Overview of UnitedHealthCare
UnitedHealthCare is an operating division of UnitedHealth Group, the largest single health carrier in the United States. UnitedHealth Group Inc. is an American for-profit managed health care company based in Minnetonka, Minnesota. UnitedHealth Group offers health care products and insurance services.
UnitedHealthCare has four divisions; UnitedHealthCare Employer and Individual, UnitedHealthCare Community and State, UnitedHealthCare Medicare and Retirement, and UnitedHealthCare Global. UnitedHealthcare offers commercial group health insurance plans across the United States under several product names with different offerings.
UnitedHealthcare Select is exclusive provider organization (EPO) with no coverage for out-of-network providers while UnitedHealthcare Select Plus is a preferred provider organization (PPO). UnitedHealthcare Choice functions as a HMO plan with access to specialists, whereas UnitedHealthcare Choice Plus is an HMO which allows for out-of-network coverage.
UnitedHealthcare Navigate, Charter, and Compass require a primary care physician referral to see a specialist meaning that they are more restrictive managed care plans, similar to point of service plans.
UnitedHealthcare has various insurances all with different plans. No matter which plan an individual chooses, they will pay a monthly payment (premium) to keep their insurance coverage. A co-payment or co-insurance may be paid each time an individual receives medical care. Generally, the more a person pays per month (premium), the lower the deductible (out-of-pocket costs). Individuals can enroll in a plan only during an open enrollment period. If a person is between open enrollment periods, they might be eligible for special enrollment. The list of qualifying life events may include marriage, birth of a baby, change of address, job change, etc.
These different types of insurances include:
- Health Insurance Plans: Medicare and Medicaid, Self-Employed Health Insurance and Individual and Family Insurance
- Short Term Insurance
- Dental Insurance
- Supplemental Insurance
- Student Health Insurance
- Vision Insurance
- Term Life Insurance
- Accident Insurance
- Critical Illness Insurance
- International Travel Medical Insurance
- Hospital and Doctor Insurance
- Dual Eligible Special Needs Plans (DSNP)
- Children’s Health Insurance Program (CHIP)
UnitedHealthCare provides individuals the option of insurance bundles, in order to get the coverage that an individual needs. Individuals may choose insurance bundles if they are concerned about costs, lack of benefits under a plan, etc. Bundles may include:
- Bundling short term health insurance and dental insurance
- Bundling fixed indemnity insurance and dental insurance
- Dental and vision insurance bundle
- Accident and dental insurance bundle
Summary of Benefits and Coverage
A Summary of Benefits and Coverage (SBC) is something that all health plan companies are required to provide in order to help an individual make a decision about choosing a plan and utilizing the benefits that come with each plan. This document outlines cost and what is covered as well as not covered under the health plan. Below is what is included in an SBC:
- An overview of what’s covered.
- An explanation of what’s not covered and/or the limits on coverage.
- Information on costs you might have to pay – like deductibles, coinsurance and copayments.
- Coverage examples, including how coverage works in the case of a pregnancy or a minor injury.
- A reminder that the SBC is only a summary. To get all the details, you’ll want to look at complete health plan documents.
- Information about where to go online to review and print copies of complete health plan documents.
- Where to find a list of network providers.
- Where to find prescription drug coverage information.
- Where to find a Glossary of Health Coverage and Medical Terms. (also called a “Uniform Glossary”.)
- A contact number to call with questions.
- A statement on whether the plan meets minimum essential coverage (MEC) for the Affordable Care Act (ACA).
- A statement that it meets minimum value (plan covers at least 60 percent of medical costs of benefits for a population on average).
To obtain a Summary of Benefits and Coverage for a UnitedHealthCare plan visit: https://www.uhc.com/contact-us
Behavioral Health Benefit
While each plan under UnitedHealthCare is individualized, there is a behavioral health benefit. This includes counseling and substance abuse recovery services. To access the behavioral health benefit, an individual must visit liveandworkwell.com and click the “find a provider” link. Here an individual has the option to see a provider in person or via private video conferencing. Services received through the behavioral health benefit may require pre-authorization and/or co-payment and/or coinsurance, and there may be a deductible. There is no charge for obtaining a referral, and an individual may access information and develop personal plans at liveandworkwell.com as often as needed want for free. For other information on mental health services visit myuhc.com, select “Benefits & Coverage,” and click the “Mental Health and Substance Abuse” link or call the toll-free phone number on the back of the supplied ID card.
References and Additional Resources