Connect Gold CMS Standard
Cigna Health and Life Insurance Company
Plan overview
Medical deductible
Individual: $2000
Family: $4000
Per Person: $2000
Prescription drug deductible
Individual: $0
Family: $0
Per Person: $0
Combined medical and drug out of pocket maximum
Individual: $8200
Family: $16400
Per Person: $8200
Office visit
Primary Doctor
CoPay: $30.00
CoInsurance: Not Applicable
Covered: Covered
Benefit Explanation: Including doctor visits in the home and online visits. Includes Mental Health Office Visits and Substance Use Disorder Office Visits. Refer to the policy for more information about Virtual Care Services.
Specialist
CoPay: $60.00
CoInsurance: Not Applicable
Covered: Covered
Benefit Explanation: This benefit applies to Specialist Office Visits. All other Outpatient Services are covered at the Outpatient professional services benefit. Please refer to the Policy for more information.
Prescription drug information
Preferred brand drugs
CoPay: $30.00
CoInsurance: Not Applicable
Covered: Covered
Limit Quantity:
Limit Unit:
Benefit Explanation: You pay a copayment for each 30 day supply. 30-day supply at any Participating Pharmacy or up to a 90-day supply at a Designated 90-day Pharmacy. The cost-sharing payment for a covered prescription insulin drug is limited to a $50 maximum per 30 day supply. Refer to the prescription drug list for more information. Covers prescription legend drugs from either a Retail Pharmacy or the PBM's Home Delivery Pharmacy; self-administered injectable drugs; self-injectable insulin and supplies and equipment used to administer insulin; self-administered contraceptives, including oral contraceptive drugs, self-injectable contraceptive drugs, contraceptive patches, and contraceptive rings. Certain contraceptives are covered under the 'Preventive Care' benefit. Includes coverage for special food products or supplements when prescribed by a Doctor when medically necessary; Flu Shots (including administration). Inpatient or IV therapy drugs used in the treatment of cancer pain will not be denied on the basis that the dosage exceeds the recommended dosage of the pain relieving agent, if prescribed in compliance with established statutes pertaining to patients with intractable cancer pain.
Non preferred brand drugs
CoPay: $60.00
CoInsurance: Not Applicable
Covered: Covered
Limit Quantity:
Limit Unit:
Benefit Explanation: You pay a copayment for each 30 day supply. 30-day supply at any Participating Pharmacy or up to a 90-day supply at a Designated 90-day Pharmacy. Covers prescription legend drugs from either a Retail Pharmacy or the PBM's Home Delivery Pharmacy; self-administered injectable drugs; self-injectable insulin and supplies and equipment used to administer insulin; self-administered contraceptives, including oral contraceptive drugs, self-injectable contraceptive drugs, contraceptive patches, and contraceptive rings. Certain contraceptives are covered under the 'Preventive Care' benefit. Includes coverage for special food products or supplements when prescribed by a Doctor when medically necessary; Flu Shots (including administration). Inpatient or IV therapy drugs used in the treatment of cancer pain will not be denied on the basis that the dosage exceeds the recommended dosage of the pain relieving agent, if prescribed in compliance with established statutes pertaining to patients with intractable cancer pain.
Generic drugs
CoPay: $15.00
CoInsurance: Not Applicable
Covered: Covered
Limit Quantity:
Limit Unit:
Benefit Explanation: You pay a copayment for each 30 day supply. 30-day supply at any Participating Pharmacy, or up to a 90-day supply at a Designated 90-day Pharmacy. Refer to the prescription drug list for more information. Covers prescription legend drugs from either a Retail Pharmacy or the PBM's Home Delivery Pharmacy; self-administered injectable drugs; self-injectable insulin and supplies and equipment used to administer insulin; self-administered contraceptives, including oral contraceptive drugs, self-injectable contraceptive drugs, contraceptive patches, and contraceptive rings. Certain contraceptives are covered under the 'Preventive Care' benefit. Includes coverage for special food products or supplements when prescribed by a Doctor when medically necessary; Flu Shots (including administration). Inpatient or IV therapy drugs used in the treatment of cancer pain will not be denied on the basis that the dosage exceeds the recommended dosage of the pain relieving agent, if prescribed in compliance with established statutes pertaining to patients with intractable cancer pain.
Specialty drugs
CoPay: $250.00
CoInsurance: Not Applicable
Covered: Covered
Limit Quantity:
Limit Unit:
Benefit Explanation: Including other high cost drugs. You pay a copayment for each 30 day supply. 30-day supply at any Participating Pharmacy or up to a 30-day supply at a Designated 90-day Pharmacy. The cost-sharing payment for a covered prescription insulin drug is limited to a $50 maximum per 30 day supply. Covers prescription legend drugs from either a Retail Pharmacy or the PBM's Home Delivery Pharmacy; self-administered injectable drugs; self-injectable insulin and supplies and equipment used to administer insulin; self-administered contraceptives, including oral contraceptive drugs, self-injectable contraceptive drugs, contraceptive patches, and contraceptive rings. Certain contraceptives are covered under the 'Preventive Care' benefit. Includes coverage for special food products or supplements when prescribed by a Doctor when medically necessary; Flu Shots (including administration). Inpatient or IV therapy drugs used in the treatment of cancer pain will not be denied on the basis that the dosage exceeds the recommended dosage of the pain relieving agent, if prescribed in compliance with established statutes pertaining to patients with intractable cancer pain.
Inpatient coverage
Hospital services
CoPay: Not Applicable
CoInsurance: 25.00% Coinsurance after deductible
Covered: Covered
Benefit Explanation: Benefits for room, board, and nursing services include: a room with two or more beds; a private room when medically necessary for isolation and no isolation facilities are available; a room in an approved special care unit; meals, special diets; general nursing services; operating, childbirth, and treatment rooms and equipment; prescribed drugs; anesthesia, anesthesia supplies and services given by the hospital or other provider; medical and surgical dressings and supplies, casts, and splints; blood and blood products; diagnostic services. Includes coverage for general anesthesia and hospitalization services when determined by dentist and treating physician that such services are required to effectively and safely provide dental care for (i) children under the age of 5, (ii) covered persons who are severely disabled, or (iii) covered persons who have a medical condition that requires admission to a hospital or Outpatient surgery facility.
Inpatient services
CoPay: Not Applicable
CoInsurance: 25.00% Coinsurance after deductible
Covered: Covered
Benefit Explanation: Includes medical care visits; intensive medical care when medically necessary; treatment for a health problem by a Doctor who is not your surgeon while you are in the Hospital for surgery; treatment by two or more Doctors during one Hospital stay when the nature or severity of your health problem calls for the skill of separate Doctors; a personal bedside exam by another Doctor when asked for by your Doctor; surgery and general anesthesia; professional charges to interpret diagnostic tests such as imaging, pathology reports, and cardiology. Surgeries and procedures to correct congenital abnormalities that cause functional impairment and congenital abnormalities in newborn children; other invasive procedures, such as angiogram, arteriogram, amniocentesis, tap or puncture of brain or spine; endoscopic exams, such as arthroscopy, bronchoscopy, colonoscopy, laparoscopy; treatment of fractures and dislocations; anesthesia and surgical support when medically necessary; medically necessary pre-operative and post-operative care. Medical benefits are limited to certain oral surgeries including: treatment of medically diagnosed cleft lip, cleft palate, or ectodermal dysplasia; maxillary or mandibular frenectomy when not related to a dental procedure; alveolectomy when related to tooth extraction; orthognathic surgery because of a medical condition or injury or for a physical abnormality that prevents normal function of the joint or bone and is medically necessary to attain functional capacity of the affected part; oral / surgical correction of accidental injuries; surgical services on the hard or soft tissue in the mouth when the main purpose is not to treat or help the teeth and their supporting structures; treatment of non-dental lesions, such as removal of tumors and biopsies; incision and drainage of infection of soft tissue not including odontogenic cysts or abscesses. Includes surgical treatment of injuries and illnesses of the eye.
Emergency and urgent care
Emergency room
CoPay: Not Applicable
CoInsurance: 25.00% Coinsurance after deductible
Covered: Covered
Benefit Explanation: Benefits are available in a Hospital Emergency Room or an independent, free-standing emergency facility for services and supplies to treat the onset of symptoms for a medical emergency. Out-of-network: You pay the same level as In-network if it is an emergency as defined in your plan, otherwise Not covered.
Urgent care facility
CoPay: $45.00
CoInsurance: Not Applicable
Covered: Covered
Benefit Explanation: Includes X-ray services; Care for broken bones; Tests such as flu, urinalysis, allergy test, pregnancy test, rapid strep; Lab services; Stitches for simple cuts; and Draining an abscess. Out-of-Network: You pay the same level as In-network if it is an Urgent Health Problem as defined in your plan, otherwise Not covered. See Policy for telehealth coverage details.
Maternity
Labor and delivery hospital stay
CoPay: Not Applicable
CoInsurance: 25.00% Coinsurance after deductible
Covered: Covered
Benefit Explanation: Includes services needed during a normal or complicated pregnancy and for services needed for a miscarriage. Covered maternity services include: pregnancy testing; professional and facility services for childbirth including use of the delivery room and care for normal deliveries, in a facility or the home including the services of a licensed nurse midwife, certified midwife or licensed certified midwife; anesthesia services to provide partial or complete loss of sensation before delivery; routine nursery care for the newborn during the mother's normal hospital stay, including circumcision of a covered male dependent; allowed fetal screenings, which are genetic or chromosomal tests of the fetus. Hospital stay for childbirth for mother and newborn may not be limited to less than 48 hours after vaginal birth or less than 96 hours after a cesarean section, unless the mother and attending provider request it.
Pre and Postnatal office visit
CoPay: Not Applicable
CoInsurance: 25.00% Coinsurance after deductible
Covered: Covered
Benefit Explanation: Includes prenatal and postnatal services for the mother; postnatal services for the baby, including hemoglobinopathies screening; gonorrhea prophylactic medication; hypothyroidism screening, PKY screening and Rh incompatibility testing.
Vision
Routine Eye Exams for Children
CoPay: Not Applicable
CoInsurance: No Charge
Covered: Covered
Limit Quantity: 1
Limit Unit: Visit(s) per Year
Benefit Explanation: Includes complete eye exam with dilation, as needed to check all aspects of vision, including the structure of the eyes and how well they work together.
Major dental care
Routine dental checkups for children
CoPay:
CoInsurance:
Covered: Not Covered
Limit Quantity:
Limit Unit:
Routine dental checkups for adults
CoPay:
CoInsurance:
Covered:
Limit Quantity:
Limit Unit:
Benefit Explanation:
Medical plan coverage offered by: ((page_properties.carrierName)) of Arizona, Inc.; Rocky Mountain Health Maintenance Organization, Incorporated in CO; UnitedHealthcare of Florida, Inc.; UnitedHealthcare of Georgia, Inc.; UnitedHealthcare of Illinois, Inc.; UnitedHealthcare Insurance Company in LA, TN and AL; Optimum Choice, Inc. in VA and MD; UnitedHealthcare Community Plan, Inc. in MI; UnitedHealthcare of North Carolina, Inc.; UnitedHealthcare of Oklahoma, Inc.; UnitedHealthcare of Texas, Inc.; and UnitedHealthcare of Oregon, Inc. in WA. Administrative Services provided by United HealthCare Services, Inc. or their affiliates.
Plan specifics and benefits may vary by coverage area and by plan category. Please review the plan details to learn more. This policy has exclusions, limitations, reduction of benefits, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, call or write your insurance agent or the company (whichever is applicable). By responding to this offer, you agree that a representative may contact you.
You are required to select a Primary Care Physician (PCP) within our network. Your PCP refers you to specialists when necessary. If you use a specialist without a referral or see a provider who is not in your network, you may have to pay the full cost of the benefits and services. Emergency services received by an out-of-network provider are covered.
Health Maintenance Organization, Inc. in Colorado and UnitedHealthcare Insurance Co. in Tennessee. Administrative Services provided by United HealthCare Services, Inc. or their affiliates.
Plan specifics and benefits may vary by coverage area and by plan category. Please review the plan details to learn more. This policy has exclusions, limitations, reduction of benefits, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, call or write your insurance agent or the company (whichever is applicable). By responding to this offer, you agree that a representative may contact you.
Disclaimers
Aetna
Aetna Health Plans for Individuals, Families and the Self-Employed are underwritten by Aetna Life Insurance Company (Aetna). In some states, individuals may qualify as a business group of one and may be eligible for guaranteed issue, small group health plans. Rates displayed are quoted rates only. Final rates are subject to change based on your eligibility, age, zip code, smoking status, state regulations, effective date of coverage, and any optional benefits selected. Thank you for choosing Aetna. The rates for Aetna are provided by Quotit.
Aetna CVS Health, HealthAmerica PA
Compliance with State law. An agent or broker that enrolls qualified individuals in a QHP in a manner that constitutes enrollment through the Exchange or assists individuals in applying for advance payments of the premium tax credit and cost-sharing reductions for QHPs must comply with applicable State law related to agents and brokers, including applicable State law related to confidentiality and conflicts of interest.
Anthem Blue Cross
Health care service plans provided by Anthem Blue Cross. Insurance policies provided by Anthem Blue Cross Life and Health Insurance Company. Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association®. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc.® The Blue Cross name and symbol are registered marks of the Blue Cross Association.
Anthem Blue Cross Blue Shield
Anthem Blue Cross and Blue Shield is the trade name of Rocky Mountain Hospital and Medical Service, Inc. Independent licensees of the Blue Cross and Blue Shield Association®. Registered marks Blue Cross and Blue Shield Association. Serving residents and businesses in Colorado and Nevada.
Arise Health Plan
Rates shown are preliminary and subject to change. Final rates are always determined by the health insurance company or, if the policy is purchased through healthcare.gov, by the Health Insurance Marketplace.
Please note: The rates shown are for your requested effective date. Your effective date is subject to approval by WPS Health Plan, Inc. (d/b/a Arise Health Plan). If the actual effective date of your policy is different from your requested effective date, the cost of your policy may differ from the rates above. This difference may be due to rate increases and/or one or more family members having a birthday between the requested effective date and the actual effective date.
Assurant Health
Assurant Health is the brand name for products underwritten by Time Insurance Company. Plan information on this site is provided as general information only. For a complete listing of benefits, exclusions, and terms and conditions please refer to the policy specimen, available at www.assuranthealth.com/plandocuments. Rates may vary slightly and are not guaranteed. Rates quoted are based on the preliminary information you provided at the start of the quote; actual rates will be based on the information submitted on your application once accepted by Assurant Health.
Provider information contained in the directory is updated periodically. This information is subject to change at any time, without notice. Therefore please check with the provider before scheduling your appointment or receiving services to confirm he or she is participating in the network. Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of the network. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change.
Blue Cross Blue Shield of Illinois
HealthMarkets Insurance Agency, Inc. is an independent, authorized agent for Blue Cross and Blue Shield of Illinois. Blue Cross and Blue Shield of Illinois: A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. Effective dates are available on the first of the month only, unless otherwise required by law. Applications must be received by Blue Cross and Blue Shield of Illinois within the defined enrollment period to be accepted.
Blue Cross and Blue Shield of Montana
HealthMarkets Insurance Agency, Inc is an independent, authorized agent for Blue Cross and Blue Shield of Montana.
Blue Cross and Blue Shield of Montana: A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.
Effective dates are available on the first of the month only, unless otherwise required by law. Applications must be received by Blue Cross and Blue Shield of Montana within the defined enrollment period to be accepted.
Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company
The premiums shown include BCBSM's/BCN's estimates of applicable Federal and state taxes, fees and assessments. BCBSM's/BCN's estimates are subject to change. BCBSM/BCN will not reconcile or settle any amounts collected with actual amounts owed for such Federal and state taxes, fees, and assessments.
HSA Eligible Products - Products that are HSA eligible:
- Blue Cross® Premier PPO Bronze HAS
- Blue Cross® Premier PPO Silver Saver HAS
- Blue Cross® Preferred HMO Bronze Saver HAS
- Blue Cross® Select HMO Bronze Saver HAS
- Blue Cross® Local HMO Bronze Saver HAS
- Blue Cross® Metro Detroit HMO Bronze Saver HAS
There is a $0* charge per month for our HSA. If you would like to learn more please visit: www.bcbsm.com/healthybluehsa.
* fee is subject to change
BlueCross BlueShield of New Mexico
HealthMarkets Insurance Agency, Inc is an independent, authorized agent for Blue Cross and Blue Shield of New Mexico.
Blue Cross and Blue Shield of New Mexico: A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.
Effective dates are available on the first of the month only, unless otherwise required by law. Applications must be received by Blue Cross and Blue Shield of New Mexico within the defined enrollment period to be accepted.
Blue Cross and Blue Shield of Oklahoma
HealthMarkets Insurance Agency, Inc is an independent, authorized agent for Blue Cross and Blue Shield of Oklahoma.
Blue Cross and Blue Shield of Oklahoma: A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.
Effective dates are available on the first of the month only, unless otherwise required by law. Applications must be received by Blue Cross and Blue Shield of Oklahoma within the defined enrollment period to be accepted.
BlueCross BlueShield of South Carolina
BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. HealthMarkets is an authorized agent of BlueCross BlueShield of South Carolina.
BlueCross BlueShield of Tennessee
1998-2015 BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association. BlueCross BlueShield of Tennessee is a Qualified Health Plan issuer in the Health Insurance Marketplace. 1 Cameron Hill Circle, Chattanooga TN 37402-0001
Blue Cross and Blue Shield of Texas
HealthMarkets Insurance Agency, Inc is an independent, authorized agent for Blue Cross and Blue Shield of Texas.
Blue Cross and Blue Shield of Texas: A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.
Effective dates are available on the first of the month only, unless otherwise required by law. Applications must be received by Blue Cross and Blue Shield of Texas within the defined enrollment period to be accepted.
CareFirst BlueCross BlueShield, CareFirst
Serving Maryland, the District of Columbia and portions of Virginia, CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst of Maryland, Inc., Group Hospitalization and Medical Services, Inc. and CareFirst BlueChoice, Inc. are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield Names and Symbols are registered trademarks of the Blue Cross and Blue Shield Association.
Cigna Healthcare, Cigna HealthCare of Arizona, Inc, Cigna Health and Life Insurance Company, Cigna HealthCare of Florida, Inc., Cigna HealthCare of IL, Inc., Cigna HealthCare of Texas, Inc.
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of North Carolina, Inc. and Cigna Dental Health, Inc. The Cigna name, logo and other Cigna marks are owned by Cigna Intellectual Property, Inc. Nondiscrimination Link
Health Net of California, Inc, Health Net Life Insurance Company
Your actual effective date may be different from your requested effective date. Your actual effective date is subject to you meeting the regulatory requirements for a Special Enrollment Qualifying Event. In order to qualify for a Special Enrollment, you must show proof of your qualifying event (e.g., if your qualifying event is a marriage, you must provide a copy of your marriage license, etc.). You must submit all supporting documentation WITH your application. Applications submitted without appropriate documentation cannot be processed. All documents (application and supporting documentation) must be submitted at the same time and through the same method (online application, envelope/email/fax). If supporting documentation is sent separate from the application there is no guarantee that it will be matched to the application.
Community Care HMO plans, offered by Health Net of California, are pending regulatory approval by the Department of Managed Health Care.
The premium rates quoted are subject to change.
HMO Coverage is provided by Health Net of California, Inc., PPO Insurance Plans are underwritten by Health Net Life Insurance Company.
Health Net of California, Inc. and Health Net Life Insurance Company are subsidiaries of Health Net, Inc. Health Net® is a registered trademark of Health Net, Inc.
HealthSpan
The insurance premium rate quotes provided to you through this website are for pricing comparison and estimating the cost of coverage. They do not constitute an offer of insurance. Once HealthSpan reviews and verifies the information you provide, we will issue you a formal and binding rate quote.
Humana
Affordable Care Act qualified Medical plans effective 1/1/14 or later: This quote is an estimate only based on information entered by your agent and the rates are not guaranteed. The final rate and effective date will be determined upon receipt and acceptance of a completed application by Humana. Humana Connect Basic 6350/6350 (HMO) Plan and National Preferred Basic 6350/6350 (PPO) Plan: Who can apply for this plan: People who are under the age of 30 before the plan year begins, or those who have received certification from the Health Insurance Marketplace or a State Exchange that they are exempt from the individual mandate because they qualify for a hardship exemption. Families can purchase this plan if each individual enrolled in the coverage meets the eligibility requirements for enrollment. You must live in the U.S., you must be a U.S. citizen or national (or lawfully present) and you cannot be currently incarcerated. For Medical Plans: *Your total premium includes the cost of certain fees and taxes. Some of these fees and taxes support and fund components of the Affordable Care Act (ACA, commonly known as healthcare reform). Humana will pay any such applicable fees directly in compliance with federal and state regulation. More information on healthcare reform can be found at http://www.humana.com/healthreform.
Health Net
Plans are pending regulatory approval (applicable to PPO Off Exchange plans).
HealthyCT
This is not a contract. The HealthyCT Certificate of Coverage and Additional Benefit Materials Must Be Consulted To Determine The Exact Terms and Conditions of Coverage. A Copy of The Certificate of Coverage Will Be Furnished Upon Request.
Meritus Health Partners
Meritus - @2016 Meritus. Meritus products and services are provided through Meritus Mutual Health Partners - PPO and Meritus Health Partners - HMO. A licensed insurance producer may contact you to discuss enrollment in a Meritus health plan. Meritus Mutual Health Partners PPO and Meritus Health Partners HMO are licensed only in Arizona and are Qualified Health Plan issuers on the Health Insurance Marketplace.
Minuteman Health
Minuteman Health Catastrophic plan. MyDoc Simple Care meets the federal definition of a Catastrophic Plan and as such is only available to certain eligible dependents: Are under age 30 prior to the date of enrollment, -or- Have received a certification from the Massachusetts Health Connector that you are exempt from the federal requirement to buy health insurance, also known as the Individual Mandate. **IMPORTANT NOTE: Some Minuteman Health plans do not include coverage of pediatric dental services as required by the Patient Protection and Affordable Care Act (PPACA). Please note that plans with the words with Child Dental in the plan name include coverage for pediatric dental services as required by PPACA. For those plans that do not include coverage of pediatric dental services, a health benefit policy will only be offered when Minuteman Health is reasonably assured that an applicant is covered by a stand-alone dental plan with the required level of coverage for pediatric dental services.
UnitedHealthcare, Rocky Mountain Health Plans / UHC, UnitedHealthcare of Illinois, Inc., UnitedHealthcare Insurance Company, UnitedHealthcare of New Mexico, Inc., Optimum Choice, Inc., UnitedHealthcare of OR
Medical plan coverage offered by: UnitedHealthcare of Arizona, Inc.; Rocky Mountain Health Maintenance Organization, Incorporated in CO; UnitedHealthcare of Florida, Inc.; UnitedHealthcare of Georgia, Inc.; UnitedHealthcare of Illinois, Inc.; UnitedHealthcare Insurance Company in LA, TN and AL; Optimum Choice, Inc. in VA and MD; UnitedHealthcare Community Plan, Inc. in MI; UnitedHealthcare of North Carolina, Inc.; UnitedHealthcare of Oklahoma, Inc.; UnitedHealthcare of Texas, Inc.; and UnitedHealthcare of Oregon, Inc. in WA. Administrative Services provided by United HealthCare Services, Inc. or their affiliates.
Plan specifics and benefits may vary by coverage area and by plan category. Please review the plan details to learn more. This policy has exclusions, limitations, reduction of benefits, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, call or write your insurance agent or the company (whichever is applicable). By responding to this offer, you agree that a representative may contact you.
You are required to select a Primary Care Physician (PCP) within our network. Your PCP refers you to specialists when necessary. If you use a specialist without a referral or see a provider who is not in your network, you may have to pay the full cost of the benefits and services. Emergency services received by an out-of-network provider are covered.
Health Maintenance Organization, Inc. in Colorado and UnitedHealthcare Insurance Co. in Tennessee. Administrative Services provided by United HealthCare Services, Inc. or their affiliates.
Plan specifics and benefits may vary by coverage area and by plan category. Please review the plan details to learn more. This policy has exclusions, limitations, reduction of benefits, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, call or write your insurance agent or the company (whichever is applicable). By responding to this offer, you agree that a representative may contact you.
UPMC Health Plan
Rates shown are determined based on age, geographic region, and tobacco use and are dependent on information provided by or on behalf of the consumer. If changes are made to the determining factors, rates will change accordingly. UPMC Health Plan is not responsible for typographical errors, errors of fact, or any other error resulting from information provided by or on behalf of consumer. UPMC Health Plan is not responsible for the calculation of any financial assistance, including advance payments of the premium tax credit, provided through the Federally Facilitated Marketplace. This managed care plan may not cover all of your health care expenses and all benefits are subject to the terms and conditions set forth in your policy. Read your contract/policy carefully to determine which health care services are covered.
Nondiscrimination statement
UPMC Health Plan1 complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
UPMC Health Plan is the marketing name used to refer to the following companies, which are licensed to issue individual and group health insurance products or which provide third party administration services for group health plans: UPMC Health Network Inc., UPMC Health Options Inc., UPMC Health Coverage Inc., UPMC Health Plan Inc., UPMC Health Benefits Inc., UPMC for You Inc., and/or UPMC Benefit Management Services Inc.
Translation Services
Wellpoint
Coverage provided by Simply Healthcare Plans, Inc. doing business as Wellpoint Florida, Inc.
Coverage provided by Wellpoint Maryland, Inc.
This site is not the Health Insurance Marketplace website, and the link to the FFM website is www.healthcare.gov