You can use any doctor, clinic, hospital or health care facility in the national network, which helps save you money.
With this plan, you may pay less when you use Tier 1 providers. Be sure to look for the two blue hearts to ensure that your doctor will be in the Tier 1 network when your benefits start for the new year.
Look for the two blue hearts when doing a network search for a 2018 Tier 1 Provider.
The EDGE Plan highlights
Get a plan with access to a national network and help save with Tier 1 providers.
- You may save even more by using Tier 1 providers. They have been recognized for providing the greatest value from your health care benefits.
- There’s coverage if you need to go out of the network. Receive care and services from anyone in or out of our network. Out-of-network providers will likely charge you more than network providers.
- There's no need to choose a primary care physician (PCP) or get referrals to see a specialist.Consider choosing a PCP. Your PCP can be your partner in managing your care. They can help you avoid duplicating tests and services and connect you to a specialist.
- Preventive care is covered 100 percent in our network.
The network can help lower your costs.
To help you save money, we make it easier for you to find UnitedHealth Premium® providers in our network.
You may pay less with these Tier 1 providers
Where you go for care can make a difference.
Look for the Tier 1 blue dot when choosing doctors, hospitals and other health care providers. “Spot the dot” for providers that may offer you the greatest value from your health care benefits.
|Tier 1 (lowest cost option)||$|
|Out-of-network (highest cost option)||$$$|
- Tier 1 providers - these are primary care physicians (PCPs) and medical specialists who may offer you the greatest value from your health care benefits.
- Premium care physicians - these are physicians in designated specialties that have met benchmarks for quality and cost-efficient care criteria through the UnitedHealth Premium Program.
- Tier 1 oncologists - oncologists are doctors who treat cancer. They help manage a patient’s care and their cancer treatments
- Tier 1 hospitals - these hospitals usually charge less for the same services compared to other hospitals.
Save more by using network freestanding facilities
Freestanding facilities (also called Free standing centers) are health care facilities that do not bill as part of a hospital for services such as an MRI or surgery. To help you save money, we make it easy for you to find these providers.
Remember, if you go out of the network, you will be responsible for all of the costs. That can be very costly for you.
How the EDGE Plan works
- You pay a deductible before your plan will pay.
- You pay coinsurance, where you share a percentage of the cost with your plan. You may pay a lower percentage when you use Tier 1 providers.
- You reach an out-of-pocket limit. You'll never pay more than your out-of-pocket limit during the plan year. The out-of-pocket limit includes all of your network payments.
You may be required to receive approval for some services before they can be covered
Summary of covered services
This plan covers the following health care services and more, including:
- Doctor office visits
- Emergency services
- Hospital care
- Lab services
- Mental health and substance use disorder services
- Outpatient care services
- Pregnancy and newborn care
- Prescription drugs
- Preventive care services
- Rehabilitation services and devices
- Wellness services
This may not be a complete list of the services covered under this plan. This plan has exclusions, limitations and reductions of benefits. See your health plan documents for coverage details.