United Healthcare Choice Plus
The United Healthcare (UHC) Choice Plus plan is a PPO plan that allows you to see any doctor in their network – including specialists – without a referral. United Healthcare has a national network of providers; however, you may use any licensed provider you choose.
There are two levels of coverage under the plan. Your level of coverage is determined each time you receive care, depending on whether you use a network or non-network provider. Your out-of-pocket costs under both levels of coverage may include office visit copayments, deductibles and coinsurance.
- Summary of Benefits and Coverage (2014, SBC)
- Summary of Benefits (2014)
- Summary of Benefits (2013)
- Summary of Benefits and Coverage (SBC)
This is the format mandated by the Affordable Care Act.
- Summary of Benefits for those living outside the U.S. (2014)
- SBC for those living outside the U.S. (2014)
In-Network: This level of benefits applies when you use a physician, specialist or other provider who is a member of the United HealthCare Choice Plus network. By utilizing In-Network providers, you will pay lower copayments, deductibles and coinsurance than you will using Out-of-Network providers. Please note that there is no penalty for seeking specialist care without a referral, thus providing more freedom and easier access to care.
Out-of-Network:This level of benefits applies when you use a provider who is not a member of the United HealthCare Choice Plus network. You will be covered, but you will pay higher copayments, deductibles, and coinsurance than you will using In-Network providers. In addition, you are responsible for any amounts incurred in excess of the "covered charges". "Covered charges" are pre-determined usual, customary and reasonable charges for a particular service. Covered charges may vary from one geographical area to another. Additionally, Out-of-Network providers may require you to pay for services at the time of service and you will have to file a claim with the Plan in order to be reimbursed.
Finding a Doctor
The United Healthcare Choice Plus network is a national network of providers. To locate a medical provider, go to UHC's on-line directory, or contact UHC member services by phone at 1-888-332-8885.
Mental Health/Substance Abuse
The Plan provides inpatient, intermediate and outpatient care. There is a network of United providers (United Behavioral Health), but you may go to any provider. Benefits are paid differently, depending on whether you use network or non-network providers. Please note that out-of-network benefits will be paid according to predetermined covered charges and you will be responsible for remaining balances.
Prescription Drug Plan
Participants in the United Healthcare Choice Plus plan automatically participate in the prescription drug plan from OptumRx, a United Healthcare Group company. You can choose between retail and mail order options. If you are a member of the United Healthcare Choice Plus plan, and take maintenance prescription medication, we encourage you to investigate the mail order option. Most participants find it very convenient, and it may save you money as well.
New for 2014
Participants in the United Healthcare Choice Plus PPO through Georgetown University will have the opportunity to enroll in CRX International. This mail order prescription service offers a safe, cost effective alternative to current options for many brand name maintenance medications. If you participate with CRX International, you will have a $0 copay for those medications included in the CRX formulary. Find more information, go to the Georgetown-specific CRX website, or call CRX at 1-866-488-7874.
Filing a Claim
When you use a network provider, that provider will submit your claim to United Healthcare on your behalf. United will pay the provider as determined by plan rules and send you an Explanation of Benefits (EOB) which details for you the total amount billed by the provider, the amount that United paid, and the amount for which you are liable. Your provider will send you an invoice for the amount for which you are liable (if any).
When you use a non-network provider, your provider may require you to pay the full bill at the time the service is rendered. You should then submit a copy of your invoice to United Healthcare, along with a claim form. United will reimburse your for any amount determined to be payable by the Plan.