Benefit Plans Subject to this Guide - Chapter 1, 2020 UnitedHealthcare Administrative Guide

Benefit Plans Subject to this Guide

Plan Name

  • All Savers Insurance Company

Location of Most Members Subject to Additional Guides

  • All Markets

Location of Plan Information

Plan Name

  • MD Individual Practice Association, Inc.

Location of Most Members Subject to Additional Guides

  • District of Columbia
  • Delaware
  • Maryland
  • Virginia
  • West Virginia
  • Some counties in Southeastern Pennsylvania

Location of Plan Information

Plan Name

  • Medica HealthCare

Location of Most Members Subject to Additional Guides

  • Florida counties: Broward and Miami-Dade

Location of Plan Information

Plan Name

  • Capitated and/or Delegated Providers Commercial and MA

Location of Most Members Subject to Additional Guides

  • All Markets

Location of Plan Information

Plan Name

  • NHP: Neighborhood Health Partnership, Inc.

Location of Most Members Subject to Additional Guides

  • Florida

Location of Plan Information

Plan Name

  • OCI: Optimum Choice Inc.

Location of Most Members Subject to Additional Guides

  • District of Columbia
  • Delaware
  • Maryland
  • Virginia
  • West Virginia
  • Some counties in Pennsylvania

Location of Plan Information

Plan Name

  • OneNet PPO

Location of Most Members Subject to Additional Guides

  • District of Columbia
  • Delaware
  • Maryland
  • North Carolina
  • Pennsylvania
  • Virginia
  • West Virginia
  • Limited network in: Florida, Georgia, South Caroline, Tennessee

Location of Plan Information

Plan Name

  • Oxford Health Plans, LLC
  • Oxford Health Insurance, Inc.
  • Investors Guaranty Life Insurance Company, Inc.
  • Oxford Health Plans (NY), Inc.
  • Oxford Health Plans (NJ), Inc.
  • Oxford Health Plans (CT), Inc.

Location of Most Members Subject to Additional Guides

  • Connecticut
  • New Jersey
  • New York (except upstate)
  • Some counties in Pennsylvania

Location of Plan Information

Plan Name

  • Preferred Care Partners

Location of Most Members Subject to Additional Guides

  • Florida counties: Broward, Miami-Dade and Palm Beach

Location of Plan Information

Plan Name

  • UnitedHealthcare Services Company of the River Valley, Inc.
  • UnitedHealthcare Plan of the River Valley, Inc.
  • UnitedHealthcare Insurance Company of the River Valley

Location of Most Members Subject to Additional Guides

  • Parts of Arkansas, Georgia, Iowa, Illinois, Tennessee, Wisconsin, Virginia
  • Your UnitedHealthcare contract specifically references River Valley or John Deere Health protocols or Guides; and
  • You are located in AR, GA, IA, TN, VA, WI or these counties in Illinois: Jo Daviess, Stephenson, Carroll, Ogle, Mercer, Whiteside, Lee, Rock Island, Henry, Bureau, Putnam, Henderson, Warren, Knox, Stark, Marshall, Livingston, Hancock, McDonough, Fulton, Peoria, Tazewell, Woodford, McLean, and
  • You are providing services to a River Valley Commercial member and not a River Valley Medicare Advantage, Medicaid or CHIP member.

Note: River Valley also offers benefit plans in LA, NC, OH and SC, but the River Valley Additional Guide does not apply to those benefit plans.

Location of Plan Information

Plan Name

  • Sierra Health and Life Insurance Co., Inc.
  • Health Plan of Nevada, Inc.
  • Sierra Healthcare Options, Inc.

Location of Most Members Subject to Additional Guides

Outside NV only: The health care ID card identifies the Sierra or Health Plan of Nevada members who access the UnitedHealthcare network outside of Nevada, and includes the following reference: UnitedHealthcare Choice Plus Network Outside Nevada.

Location of Plan Information

Services rendered outside of Nevada to Sierra or Health Plan of Nevada members with the health care ID card reference described in this row are subject to your UnitedHealthcare Agreement and to this guide unless you are in Arizona or Utah and have a contract directly with Sierra or Health Plan of Nevada.

Plan Name

(Formerly referenced in this guide as “PacifiCare”)

  • UHC of California dba UnitedHealthcare of California (hereinafter referred to as UnitedHealthcare of California)
  • UnitedHealthcare Benefits Plan of California
  • UnitedHealthcare of Oklahoma, Inc.
  • UnitedHealthcare of Oregon, Inc.
  • UnitedHealthcare Benefits of Texas, Inc.
  • PacifiCare of Arizona, Inc.
  • PacifiCare of Colorado, Inc.+
  • PacifiCare of Nevada, Inc.

+ Medicare Advantage benefit plans only.

Location of Most Members Subject to Additional Guides

  • Arizona
  • California
  • Colorado
  • Nevada
  • Oklahoma
  • Oregon
  • Texas
  • Washington

Location of Plan Information 

Plan Name

  • Golden Rule Insurance Company Group #705214
  • Oxford Health Insurance, Inc. Group #908410

Location of Most Members Subject to Additional Guides

  • 705214: All Markets
  • 908410: New Jersey

Location of Plan Information