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

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

Medical & Drug Policies and Coverage Determination Guidelines for UnitedHealthcare Individual Exchange Plans

Reimbursement Policies for UnitedHealthcare Individual Exchange Plans

More UnitedHealthcare Policies and Clinical Guidelines: