This Plan is an open access value plan that provides you the freedom to choose from any health care professional in the UnitedHealthcare Choice Plus network, including specialists, without a referral from your a primary care physician (PCP). You have the opportunity to save money by making more informed decisions about the providers you choose, by selecting physicians that have been recognized for delivering quality, cost-efficient care as well as certain lower-cost facilities. Since Choice Plus Primary is an open-access product, you can seek care from any provider but you may pay more out-of-pocket costs when you do not select from certain network providers and facilities.
We 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.
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 any plan because you prefer the plan’s 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.
OPM requires that FEHB plans be accredited to validate that plan operations and/or care management meet nationally recognized standards. Unitedhealthcare hold accreditation from the National Committee for Quality Assurance (NCCQA).
To learn more about this plan’s accreditation(s), please visit the following websites: National Committee for Quality Assurance at:(www.ncqa.org);
General features of our High Option Plan
This plan is designed to make healthcare more affordable for you. Coverage for your visits to your in-network primary care physician and our contracted virtual visit physician groups will always be paid at 100% and they are not subject to deductible. This means that you have no out of pocket expense whenever you visit your primary care physician for wellness visits, for treatment for illness, for preventive services and virtual visits. These visits as well as in-network specialist visits all covered without you having to meet your deductible.
We have Open Access benefits
Our plan offers Open Access benefits. This means you can receive covered services from a participating provider without a required referral from your primary care physician or by another participating provider in the network.
We have Point of Service (POS) benefits
Our plan offers Point-of-Service (POS) benefits. This means you can receive covered services from a non-participating provider. However, out-of-network benefits may have higher out-of-pocket-costs than our in-network benefits.
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 (copayments, coinsurance, deductibles, and non-covered services and supplies).
Preventive care services
Preventive care services are generally covered with no cost sharing and are not subject to copayments, deductibles or annual limits when received from a network provider.
The annual medical deductible must be met before Plan benefits are paid for many services other than preventive care services or services specifically designed as not requiring the deductible. Your deductible for this plan is $500 for Self only and $1,000 for Self Plus One or Self and Family for In-Network and $3,000 Self Only and $6,000 Self Plus One or Self and Family Out-of-network. Information on how this deducible works can be found in Section 4 Your Cost for Covered Services. This plan has services that are paid prior to meeting your deductible such as in-network primary care visits (paid at 100%) and in-network specialist visits.
Health education resources and accounts management tools:
myuhc.com gives you the the ability to:
- Review eligibility and look up benefits
- Check current and past claim status
- Find a doctor or hospital, including UnitedHealth Premium designated physicians.
- Print a temporary ID card or request a replacement card
- Compare hospitals in quality, efficiency, and cost – all at the procedure level
- “Chat” with a nurse in real-time
- Take a health assessment and participate in Health Coaching Programs
- Use the Personal Health Record to organize health data and receive condition specific information to better manage their health
- Learn about health conditions, symptoms and the latest treatment options
myHealthcare Cost Estimator
Changing the way you access health care information for the better, my Healthcare Cost Estimator (myHCE) allows you to research treatment options based on your specific situation. Learn about the recommended care, estimated costs and time to treat your condition. The care path allows you to see the appointments, tests and follow up care involved, from the first consult to last follow up visit. You can also learn about estimated costs ahead of time to help you plan. Create a custom estimate based on your own plan details and selected.
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. OPM’s 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.
- UnitedHealthcare Insurance Company has been in existence since 1972
- Profit status – for profit
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, www.uhc.com. You can also contact us to request that we mail you a copy of that Notice.
If you want more information about us, call 877-835-9861 or visit our website at www.uhcfeds.com or if already a member www.myuhc.com.
By law, you have the right to access your protected health information (PHI). For more information regarding access to PHI, visit our website www.uhc.com to obtain a 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:
Entire states of : Alabama, Arkansas. Florida, Illinois, Iowa, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Pennsylvania, Tennessee, Texas and Virginia
District of Columbia
Georgia, Atlanta - including the counties of: (Butts, Carroll, Cherokee, Clayton, Cobb, Coweta, Dawson, DeKalb, Douglas, Forsyth, Fulton, Gwinnett, Haralson, Heard, Henry, Houston, Jasper, Morgan, Newton, Paulding, Putnam, Rockdale, Spalding and Walton)
Missouri, St Louis: (including the Missouri counties of : Bollinger, Butler, Cape Girardeau, Clark, Clinton, Crawford, Dent, Dunklin, Franklin, Gasconade, Greene, Howell, Iron, Jefferson, Lewis, Lincoln, Madison, Marion, Mississippi, Monroe, Montgomery, New Madrid, Oregon, Pemiscot, Perry, Phelps, Pike, Ralls, Randolph, Reynolds, Ripley, Scott, Shannon, St. Charles, St. Clair, St. Francois, St. Louis, St. Louis City, Ste. Genevieve, Stoddard, Texas, Warren, Washington and Wayne)