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West Virginia Commercial Health Plans

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

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Mid-Atlantic Health Plan

UnitedHealthcare® Maryland Independent Physician Association (M.D.IPA) Plan

The UnitedHealthcare Maryland Independent Physician Association (M.D.IPA) health plan encourages 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.

  • 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.
  • This health maintenance organization (HMO) individual practice plan emphasizes preventive care, including immunizations and preventive exams and health screenings.

For a detailed description of MS.IPA benefits, exclusions and limitations, please refer to FEHB brochure #73-100 uhcfeds.com.

Optimum Choice®, Inc. (OCI)

The Optimum Choice, Inc. (OCI) 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.

  • An optional health savings account (HSA) can pay for qualifying medical expenses, including the annual deductible.
  • An optional health reimbursement arrangement (HRA) can offer a type of employer-funded health benefit plan that reimburses employees for out-of-pocket medical expenses.

If services are delivered outside of the local network, the plan will not cover the cost except in an emergency. 

Forms, Tools & Resources

These resources are available to care providers with members in M.D.IPA, M.D.IPA Preferred, Optimum Choice, Inc., and Optimum Choice Preferred health plans unless otherwise noted.

Bind administers an innovative personalized health plan. It accesses UnitedHealthcare provider contracts through its partnership with UnitedHealthcare. While Bind leverages the UnitedHealthcare network, members must present a Bind ID card. The plan features no deductible and no coinsurance, providing members with fewer barriers to care. With the Bind plan, members are covered across numerous common conditions and events. They can also activate coverage during the year for less common, plannable treatments if and when they need them.

All claims for Bind members must be sent directly to the Bind Payer ID 25463 or the address listed on the member ID card. Claims sent to a different address or Payer ID for UnitedHealthcare will be denied.

To check member eligibility, call 844-368-6661, or visit uhss.umr.com and enter the subscriber ID when prompted. For additional information, visit UHCProvider.com/Bind.

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® NexusACO®

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.