care providers.

UnitedHealthcare Choice Advanced and UnitedHealthcare Choice Advanced Plus build on Choice and Choice Plus plans with additional features for both members and employers.

UnitedHealthcare Compass 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.

  • UnitedHealthcare Compass 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 Compass 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 Compass Plus members need a referral from their PCP to see a network specialist for benefits to be covered. Lower network coverage applies when there is no referral or for services from an out-of-network care provider.

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.

UnitedHealthcare Compass plans are offered as Individual Exchange plans in certain states with off-Exchange versions when required by state law.

Tools & Resources

UnitedHealthcare Core health plans allow members to choose a network physician or specialist without a referral (open access). The UnitedHealthcare Core network is narrowed in some states.

  • UnitedHealthcare Core Essential members must receive care from network providers for benefits to be covered.
  • UnitedHealthcare Core plans cover out-of-network providers at a lower benefit level.

An array of health and wellness resources are available to members including the Online Health Assessment, Personal Health Record and Online Health Coaching modules.

Tools & Resources

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

The UnitedHealthcare NexusACO suite of products offers cost-saving opportunities to members when they seek care providers from a select group of Accountable Care Organizations (ACO) nationwide. There is out-of-network coverage for emergency services only.

UnitedHealthcare NexusACO Plans – Open Access
  • UnitedHealthcare NexusACO OA plans offer network-only coverage for care providers.
  • UnitedHealthcare NexusACO OAP plans offer both network and non-network coverage.
UnitedHealthcare NexusACO Plans – Referral Required
  • UnitedHealthcare NexusACO R plans offer network-only coverage for care providers.
  • UnitedHealthcare NexusACO RB plans offer network coverage when the PCP refers a member to a network specialist, and lower coverage applies when there is no referral.
  • UnitedHealthcare NexusACO RP plans offer network coverage when the PCP refers a member to a network specialist, and lower coverage applies when there is no referral or with an out-of-network specialist.

All UnitedHealthcare NexusACO members are required to select a primary care provider (PCP) within the network to provide their preventive care, treat chronic conditions, manage medications and enter specialist referrals.

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.