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California Commercial Health Plans

The following Commercial Health Plans are offered in California. Open the section below to view more information.

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Surest is a UnitedHealthcare company that administers health plans without deductibles or coinsurance. Members have access to the nationwide UnitedHealthcare and Optum® Behavioral Health networks and can check costs and care options in advance.

If you participate in UnitedHealthcare commercial plans, you automatically participate in Surest benefit plans at the existing commercial reimbursement rates per your participation agreement.

A small number of members have the Surest Flex plan, which includes the feature of flexible coverage. For a fixed list of plannable tests, procedures or treatments, the member must activate coverage at least 3 business days in advance of the service, or the member may not have coverage for the service.

Claims: Please send claims to us electronically using Surest Payer ID 25463 or by mail to Surest, P.O. Box 211758, Eagan, MN 55121. Include the subscriber ID and rendering address on the claim to help us confirm the copay/member price. Check the status of your claims in the UnitedHealthcare Provider Portal.

Eligibility and benefits: To check member eligibility and benefits, visit the provider portal or call Surest Provider Services at 844-368-6661. If you’re requesting information about a dependent, we’ll need the subscriber ID.

Variable copays: You can receive variable copay information through electronic data interchange (EDI) 270/1 transaction responses. For more information, see the 270/271 EDI Surest guide and Digital Solutions page.

For more information, please visit UHCprovider.com/surest.

The UnitedHealthcare Choice and Choice Plus health plans allow members to choose a physician or specialist from the UnitedHealthcare Choice networks but do not need a referral to receive benefits.

  • UnitedHealthcare Choice members must receive care from network care providers for benefits to be covered. There is out-of-network coverage for emergency services only.
  • UnitedHealthcare Choice Plus members are covered at a lower benefit level for services provided by out-of-network care providers.

Preventive care, including immunizations and preventive exams and health screenings, is covered at 100 percent in our UnitedHealthcare Choice and UnitedHealthcare Choice Plus networks.

UnitedHealthcare® Core and Core Essential

UnitedHealthcare Core health plans allow members to choose a network physician or specialist without a referral (open access). The UnitedHealthcare Core network is narrowed in some states.

  • UnitedHealthcare Core Essential members must receive care from network providers for benefits to be covered.
  • UnitedHealthcare Core plans cover out-of-network providers at a lower benefit level.

An array of health and wellness resources are available to members including the Online Health Assessment, Personal Health Record and Online Health Coaching modules.

Tools & Resources

UnitedHealthcare EDGE health plans allow members to choose a network physician or specialist but don’t need a referral (open-access).

Some UnitedHealthcare EDGE plans provide access to network and non-network care providers so members can seek care from any care provider they choose, but at a lower co-insurance/deductible level for network care providers.

By seeking care from Tier 1 care providers, members can maximize their in-network benefits based on UnitedHealthcare’s evaluation.

UnitedHealthcare EDGE plans provide medication benefit coverage through a four-tier pharmacy plan. UnitedHealthcare EDGE plans include health and wellness programs, services and discounts from UnitedHealth Wellness®.

UnitedHealthcare Navigate®

The UnitedHealthcare Navigate health plans encourage members to use their primary care provider (PCP) to coordinate care across a wide spectrum of health services and enter electronic referrals to network specialists. The UnitedHealthcare Navigate network is narrowed in some states.

  • UnitedHealthcare Navigate members must receive a referral from their PCP to see a network specialist for benefits to be covered. There is out-of-network coverage for emergency services only.
  • UnitedHealthcare Navigate Balanced members may see a network specialist at a reduced benefit level when there is no referral.   There is out-of-network coverage for emergency services only.
  • UnitedHealthcare Navigate Plus members may see a network specialist at a reduced benefit level when there is no referral.  Navigate Plus also provides out of network coverage.

Changes to PCP selection are permitted once per month. Changes submitted on or before the 31st of the month will be effective on the first day of the following month.

Tools & Resources

UnitedHealthcare® NexusACO®

The UnitedHealthcare NexusACO suite of products offers cost-saving opportunities to members when they seek care providers from a select group of Accountable Care Organizations (ACO) nationwide. There is out-of-network coverage for emergency services only.

UnitedHealthcare NexusACO Plans – Open Access

  • UnitedHealthcare NexusACO OA plans offer network-only coverage for care providers.
  • UnitedHealthcare NexusACO OAP plans offer both network and non-network coverage.

UnitedHealthcare NexusACO Plans – Referral Required

  • UnitedHealthcare NexusACO R plans offer network-only coverage for care providers.
  • UnitedHealthcare NexusACO RB plans offer network coverage when the PCP refers a member to a network specialist, and lower coverage applies when there is no referral.
  • UnitedHealthcare NexusACO RP plans offer network coverage when the PCP refers a member to a network specialist, and lower coverage applies when there is no referral or with an out-of-network specialist.

All UnitedHealthcare NexusACO members are required to select a primary care provider (PCP) within the network to provide their preventive care, treat chronic conditions, manage medications and enter specialist referrals.

Changes to PCP selection are permitted once per month. Changes submitted on or before the 31st of the month will be effective on the first day of the following month.

Tools & Resources

UnitedHealthcare Options PPO health plans allow members to choose a network physician or specialist without a referral (open-access).

  • It is the member's responsibility to obtain prior approvals for both network and non-network services. No referral is required to see a specialist.
  • If a non-network physician is chosen, out-of-pocket member costs will be higher and it is the member’s responsibility to obtain approvals and submit claims.

UnitedHealthcare Options PPO offers two levels of coverage: a higher level of benefits for in-network services, and a lower level of benefits for non-network services, with somewhat higher deductibles and coinsurance.

UnitedHealthcare Select health plans allow members to choose a network physician or specialist but don’t need a referral (open access).

  • UnitedHealthcare Select (in-network only) members are encouraged to see their primary care physician (PCP) to coordinate their care from providers in the network. There is out-of-network coverage for emergency services only.
  • UnitedHealthcare Select Plus members are encouraged to see their PCP to coordinate care from providers in the network. UnitedHealthcare Select Plus plans provide out-of-network coverage at a lover benefit level.

The UnitedHealthcare SignatureValue health plans encourage members to use their primary care provider (PCP) to coordinate care across a wide spectrum of health services and enter electronic referrals to network specialists. Preventive care, including checkups, is covered.

  • UnitedHealthcare SignatureValue plans offer full health maintenance organization (HMO) access to a large network of care providers and flexible benefits.
  • UnitedHealthcare SignatureValue Advantage plans offer the same level of benefit coverage as a traditional HMO plan at a lower premium with a narrower network of contracted care providers.
  • UnitedHealthcare SignatureValue Alliance cost-effective plans use a network of medical groups focused on providing patient-centered care and promoting better health outcomes at lower costs.
  • UnitedHealthcare SignatureValue Focus plans offer the same level of benefit coverage as a traditional HMO plan at a lower premium with a narrower network of contracted care providers.
  • UnitedHealthcare SignatureValue Flex plans arrange care providers into distinct networks, based on their ability to deliver quality care at lower costs.
  • UnitedHealthcare SignatureValue Harmony HMO plan is designed to offer a streamlined service experience made easier by uniting care and coverage.  

Tools & Resources

Additional Resources