How to understand what's covered.

What’s covered in each plan isn’t apples to apples. To find a plan that’s best for you, it is important to think about the coverage you’ll need for the year.

Plans cover network and out-of-network care providers differently

Each plan has agreed to cover care through a network of designated doctors, specialists, and facilities. Some plans only help cover care within its own network. Other plans are more flexible and agree to cover a part of the cost for out-of-network providers.

Plans cover preventive and diagnostic care differently

The care you receive is considered either preventive or diagnostic, and each health plan covers each of these differently.

Preventive care

Helps you stay healthier — before you have symptoms.

Diagnostic care

Helps you determine what's wrong — when you already have symptoms. 

  • Routine checkups, immunizations, and tests are considered preventive: Check to make sure you know each plan’s covered preventive services and how often you can use these services in one plan year. For example, your plan may cover the bill for one wellness visit per year.
  • Services other than routine care are considered diagnostic: It’s always a smart idea to ask if certain tests, procedures, doctors and specialists are considered diagnostic before you receive care. These services generally cost a lot more.
  • Get the care you need and save: Our QuickCare FinderTM tool can help you find a wider range of other treatment options to help you get care for minor care needs or injuries and may help you save.

A doctor's visit could be considered:

Preventive
If you visit your doctor for a wellness checkup.

Diagnostic
If you visit your doctor because you have a cough that isn't getting better.

A mammogram could be considered:

Preventive
If you have a routine mammogram to screen for breast cancer.

Diagnostic
If your doctor orders a mammogram to learn more about a lump that was found.

A colonoscopy could be considered:

Preventive
If you have a routine colonoscopy but do not have symptoms.

Diagnostic
If your doctor does a colonoscopy based on symptoms you're having.

 

Plan for the coverage you need.

We all have different coverage needs. Before picking a plan, it’s important to identify what kinds of care you’ll need and if your plan will help cover those costs.

1. Identify the coverage most important to you

Think through what coverage you'll need in the coming year and see which plan aligns the best.

Who do you need coverage for and what health services do they use most?

Do you foresee any major life changes that could affect your coverage needs, such as pregnancy, chronic conditions, surgeries, etc.?

Are your medications covered on the plan's Prescription Drug List (PDL)?

Is your favorite doctor or specialist covered in the plan's network?

Will you need vision and dental coverage?

2. Compare each plan's coverage details

Once you've identified the coverage you care about, there are at least two plan documents you can look at to identify what's covered.

Review each plan's summary of benefits
Every plan year, you will receive from your employer a new summary of benefits, which includes an overview of coverage for each plan such as benefits, cost-sharing requirements, and coverage limitations and exceptions.

Ask for the full coverage document
If you still l have questions or want to dive deeper into a plan's coverage details, ask your employer for a copy of the entire plan coverage document.

3. Confirm coverage before you receive care

Don’t hesitate to ask questions and make sure you know what specifics your plan is covering before you receive care. If you have a health plan through UnitedHealthcare, visit your member website (myuhc.com®) or call the number on your health plan ID card to confirm what’s covered.

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