UnitedHealthcare NexusACO Plan Overview

[Pages:2]UnitedHealthcare NexusACO

2022 quick reference guide

UnitedHealthcare? NexusACO is a commercial tiered benefit plan designed to encourage members to seek care f rom Tier 1 health care professionals. Tier 1 includes selected accountable care organizations (ACOs) and other key health system or medical group partners, along with UnitedHealth Premium? Care Physicians.

Key features

? NexusACO members have access to a tiered network of health care professionals ? Members are required to select a primary care provider (PCP) to manage their health care needs ? UnitedHealthcare NexusACO R requires referrals, while UnitedHealthcare NexusACO OA doesn't

require ref errals ? Standard referral processes and prior authorization and notification requirements apply as

ref erenced in the UnitedHealthcare administrative guide

Benefits

NexusACO plans feature a tiered network. Copayments and coinsurance are lower when members use NexusACO Tier 1 (f eatured ACO or UnitedHealth Premium? Care) health care professionals.

Plan name

NexusACO OA NexusACO OAP NexusACO R NexusACO RB NexusACO RP

Member's network access

Network-only coverage Both network and non-network coverage Network-only coverage

Network-only coverage

Both network and non-network coverage

Is a referral required?

No No

Yes ? no coverage if no ref erral Yes ? lower-level benef it if no referral Yes ? lower-level benef it if no referral

Member benefits when seeking out-of-network care No coverage* Non-network benefits

No coverage*

No coverage*

Non-network benefits

*Except for emergency services and related admissions

Member ID card

The member ID card includes: ? NexusACO plan name ? "Ref errals Required" (if applicable) ? ACO name (if applicable) ? Shared Savings logo identifies plans

with additional network benefits

Sample member ID cards for illustration only; actual infor mation varies depending on payer, plan and other requirements.

PCA-1-21-03025-UHN-QRG_09242021

Additional information

For additional information regarding NexusACO, go to plans > Choose your state > Commercial > UnitedHealthcare NexusACO. You can view your UnitedHealthcare NexusACO tier status on the My Practice Profile tool on the UnitedHealthcare Provider Portal or by checking the UnitedHealthcare NexusACO directory at connect.plans/uhc/1.

Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Health plan coverage provided by UnitedHealthcare of Arizona, Inc., UHC of California DBA UnitedHealthcare of California, UnitedHealthcare Benefits Plan of California, UnitedHealthcare of Colorado, Inc., UnitedHealthcare of the Mid-Atlantic, Inc., MAMSI Life and Health Insurance Company, UnitedHealthcare of New York, Inc., UnitedHealthcare Insurance Company of New York, UnitedHealthcare of Oklahoma, Inc., UnitedHealthcare of Oregon, Inc., UnitedHealthcare of Pennsylvania, Inc., UnitedHealthcare of Texas, Inc., UnitedHealthcare Benefits of Texas, Inc., UnitedHealthcare of Utah, Inc., UnitedHealthcare of Washington, Inc., Optimum Choice, Inc., Oxford Health Insurance, Inc., Oxford Health Plans (NJ), Inc., Oxford Health Plans (CT),Inc., All Savers Insurance Company, or other affiliates. Administrative services provided by OptumH ealth Care Solutions, LLC, OptumRx, Oxford Health Plans LLC, United HealthCare Services, Inc., or other affiliates. Behavioral heal th products provided by U.S. Behavioral Health Plan, California (USBHPC), United Behavioral Health (UBH), or its affiliates. PCA-1-21-03025-UHN-QRG_09242021 ? 2021 United HealthCare Services, Inc. All Rights Reserved.

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