Heritage Plus (Heritage PPO)
Available only in certain areas.
Under the Heritage Plus Insurance Plans, members have greater control over directing their health care, compared to traditional HMO plans. Heritage Plus members can choose the health care providers they want to see -- without needing a referral.
Heritage Plus plans can be purchased by insured employers from UnitedHealthcare Insurance Company of the River Valley, or by self-funded employers from UnitedHealthcare Services Company of the River Valley, Inc. A Heritage Plus plan can be a traditional deductible plan or a qualified high-deductible health plan (HDHP). An HDHP can be paired with a tax-advantaged Health Savings Account (HSA).
Using participating Heritage Plus providers whenever possible (including specialists for surgeries) is an important way that members can help lower their out-of-pocket costs. If members use non-participating providers in non-emergency situations, costs are higher. Also, when members use participating providers, the members do not need to worry about medical management requirements that the plan has in place.
Members can find out which providers are in the Heritage Plus network by using the online provider directory. Members should always verify a provider’s participation before getting services. To make sure that a provider is currently in the network, members can visit the online directory or call the Customer Service number on the back of their member ID card.
Keep the following points in mind regarding non-participating providers:
- Members may see non-participating providers for most covered services at a lower, or “out-of-network,” benefit level (with the exception of a medical emergency, which is covered at an in-network benefit level).
- When members obtain certain items, services, or procedures requiring preauthorization from non-participating providers, they are required to get prior health plan approval. If members fail to do so, they may have to pay a financial penalty for covered services in addition to any applicable deductible, copayment, and/or coinsurance. To learn what items, services, and procedures require preauthorization, visit our online preauthorization section, or call the Customer Service number on the back of the member ID card.
- When members receive covered services from non-participating providers, they will also be responsible for paying any amounts the provider charges above the Maximum Allowance* (with the exception of medical emergencies). Refer to plan documents for more information on Maximum Allowance.
Heritage Plus members should also be aware that their plan may have benefit limits for certain services (e.g., home health, durable medical equipment), as well as a lifetime benefit maximum. Check plan documents for more information.
Heritage Plus plan availability varies by the employer’s location, benefit plan options, and funding arrangement. Call a local UnitedHealthcare Account Representative for more information.
* Maximum Allowance is the portion of a non-participating provider’s charge that the health plan will consider in calculating benefits. The Maximum Allowance will be determined by the health plan based on the determination of the average discount the plan has negotiated with participating providers for a covered service.