This Plan is a high option Health Maintenance Organization (HMO) Individual Practice Plan. This plan requires referrals for most services, and we require you to see specific physicians, hospitals, and other providers that contract with us. These Plan providers coordinate your health care services. We are solely responsible for the selection of these providers in your area. Contact us for a copy of our most recent provider directory. OPM requires that FEHB plans be accredited to ensure that plan operation sand care management meet or exceed standards that have been validated by an independent non-profit organization. MD IPA holds accreditation through the National Committee for Quality Assurance (NCQA).
To learn more about accreditation, please visit the following website:
We require you to see specific physicians, hospitals, and other providers that contract with us. You must see a Network physician in order to obtain benefits. Benefits are not available for services provided by out-of-Network providers. This Plan does not provide an out-of-Network level of benefits. You are not required to select a Primary Care Physician (PCP) in order to obtain benefits.
These Plan providers coordinate your health care services. We are solely responsible for the selection of these providers in your area. Contact us for a copy of our most recent provider directory or access the full provider listing at uhcfeds.com or from your member portal at myuhc.com.
Benefits for facility services apply when Covered Services are provided at a Network facility. Benefits include physician services provided in a Network facility by a Network or an out-of-Network radiologist, anesthesiologist, pathologist, emergency room physician and consulting physician. Benefits also include emergency services.
HMOs emphasize preventive care such as routine office visits, physical exams, well-baby care, and immunizations, in addition to treatment for illness and injury. Our providers follow generally accepted medical practice when prescribing any course of treatment.
You must show your identification card (ID card) every time you request health care services from a Network provider. If you do not show your ID card, Network providers have no way of knowing that you are enrolled under a UnitedHealthcare policy. As a result, they may bill you for the entire cost of the services you receive.
When you receive services from Plan providers, you will not have to submit claim forms or pay bills. You pay only the copayments, coinsurance, and deductibles described in this brochure. When you receive emergency services from non-Plan providers, you may have to submit claim forms.
You should join an HMO because you prefer the plans benefits, not because a particular provider is available. You cannot change plans because a provider leaves our Plan. We cannot guarantee that any one physician, hospital, or other provider will be available and/or remain under contract with us.;
Questions regarding what protections apply may be directed to us at 1-877-835-9861. You can also read additional information from the U.S. Department of Health and Human Services at www.healthcare.gov,
General features of our High Option Plan
- You must have referrals from your Primary Care Physician (PCP) for most services.
- We have a wide service area of participating providers you must use to access care.
- You will not have to routinely file claims for medical services.
- We have Customer Service available at 1-877-835-9861 (TTY: 711).
- We participate in the FSAFEDS Paperless Reimbursement Program (see Section 11 for more details regarding FSAFEDS).
How we pay providers
We contract with individual physicians, medical groups, and hospitals to provide the benefits in this brochure. These Plan providers accept a negotiated payment from us, and you will only be responsible for your cost-sharing, coinsurance, deductibles and any non-covered services and supplies. We follow Maryland state law for payment of non-participating providers when authorized by the Plan.
Your rights and responsibilities
OPM requires that all FEHB plans provide certain information to their FEHB members. You may get information about us, our networks, and our providers and facilities. OPM FEHB Website (www.opm.gov/insure) lists the specific types of information that we must make available to you. Some of the required information is listed below.
- M.D. IPA has been in existence since 1979
- M.D. IPA is a for-profit organization
You are also entitled to a wide range of consumer protections and have specific responsibilities as a member of this Plan. You can view the complete list of these rights and responsibilities by visiting our website, M.D. IPA at www.myuhc.com . You can also contact us to request that we mail a copy of that Notice.
If you want more information about us, call 1-877-835-9861, (TTY:711), or write to the M.D. IPA Federal Employees Health Benefits Program at 10175 Little Patuxent Parkway, 6th Floor, Columbia, MD 21044 or visit our Web site at www.uhcfeds.com.
By law, you have the right to access your protected health information (PHI). For more information regarding access to PHI, visit our website at www.myuhc.com to obtain a copy of our Notice of Privacy Practices. You can also contact us to request that we mail you a copy of that Notice.
Your medical and claims records are confidential
We will keep your medical and claims records confidential. Please note that we may disclose your medical and claims information (including your prescription drug utilization) to any of your treating physicians or dispensing pharmacies.
To enroll in this Plan, you must live in or work in our service area. This is where our providers practice. Our service area is:
District of Columbia
Cities of: Alexandria, Fairfax, Falls Church, Fredericksburg, Harrisonburg, Manassas, Manassas Park, and Winchester.
Counties of: Arlington, Clarke, Culpeper, Fairfax, Fauquier, Frederick, Greene, King George, Loudoun, Madison, Orange, Page, Prince William, Rappahannock, Rockingham, Shenandoah, Spotsylvania, Stafford and Warren.
Ordinarily, you must get your care from providers who contract with us. If you receive care outside our service area, we will pay only for emergency care benefits. We will not pay for any other healthcare services out of our service area unless the services have prior plan approval.
If you or a covered family member move outside of our service area, you can enroll in another plan. If your dependents live out of the area (for example, if your child goes to college in another state), you should consider enrolling in a fee-for-service plan or an HMO that has agreements with affiliates in other areas. If you or a family member move, you do not have to wait until Open Season to change plans. Contact your employing or retirement office.