How do i know if i have ppo or hmo unitedhealthcare

The Traditional PPO medical plan has full coverage for in-network preventive care with you sharing the cost of other services through co-pays, coinsurance and your deductible. You have the same UnitedHealthcare (UHC) Choice Plus network of doctors as the HSA PPO plan. If you reside in Maine, Massachusetts or New Hampshire you have access to both the Choice Plus network and UHC’s broader Harvard Pilgrim network. You must meet your annual deductible before the plan begins to pay benefits. Co-pays for office and specialist visits, do not apply to your annual deductible, but do apply to your annual out-of-pocket maximum. Prescription drugs are part of your deductible. Visit the Pharmacy page for more information.

You are eligible to enroll in the General Purpose Flexible Spending Account (GPFSA) for your out-of-pocket expenses, when enrolled in the Traditional PPO plan.

The Traditional PPO plan gives you the option to visit any provider, allowing you to shop around when you need health care. You can visit any doctor or facility, but you will receive the best value when you go in-network. To find in-network providers, visit UHC’s website.

Traditional PPO Plan Details

In-NetworkOut-of-NetworkAnnual Deductible1Individual: $500
Family: $1,500Individual: $500
Family: $1,500Annual Out-of-Pocket (OOP) Maximum 2Individual: $3,000
Family: $9,000Individual: $6,900
Family: $20,700Employee Coinsurance10% after deductible30% after deductiblePreventive (Annual Physicals, Well Care Exams)100% covered, not subject to deductible30% after deductiblePhysician VisitsPrimary Care: $30/visit
Specialist: $45/visit30% after deductibleLab and X-Ray10% after deductible30% after deductibleEmergency Room3$100/visit, then 10%$100/visit, then 10%Ambulance10% after deductible10% after deductibleHospitalization10% after deductible30%  after deductibleChiropractic$45 co-pay per visit
Up to 20 visits/year30% after deductible
Up to 20 visits/yearAcupuncture$45/visit
Up to 20 visits/year30% after deductible
Up to 20 visits/yearMassage10% after deductible
Up to 20 visits/year10% after deductible
Up to 20 visits/yearSpeech Therapy3$30/visit30% after deductibleInfertility/Fertility Preservation10% after deductible
3 Smart Cycles per lifetime via ProgynyNot Covered

1 Individual deductible and OOP maximum only apply to employees enrolled in Individual tier. Members in dependent tiers must satisfy an aggregate deductible – the health plan doesn’t begin paying benefits until the entire family deductible has been met. Once the entirety of the family deductible has been met, by one family member or a combination of family members, then the cost sharing begins. Paid Interns are not eligible to enroll in the Traditional PPO plan.
2 OOP maximum includes Prescription Rx.
3 Available to those with conditions of medical necessity.

Employee Contributions for 2022

PlanEmployee OnlyEmployee +
Spouse/Domestic PartnerEmployee + Child(ren)Employee + FamilyTraditional PPO$124.55$280.25$238.12$404.80

1 Per paycheck contributions are 24 times per year. Contributions are pre-tax (except for Domestic Partner coverage).

Dependent Eligibility

• Your spouse or domestic partner. Please note: after tax contributions and imputed income may apply when covering a domestic partner. See the Domestic Partner Imputed Income Rate Table for details
• Your child(ren), your spouse’s / domestic partner’s child(ren), your foster child(ren), the minor(s) you have legal guardianship of are eligible for medical coverage until age 26, regardless of marital or student status.

For more details, see the UHC Traditional PPO Summary of Benefits and Coverage (SBC). Residences of Maine, Massachusetts or New Hampshire see the UHC Traditional PPO Harvard Pilgrim Summary of Benefits and Coverage (SBC).

Learn more about how health insurance works, including potential out-of-pocket costs and the differences among various types of health plans.

Watch our video on health insurance and patient billing.

Health Plans & Health Insurance We Accept

At UCLA Health, we accept a wide range of health insurance plans to help you get the care you need. To get you started, we’ve put together a snapshot of the health insurance accepted at UCLA Health:

• Reminders about health insurance at UCLA Health
• Government health insurance programs (Medicare and Medi-Cal)
• Medicare Advantage
• Coverage through your employer: HMO (health maintenance organization) and POS (point of service) insurance
• Coverage through your employer: PPO (preferred provider organization) insurance
• Health insurance purchased by individuals, families and small businesses
• Health insurance for organ and stem cell transplants
• Health insurance for behavioral health

Health Insurance Accepted for Medical Care at UCLA Health Hospitals

We accept a range of insurance plans at Ronald Reagan UCLA Medical Center and UCLA Santa Monica Medical Center. The plans we accept include:

Government health insurance programs

• Medicare
• Medi-Cal

Medicare Advantage

HMOs:

• Blue Shield Enhanced (Effective January 1, 2023)
• UnitedHealthcare - AARP Medicare Advantage SecureHorizons Focus
• UnitedHealthcare - AARP Medicare Advantage SecureHorizons Premier
• UnitedHealthcare - AARP Medicare Advantage Rebate
• UnitedHealthcare - AARP Medicare Advantage Patriot

PPOs:

• Anthem Medicare Advantage
• UnitedHealthcare - AARP Medicare Advantage Choice Plan 1
• UnitedHealthcare - AARP Medicare Advantage Choice Plan 2

Please call the UCLA Health referral line at 310-825-2631 or your health plan for the latest updates on which insurance plan networks UCLA hospitals and physicians participate. 

Health insurance through your employer: HMO insurance and POS insurance

• Aetna
• Anthem Blue Cross
• Blue Shield of California
• Cigna
• Health Net of California
• UnitedHealthcare
• Vivity (offered by Anthem Blue Cross)

Please call the UCLA Health referral line at 310-825-2631 or your health plan for the latest updates on which insurance plan networks UCLA hospitals and physicians participate. 

Health insurance through your employer: PPO insurance

• Aetna
• Anthem Blue Cross
• Blue Shield of California
• Centivo
• Cigna
• First Health
• Health Net of California
• Interplan (part of HealthSmart)
• MultiPlan
• UFCM Health System, Inc., doing business as California Foundation for Medical Care (CFMC)
• Prime Health Services
• Private Healthcare Systems (PHCS)
• TRICARE
• UnitedHealthcare

Health insurance purchased by individuals, families and small businesses

We also accept select plans purchased on your own. You can purchase these plans through an agent or directly from an insurance company. You can also purchase them at Covered California, the state’s official health insurance marketplace, or exchange (learn more about our relationship with Covered California).

If you use the exchange, Blue Shield offers several plans that may cover care at UCLA Health. Call Blue Shield at 888-626-6780 for more information.

Health insurance for organ and stem cell transplants

Health plans — or their partners — often designate medical centers of excellence where they cover transplants of organs or stem cells. We have such relationships with:

• Aetna - Institute of Excellence
• Anthem Blue Cross - Centers of Medical Excellence
• Blue Shield of California
• Cigna LifeSOURCE
• Health Net of California
• INTERLINK
• LifeTrac
• Optum Transplant Centers of Excellence (formerly United Resource Network)

Health insurance for behavioral health at UCLA Health

Not all health plans provide coverage for treating mental health and other behavioral health needs. Those that do may use another company to provide the benefits you use with our doctors or at Resnick Neuropsychiatric Hospital at UCLA.