Overview

UnitedHealthcare is a network model Health Maintenance Organization (HMO). It contracts with doctors who are in private practice or are part of established Medical Groups. You choose a participating Medical Group and from that Medical Group you must select a primary care physician (PCP). Your PCP will be responsible for all of your healthcare needs, and will refer you to a specialist when necessary. Note that certain providers allow for annual enrollments only.

Lifetime Maximum

No plan maximum

Annual Copayment Maximums

$2,500/individual and $5,000 for family

Inpatient Hospital Charges

$250 per admission

Outpatient Office Visits and Most Outpatient Services

Your copayment is: $5 (for most primary care visits)
$25 (for most physician specialist visits)

Other Outpatient Services

• Ambulance - Paid in Full
• Cochlear Implants - Paid in Full
• Health Education Services - Paid in Full
• Home Health Care Visits (Up to 100 per calendar year) - Paid in Full
• Hospice Care (Prognosis of life expectancy of one year or less) - Paid in Full
• Laboratory and Radiology - Paid in Full
• Maternity Care, Tests and Procedures - Paid in Full
• Outpatient Surgery at a participating Free-Standing or Outpatient Facility - Paid in Full
• Well-Baby Care - Paid in Full

Emergency Services and Urgently Needed Services

$250 Copayment unless admitted to hospital.

Chiropractic

The Chiropractic benefits covers the services described in this section when performed by a Participating ACN Group, Inc. Chiropractor and authorized when necessary by ACN Group, up to the Annual maximum Benefit listed.

• Copayments for Each Visit - $5.00
• Annual Maximum Benefit - 30 Visits
• Annual Maximum Benefit for Chiropractic Appliances - $50.00

Prescriptions

BIN/PCN/Submitted Group
BIN: 610279
PCN: 9999
GRP: UHCNICE

Additional Info

Phone: 1-800-624-8822
Web Site: https://www.myuhc.com

Summary Schedule of Benefits
Group #:
Active - 144786
Early Retiree - 144787
Non-medicare - 144788
Medicare - 4257

SignatureValue Harmony: Instructions to Find a Doctor
Harmony Brochure
Participating physician groups - Harmony
Rally - Great Health Recommendations Just for You
Virtual Visits
Evidence of Coverage
Chiropractic Schedule of Benefits
Summary of Benefits and Coverage (SBC)
Virtual card: Information on how to access your virtual card