Individual Exchange Policies

These policies apply to UnitedHealthcare Individual Exchange plans, also referred to as Individual and Family plans. We currently offer these plans in Alabama, Arizona, Florida, Georgia, Illinois, Kansas, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Tennessee, Texas, Virginia and Washington.

Beginning Jan. 1, 2024, these reimbursement policies, medical policies and medical benefit drug policies will also apply to New Jersey’s Oxford Metro Individual Exchange plans, and plans in New Mexico, South Carolina and Wisconsin.

Reimbursement policies

• These reimbursement policies also apply to Colorado (Rocky Mountain Health Plan)
• For all other states (including Massachusetts and New York), refer to our UnitedHealthcare Commercial Reimbursement Policies page

Medical policies

• These medical policies also apply to Massachusetts and New York, unless otherwise indicated
• Colorado: Refer to the MCG Health Care Guidelines page
• Nevada: Refer to the Health Plan of Nevada’s Medical Policies page

Medical benefit drug policies

• These medical benefit drug policies also apply to Colorado
• Nevada: Refer to the Health Plan of Nevada’s Medical Policies page
• For all other states (including Massachusetts and New York), refer to our UnitedHealthcare Commercial Medical & Drug Policies and Coverage Determination Guidelines

More UnitedHealthcare Policies and Clinical Guidelines:

• Clinical Guidelines