UnitedHealthcare® Tiered Benefit Plans

UnitedHealthcare Tiered Benefit plans feature lower copays and/or co-insurance when members seek care from a Tier 1 care provider for their primary care physician (PCP), specialist, or hospital inpatient or outpatient services.

  • Premium Care Physicians meet the UnitedHealth Premium quality care criteria which includes safe, timely, effective and efficient care.  Physicians in Tier 1 include a subset of Premium Care Physicians who provide a lower cost of care and physicians participating in UnitedHealthcare NexusACO® in certain markets.  These physicians can be identified by the Tier 1 blue dot.
  • Some plans also reduce member cost share for utilizing free-standing facilities for certain radiology, labs or outpatient surgeries.

Products with UnitedHealthcare Tiered Benefit Plans

Any one of our commercial products listed below may feature tiered benefits; UnitedHealthcare NexusACO is offered as a tiered benefit plan only. Some Medicare Advantage plans may also include tier benefits.

  • UnitedHealthcare Choice and UnitedHealthcare Choice Plus
  • UnitedHealthcare Charter, UnitedHealthcare Charter Plus and UnitedHealthcare Charter Balanced
  • UnitedHealthcare Core and UnitedHealthcare Core Essential
  • UnitedHealthcare EDGE®
  • UnitedHealthcare Navigate®, UnitedHealthcare Navigate Plus® and UnitedHealthcare Navigate Balanced®
  • UnitedHealthcare NexusACO
  • UnitedHealthcare Options PPO
  • UnitedHealthcare Select and UnitedHealthcare Select Plus