Frequently asked questions
Find answers to common questions about health plans and coverage
Whether you're new to your health plan or have been a member for years, from time to time, it's natural that questions may pop up. We've gathered common health plan and coverage questions below to help you get started with finding the answers you may be looking for.
If you're looking for answers about your specific health plan benefits and coverage, the first step is to sign in to your health plan account. There, you can find details that are specific to you and your health plan.
Accessing your health plan information
When you sign in to your health plan account, you’ll find ways to view your personalized information and manage the details of your plan. Here are a few things you can do when you set up your account and use your member site:
- Find network doctors and pharmacies
- Find and estimate costs
- View and pay claims
- Check your account balances
- Learn about covered preventive care
If you get your health plan through work, you may have a change in your group number at times. However, you will not need to re-register with your new group number or create a new username or password.
- Your registration stays the same even if you switch employers or if your employer changes group numbers
- When you sign in to your health plan account, you can choose which account you want to see: the old group number account or the new group number account
When you're out and about, the UnitedHealthcare app helps you access your health plan details, like digital ID cards, network providers, claims and coverage information and more. You can download it on the App Store® or on Google Play® for free.
Yes. You can call the number on your member ID card. It can help to write the number down or save it to your phone so you have it handy if you lose your card.
Your member ID card (health plan ID card)
While you’re watching the mail for your member ID card to arrive, there are a few things you can do while you’re waiting for your coverage to start, including looking for network providers and learning how to register for a health plan account.
When you have your member ID card, you can get started by reviewing the new member checklist. You'll get information on how to register for a health plan account, find a doctor, learn about your benefits and more.
With almost every plan, you may pay less for health care when you choose providers in your network.
- If you're already a member and have your member ID card, sign in to your health plan account or use the UnitedHealthcare app to view network doctors, clinics and providers for your health plan.
- If you don’t have your member ID card yet or if you're shopping for a health plan, you can still use the provider search tool to learn which doctors, clinics and providers are in network.
Virtual visits (or telehealth) are a way to connect with a health care provider from home or at work. With virtual visits, you use digital technologies, like your smartphone, tablet or computer, to talk with a provider. You may get treatment options and may even get prescriptions for medications, if needed.
We offer members options for telehealth visits with local providers or by using UnitedHealthcare preferred national providers. Sign in to your health plan account to learn about telehealth options available with your benefits.
Benefits and coverage
Checking your benefits may help you avoid cost surprises, so it’s good to review what’s covered and what’s not before you make an appointment.
- Sign in to your health plan account to review what’s covered under your plan
- If you want a copy of your coverage documents mailed to you, call the phone number on your member ID card to request a copy
If your member ID card states "Referrals Required," you'll need an electronic referral from your primary care provider (PCP) before seeking services from another network provider. A referral is when a PCP authorizes a covered person to see a specialist for diagnosis or treatment of a medical condition. Most often, that means you have to contact your PCP before seeing a specialist.
Not all health plans require a referral, but if your plan does, ask your PCP or clinic for an electronic referral before you visit a specialist. Without this referral, you may pay more or your care may not be covered.
If you don’t know if you need a referral, sign in to your health plan account to review your benefits or call the number on your member ID card to learn more.
Prior authorization means getting approval before you can get access to medication or services. With prior authorization, your health plan agrees to help pay for the service (this is subject to any cost-sharing or other limitations) — and it’s important to know that ahead of time. Review our list of common terms to get more help with understanding health insurance terms.
Yes — you can enjoy less paper and less clutter. Sign up to get your required communications online instead. Just sign in to your health plan member account to get started.
Managing costs and claims
You can find an overview of your HSA details when you sign in on myuhc.com.
- Go to Claims & Accounts to see your claims status and history.
- Go to Coverage & Benefits to see what’s covered under your plan.
You can also call the number on your member ID card to talk with a representative.
Pharmacy and prescriptions
If you're looking for specific details about your prescription drug coverage, you may sign in to your health plan account. After you're signed in, go to pharmacy and prescription coverage to locate a network pharmacy.
When you're signed in, you can also:
- See your medication cost and coverage.
- See if your medications have any requirements, like prior authorization or step therapy, before filling them.
- Sign up for home delivery if it's available with your plan. With some plans, you may be able to order up to a 3-month supply of medications you take regularly.
You can also call the phone number on your member ID card with questions.
You’ll find the detail about most prescription drug benefits by looking at your plan’s Prescription Drug List (PDL), also called a Formulary. It’s a list of medications and how they’re covered by your plan. If you have a prescription for a certain kind of medication, you can look it up in your PDL to see how it’s covered.
Sign in to your health plan account and look under your pharmacy and prescription coverage information to see your plan’s PDL.
If you have a new plan or if you have a new prescription mediation, sign in to your health plan account and look under your pharmacy and prescription coverage information to understand your coverage.
When your doctor prescribes medication, look at your Prescription Drug List (PDL) and talk about the cost. You can ask about a lower cost alternative if the drug your doctor chooses is too expensive or isn’t covered. At times, a similar drug may work just as well — like if there’s a generic version of the drug.
We’re always looking out for what may be the safest, most effective and lower cost medication to include with our health plans. As the options on the market change, you may see changes in covered prescriptions for your plan.
You can sign in to your health plan account to view your Prescription Drug List (PDL) and check your coverage. Your PDL shows medications that are covered by your plan. It may also help you understand plan requirements that may affect your coverage for a medication.
Accreditations and certifications
What accreditations and certifications has UnitedHealthcare received?
National Committee for Quality Assurance (NCQA) has awarded UnitedHealthcare:
Health Plan Accreditation
NCQA Health Plan Accreditation is a nationally recognized evaluation that purchasers, regulators and consumers can use to assess health plans.
- Many of UnitedHealthcare's health plans have been awarded NCQA Health Plan Accreditation. This includes Commercial HMO, HMO/POS, and PPO plans and Marketplace HMO, EPO and PPO plans.
- Check the accreditation status for health plans at NCQA Health Plan Report Card.
Physician Quality Certification
NCQA's Physician Quality (PQ) Certification program evaluates how well health plans measure and report the quality and cost of physicians.
- Check on certification status for Physician Quality at NCQA Physician Quality Report Card.
NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance.
CHAP Hospice Standards of Excellence has been awarded to Evercare Hospice & Palliative Care, a UnitedHealthcare preferred provider.
Community Health Accreditation Program, Inc. (CHAP) is an independent not-for-profit accrediting body for community-based health care organizations. CHAP has deeming authority by the Centers for Medicare and Medicaid Services (CMS), meaning CHAP has full deeming authority for home health, hospice and home medical equipment providers.
More questions? We’re here to help.
Contact us or call the phone number on your member ID card to talk with a representative.
- Tools and information may vary based on your benefit plan.
- Note this functionality is not available to Community & State New Jersey members.
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