The following commercial health plans are offered in West Virginia. Open any section below to view more information.
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.
For a detailed description of MS.IPA benefits, exclusions and limitations, please refer to FEHB brochure #73-100 uhcfeds.com.
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.
If services are delivered outside of the local network, the plan will not cover the cost except in an emergency.
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.
Surest, a UnitedHealthcare company, administers a health plan without a deductible or coinsurance. Members have access to the nationwide UnitedHealthcare and Optum Behavioral Health networks and can check costs and care options in advance.
Some members have the Surest Flex plan, which includes the feature of flexible coverage. For a small number of plannable tests, procedures or treatments, the member must activate coverage at least 3 business days in advance of the service.
Claims: All claims must be sent directly to the Surest Payer ID 25463 or by mail to P.O. Box 211758, Eagan, MN 55121. Please include the subscriber ID and rendering address on the claim to help us confirm the copay/member price.
Eligibility and benefits: To check member eligibility and benefits, visit the UnitedHealthcare Provider Portal: Sign In With Your One Healthcare ID or call UHSS Provider Services at 844–368–6661. You’ll need to provide the subscriber ID if you’re requesting information about a dependent.
For more information, please visit UHCprovider.com/surest.
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.
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 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.
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.
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.
UnitedHealthcare Options PPO health plans allow members to choose a network physician or specialist without a referral (open-access).
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.