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Pennsylvania Commercial Health Plans

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

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Surest is a UnitedHealthcare company that administers health plans without deductibles or coinsurance. Members have access to the nationwide UnitedHealthcare and Optum® Behavioral Health networks and can check costs and care options in advance.

If you participate in UnitedHealthcare commercial plans, you automatically participate in Surest benefit plans at the existing commercial reimbursement rates per your participation agreement.

A small number of members have the Surest Flex plan, which includes the feature of flexible coverage. For a fixed list of plannable tests, procedures or treatments, the member must activate coverage at least 3 business days in advance of the service, or the member may not have coverage for the service.

Claims: Please send claims to us electronically using Surest Payer ID 25463 or by mail to Surest, P.O. Box 211758, Eagan, MN 55121. Include the subscriber ID and rendering address on the claim to help us confirm the copay/member price. Check the status of your claims in the UnitedHealthcare Provider Portal.

Eligibility and benefits: To check member eligibility and benefits, visit the provider portal or call Surest Provider Services at 844-368-6661. If you’re requesting information about a dependent, we’ll need the subscriber ID.

Variable copays: You can receive variable copay information through electronic data interchange (EDI) 270/1 transaction responses. For more information, see the 270/271 EDI Surest guide and Digital Solutions page.

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

UnitedHealthcare Catalyst is a high deductible health plan that uses a pre-deductible allowance to help employees pay everyday health care expenses before they meet their deductible, including physician office visits or urgent care. The pre-deductible allowance is the amount the plan will pay per member before the deductible applies. Each family member has their own pre-deductible allowance.

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 Catalyst is a UnitedHealthcare Choice or UnitedHealthcare Choice Plus health plan with the addition of a pre-deductible allowance plan.

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 Tier 1 UnitedHealth Premium® Care Physicians.

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

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.