With Choice HMO, you gain the freedom to choose any doctor, clinic, hospital, or healthcare facility from our extensive national network, designed to help reduce costs. Stay within our network to enjoy coverage. However, if you opt for an out-of-network provider, you’ll be responsible for all costs. The best part of Choice HMO? Referrals are not required to see a specialist, which means you have more access to the care you need.
Stay proactive with your health as our plan covers 100% of preventive care within the network. There are no out-of-pocket costs for age-appropriate preventive services when you see a network doctor.
Keep in mind that this plan includes a global out-of-pocket limit of $9,450 for individuals and $18,900 for families per year. This limit covers both medical and pharmacy costs.
Embrace the freedom of choice with Choice HMO — the pathway to quality healthcare.
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Our comparison chart helps you find your best fit by listing important plan benefits side-by-side.
Summary
Network coverage
Only network providers covered.
Primary Care Provider
Choosing a primary care provider is not required.
Copays
Copay due for certain services and prescriptions.
Savings account options
Savings account options not offered with Choice HMO but are offered with High Deductible Health Plan (HDHP) through Chard Snyder.
Plan Details
| Individual | Family | |
|---|---|---|
| Deductible | $0.00 | $0.00 |
| Out-of-pocket Limit | $1,500.00 | $3,000.00 |
Are your providers in network?
Network Coverage
Unlock cost savings and quality care with our extensive national network coverage. When you choose our network, you gain access to a group of healthcare providers and facilities that have a contract with UnitedHealthcare. Finding the right provider for your needs is easy with our convenient Provider Search tool.
Stay in the Network
To help save on costs, choose care and services from within our network.
Look for the Hearts
From primary care providers to specialists, UnitedHealthcare makes it easy to find network physicians and other providers who consistently meet the UnitedHealth Premium quality care criteria which includes safe, timely, effective and efficient care — just look for the 2 blue hearts on myuhc.com.
*The UnitedHealth Premium®️ designation program is a resource for informational purposes only. Designations are displayed in UnitedHealthcare online physician directories at myuhc.com®️. You should always visit myuhc.com for the most current information. Premium designations are a guide to choosing a physician and may be used as one of many factors you consider when choosing a physician. If you already have a physician, you may also wish to confer with him or her for advice on selecting other physicians. You should also discuss designations with a physician before choosing him or her. Physician evaluations have a risk of error and should not be the sole basis for selecting a physician. Please visit myuhc.com for detailed program information and methodologies.
Primary Care Provider
While choosing a primary care provider (PCP) is not mandatory with this plan, we highly recommend selecting one for you and your covered family members. Your PCP acts as your invaluable health guide, coordinating your care, helping you avoid cost surprises and supporting you in achieving your best health.
Finding the perfect network PCP is easy. Simply visit our Provider Search and take the first step toward personalized care. Your health journey is important to us, and having a trusted PCP by your side may make all the difference.
Finding a Primary Care Provider
Discovering your network Primary Care Provider (PCP) is simple with our Provider Search feature. Follow these simple steps to make an informed choice:
- 1. Click on the Provider Search link above to access the network for your selected plan.
- 2. Under “What type of Medical Care can we help you find near,” click Change Location, provide your location details, and click Update Location.
- 3. Under “Find healthcare by Category,” select People > Primary Care > All Primary Care Providers to view the list of PCPs.
- 4. Scroll through the options and find the network PCP who can coordinate your care.
- 5. Click on the PCP’s name to find their 14-digit Provider ID number. Remember to jot it down for easy enrollment.
Understanding Copays and Cost Sharing
Navigating the world of health plans can be overwhelming, with terms like “deductible” and “copay” adding to the confusion. Don’t worry. We’re here to help simplify it for you.
Health plans typically involve three key aspects: the cost of care, when you pay for it, and the percentage of those costs shared between you and your plan. Let’s break it down with a clear explanation of how our health plans work.
Navigating Your Health Plan Costs
With this plan option, you have the flexibility to see any provider or go to any hospital within the UnitedHealthcare Choice network. If you choose a provider outside the network, you'll be responsible for the full cost of the service, unless it's an emergency. You'll enjoy predictable copays and won't need to meet a deductible like you would with the PPO plan or HDHP. Both your medical and pharmacy expenses count toward your out-of-pocket maximum. Once you've paid your copay, the plan covers 100% of the coinsurance. Plus, outpatient surgery and diagnostic care, including lab tests and X-rays, are fully covered at 100%, with no deductible or copay.
Understanding Copays
The Choice HMO plan has copays, which are fixed amounts you pay each time you visit a provider or purchase a prescription. You will be responsible for 100% of the copay until you reach your out-of-pocket limit.
Reaching Your Out-of-Pocket Limit
The good news is that your out-of-pocket limit is the maximum amount you'll have to pay for medical healthcare costs in a plan year. Once this limit is reached, your health plan covers 100% of these costs for the rest of the plan year.
Reaching Your Global Out-of-Pocket Limit
You also have a global out-of-pocket limit, which includes the medical costs in your out-of-pocket plus prescription costs. Like your medical out-of-pocket limit, once you reach your global limit, your health plan covers 100% of these costs for the rest of the plan year.
Services and Programs Covered
While preventive care appointments are covered at 100%* for both the Choice HMO Plan and the HDHP, diagnostic treatments performed during your preventive exam may cost extra. Outpatient diagnostic services are covered at 100% with the Choice HMO Plan. Here’s just a partial list of what else is covered. For the full list, check out our Summary of Benefits and Coverage. You can also learn more about the services and programs covered on the Member Benefits page.
*Certain preventive care items and services, including immunizations, are provided as specified by applicable law, including the Patient Protection and Affordable Care Act (ACA), with no cost-sharing to you. These services may be based on your age and other health factors. Other routine services may be covered under your plan, and some plans may require copayments, coinsurance or deductibles for these benefits. Always review your benefit plan documents to determine your specific coverage details.
Doctor Office Visits and Labs
With this plan option, you have the freedom to use any doctor or hospital in the UnitedHealthcare Choice network. If you do not use a network provider, you will be responsible for the entire cost of the service, except in the case of an emergency.
Emergency
There is a $100 copay for Emergency services.
Outpatient Care
Outpatient surgery and diagnostic care, including lab and X-rays, are covered at 100% with no deductible or copay.
Pregnancy and Newborn Care
Learn what to expect and how to manage your health through pregnancy and postpartum using the resources and tools offered by UnitedHealthcare Maternity Support.
OptumRx®
For pharmacy-related needs, OptumRx is here to help make things simpler and more convenient, and it may help you save on costs through home delivery, network pharmacies, and generic or lower-tier drugs.
Wellness Programs
Once your health plan becomes active, we encourage you to sign up for wellness programs and take advantage of health support services — all at no additional cost to you.
Behavioral Health Services
From everyday challenges to more serious issues, you can receive the confidential help of a psychiatrist or therapist and schedule in-person or virtual appointments. UnitedHealthcare also offers self-service digital tools designed to help with behavioral health issues like anxiety and depression.
Your Path to Choosing a Health Plan
Find the plan that’s the right fit for you. Our comparison chart empowers you to make an informed decision by presenting essential plan benefits side-by-side, making it easier than ever to find the health plan that suits you best.
Ready to discover your ideal fit? Access our Plan Comparison page and embark on a journey to better health and well-being.
*Administrative services provided by United Healthcare Services, Inc., or their affiliates.