This Mid-Atlantic Regional Supplement applies to services provided to members enrolled in:
MD-Individual Practice Association, Inc. (“M.D. IPA”) and M.D. IPA Preferred, or
Optimum Choice, Inc. (“Optimum Choice”), and Optimum Choice Preferred, and Optimum Choice Small Business Health Options Program (SHOP).
It may apply to care providers in DE, DC, MD, PA, VA, WV; reference your Agreement for applicability.
Care providers are subject to both the main guide and this supplement. This supplement controls if it conflicts with information in the main guide. For protocols, policies and procedures not referenced in this supplement refer to appropriate chapter in the main guide.
The term “prior authorization” referenced in this supplement is also referred to as “preauthorization”. We use both terms in this supplement. They mean the same.
A complete list of Mid-Atlantic Health plan protocols pertaining to M.D. IPA, M.D. IPA Preferred, Optimum Choice, and Optimum Choice Preferred may be located on UHCprovider.com/plans > Choose Your State.
UnitedHealthcare Optimum Choice Health Savings Account (HSA) Plan
The Optimum Choice and Optimum Choice Preferred HSA benefit plans are high-deductible medical benefit plans that combine our traditional gated HMO benefit plans with an HSA option. Expenses under this benefit plan are the member’s responsibility until their deductible is reached. HSA benefit plans require reimbursement for services provided to members are based on a fee-for-service reimbursement methodology.
Services for members enrolled in Optimum Choice HSA are excluded from your capitation payment and are paid on a fee-for-service (FFS) basis per the All Payer Payment Appendix included in the UnitedHealthcare physician Agreement.
The Optimum Choice HSA product name and member’s PCP are indicated on the member’s ID card. Specialist referral requirements are on the back of the ID card. Check Eligibility and Eligibility and Benefits (on Link).