Tiered Benefits Plans
With the tiered benefits plans, you'll have access to a national network and help save with Tier 1 providers.
- Help save money by staying in our network. You can receive care and services from any provider in our network. A network is a group of health care providers and facilities that have a contract with UnitedHealthcare.
- You may pay less when you use Tier 1 providers. Tier 1 providers are doctors and specialists that are recognized for providing the greatest value from your health benefits.
- You are not required to select a primary care physician (PCP), although we recommend you consider choosing a PCP. A PCP can be a partner to manage your care and help you avoid duplicating tests and services.
- You are not required to get a referral to see a network specialist.
- Age-appropriate preventive care is covered 100% in the network. You don't have to pay any out-of-pocket costs for preventive care as long as you use a network doctor.
Important: Depending upon your plan design, you may not have any coverage if you use an out-of-network provider. Please see your enrollment materials and summary of benefits for information.
Plan at-a-glance
Network coverage
Network coverage plays a big part in delivering you cost savings and quality care. With the network, you'll have access to a group of health care providers and facilities that have a contract with UnitedHealthcare.
Are your providers in network?
Stay in the network
To help save on costs, choose care and services from within our network.
The importance of a primary care provider (PCP)
Primary care provider
This plan does not require you to have a primary care provider (PCP), but choosing one for yourself and each covered family member is highly recommended. Your PCP is your health guide - coordinating your care, helping you avoid cost surprises and supporting you in achieving your best health.
The importance of a primary care provider (PCP)
Having a PCP to help guide and coordinate your care is important whether or not the health plan you select requires one.
Copays and cost sharing
Most health plans share the same idea: there's how much you pay for the cost of care, when you pay for it, and what percentage of those costs you and your plan share. It can all be a little confusing, especially when you add in words like "deductible" and "copay".
To make it easier, here's an example of how health plans work.
At the start of your health plan year...
You're responsible for paying 100% of the costs for covered health care, up until you reach your deductible. The deductible is the amount you pay before the plan starts sharing costs. Age appropriate preventive care is covered 100% as long as you use a network provider.
About COPAYS...
Some health plans have a copay, which is a fixed amount you pay each time you see a provider or purchase a prescription. Because copays don't count toward your deductible, you're responsible for paying 100% of your copay up until you reach your out-of-pocket limit.
When you reach your DEDUCTIBLE
Coinsurance kicks in and your health plan starts sharing a percentage of these costs with you, up until you reach your out-of-pocket limit.
When you reach your OUT‑OF‑POCKET LIMIT
The most you'll have to pay for the costs of health care in a plan year is your out-of-pocket limit. Once this limit is reached, your health plan covers you at 100% for the rest of the plan year.
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