Medical plans

With tailored network strategies and innovative benefit and plan designs, UnitedHealthcare medical plans are built to help meet the care and cost needs of your clients and their employees.

Our innovative approach to care and coverage

Delivering access to quality care at lower costs

Our network strategies are designed to deliver powerful solutions that may enhance overall plan value and performance. Plan designs are built for access, supported by the nation's largest proprietary network1 and designed to guide employees to evidence-based, cost-efficient care.

Encouraging health ownership

Plan designs and popular benefits — such as $0 copays, virtual care access and more — are built to help promote healthier choices and encourage employees to take steps toward better health.

Delivering a better health care experience

Plans include access to tools and resources designed to help employees understand their plan and navigate the health care system to get care, at the right place, at the right time.

Collaborating closely with providers

Through incentives, value-based arrangements and collaborative data sharing, we help enable delivery of quality, cost-efficient care.

Improving access to care, lowering costs

Infused with expertise and analytics, UnitedHealthcare medical plans are driven and supported by curated strategies and solutions like these, with the goal of delivering better health and lower costs.

Centers of Excellence (COEs)

Our COE program is designed to drive lower costs, fewer complications and shorter recovery times, such as a 22% shorter length of hospital stay for transplant patients compared to the national benchmark.2

Payment integrity

Experts estimate that 25% of all health care spending is wasteful.3 Our payment integrity solutions work to help reverse this trend by implementing strategies like focused claims reviews to help identify errors and fraud/abuse, which has resulted in $34.86 average savings per member per month.4

Provider relationships

Patients who regularly engaged with a primary care provider (PCP) had 10% lower costs than those who didn’t.5 And because PCPs can impact 62% of the health care dollar,5 we work closely with providers with the goal of achieving better results on everything from site of care guidance to reducing unnecessary or duplicative testing to cost-effective prescribing.

Share with your clients

Solutions designed to help improve claims accuracy and control costs.

Program helps employees locate quality and cost-efficient providers and review options.

See why this network option helps your clients' employees make more informed choices in their health care.

Learn more about this open-access plan offering a large national network with more than 1 million doctors and over 6,000 hospitals.6

A selection of UnitedHealthcare medical plan options

A selection of UnitedHealthcare medical plan options
Examples Details
Choice and Choice Plus

These traditional open-access health plans give employees and covered family members the freedom to choose a network physician or specialist from the UnitedHealthcare Choice/Choice Plus network without a referral from a primary care provider (PCP).

  • With Choice plans, employees must receive care from network providers for benefits to be covered. There is out-of-network coverage for emergency services only
  • Choice Plus plans include plan coverage for out-of-network providers at a lower benefit level
UnitedHealthcare Navigate® and UnitedHealthcare Charter®
(not available in all states; reach out to your UnitedHealthcare representative regarding availability in your market)

Navigate and Charter offer a variety of plan design options that provide traditional benefits with the guidance of a PCP.

  • Both have their own national network that employers can narrow, which is different than with the Choice network
  • For Navigate and Charter, non-network coverage is not available, except in the case of emergency care, or it's provided at the lowest level of coverage for some plan options
Tiered benefits

Tiered benefits are built on traditional UnitedHealthcare plans and include additional features that help encourage employees and covered family members to receive their care from providers and facilities that may offer the greatest value, with the flexibility to access the larger network at higher cost-sharing.

  • Premium tiering allows for tiering on UnitedHealth Premium® designated PCPs and specialists
  • Hospital tiering on Premium designated PCPs, specialists and hospitals (market restrictions apply)
  • Place of service differentials help empower employees to receive a lower cost-share if services are delivered from a freestanding facility versus a hospital-based facility
  • Preferred lab tiering allows employees to receive lab services at no additional cost when services are delivered by a Preferred Lab facility
NexusACO®

NexusACO plans offer access to high-performing providers and Accountable Care Organizations (ACOs) through tiered plan designs.

  • Multiple plans are available to help meet employer needs, including non-referral open access plans and PCP centered plans with referral requirements
UnitedHealthcare FlexWorkTM

UnitedHealthcare FlexworkTM is a new coverage making healthier possible for all by providing comprehensive, customizable benefit options for full-time, part-time, and anytime employees.

Learn more about UnitedHealthcare Flexwork

All Savers® Alternate Funding
(for employers with 5 to 300 employees)

All Savers consists of 3 parts:

  • Self-funded medical plan that pays covered medical expenses
  • Third-party administration for claims processing
  • Billing and plan participant services and stop loss insurance
Preventive Plan
(only for self-funded employer groups with at least 100 employees)

A limited benefit plan with coverage focusing on 100% preventive care and preventive medications. Preventive Plan meets the minimum standard requirements for value and affordable health care coverage required to be offered by certain employers.

The value of simplicity through integrated benefits

Integrated medical benefits with specialty, pharmacy and behavioral may create opportunities to diagnose and manage chronic conditions sooner, identify and deploy clinically effective treatments, intervene early in behavioral issues and more.

Footnotes

  1. UnitedHealthcare internal analysis as of Sept. 30, 2020.
  2. Hanson S., Bentley T. 2014 U.S. organ and tissue transplant cost estimates and discussion. Milliman, Inc. Published December 30, 2014. Accessed March 2, 2020. Note: Length of Stay (LOS) includes days within the inpatient confinement period of a transplant episode. Optum BoB LOS adjusted for transplant mix to match that of Milliman.
  3. William H. Shrank, MD, MSHS; Teresa L. Rogstad, MPH; Natasha Parekh, MD, MS. “Waste in the US Health Care System: Estimated Costs and Potential for Savings.” JAMA. 2019;322(15):1501-1509.
  4. Savings are based on 2018 UnitedHealthcare ASO data analysis.
  5. National Health Expenditures, 2018 Highlights (pdf)
  6. UnitedHealthcare Employer & Individual network statistics, ending Q2, 2020.

Disclaimers

This policy has exclusions, limitations and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, contact your UnitedHealthcare sales representative.

Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Health Plan coverage provided by or through a UnitedHealthcare company.

Administrative services provided by United HealthCare Services, Inc. or their affiliates, and UnitedHealthcare Service LLC in NY. Stop-loss insurance is underwritten by All Savers Insurance Company (except MA, MN, NJ and NY), UnitedHealthcare Insurance Company in MA and MN, UnitedHealthcare Life Insurance Company in NJ, and UnitedHealthcare Insurance Company of New York in NY.