UHC Bronze Value ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)

54332NC0030032
Expanded Bronze
HMO

UHC Bronze Value ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) is an Expanded Bronze HMO plan by UnitedHealthcare.

Locations

UHC Bronze Value ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) is offered in the following counties.

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Plan Overview

This is a plan overview for 2025 version of UHC Bronze Value ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) 54332NC0030032.
Insurer: UnitedHealthcare
Network Type: HMO
Metal Type: Expanded Bronze
HSA Eligible?: No
Plan ID: 54332NC0030032

Cost-Sharing Overview

UHC Bronze Value ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) offers the following cost-sharing.

Notes:

  • Some plans have separate cost-sharing for medical and drugs, while other plans offer combined cost-sharing. The cost-sharing amounts above are combined medical and drug costs unless otherwise noted.
  • You are viewing the standard version of this plan. Your costs may be lower depending on your income. Use the “get a quote” button below to see your estimated premium and out-of-pocket costs after assistance.
Ready to sign up for UHC Bronze Value ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

Plan Features

UHC Bronze Value ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) offers the following features and referral requirements.

Wellness Program: No
Disease Program:
Notice Pregnancy: No
Referral Specialist: No
Specialist Requiring Referral:
Plan Exclusions: Some exclusions may apply. See the applicable Certificate of Coverage for details.
Child Only Option?: Allows Adult and Child-Only

Network Details

The following network details will help you understand what UHC Bronze Value ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) covers when you are out of the service area or out of the country.

Out of Country Coverage: No
Out of Country Coverage Description:
Out of Service Area Coverage: Yes
Out of Service Area Coverage Description: Plan covers eligible expenses provided by a Network Physician or other provider or facility within the Network Area. The Network Area may include select Network providers located in a neighboring state. The plan also covers emergency health care services received outside the service area.
National Network: No

Additional Benefits and Cost-Sharing

UHC Bronze Value ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) includes the following benefits at the cost sharing rates listed below.

Service In-Network
Copay / Coinsurance
Out-of-Network
Copay / Coinsurance
Limits and Explanation
Primary Care Visit to Treat an Injury or Illness
Covered
$40.00 Not ApplicableNot Applicable 100.00% Cost sharing for Virtual Primary Care matches in-person office visit.
Specialist Visit
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Other Practitioner Office Visit (Nurse, Physician Assistant)
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Outpatient Surgery Physician/Surgical Services
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Hospice Services
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Routine Dental Services (Adult)
Not Covered
Infertility Treatment
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%3.0 Treatment(s) per Lifetime Infertility Services- Benefits are provided for certain services related to the diagnosis, treatment and correction of any underlying causes of infertility for all members. Benefits are limited to three pharmaceutical ovulation induction cycles per lifetime per member. Prescription Drug Benefits- Certain prescription drugs related to treatment of infertility. Infertility drugs are limited to benefit lifetime maximums per member.
Long-Term/Custodial Nursing Home Care
Not Covered
Private-Duty Nursing
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Routine Eye Exam (Adult)
Not Covered
Urgent Care Centers or Facilities
Covered
$100.00 Not ApplicableNot Applicable 100.00% $0 Virtual Urgent Care visits are available through vendor. See SBC for additional cost share details for in-person urgent care visits.
Home Health Care Services
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Emergency Room Services
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible
Emergency Transportation/Ambulance
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Inpatient Physician and Surgical Services
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Bariatric Surgery
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00% Excludes removal of excess skin from the abdomen, arms or thighs.
Cosmetic Surgery
Not Covered
Skilled Nursing Facility
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%60.0 Days per Year Limit of 60 days will be any combination of Skilled Nursing Facility or Inpatient Rehabilitation Facility Services.
Prenatal and Postnatal Care
Covered
Not Applicable No ChargeNot Applicable 100.00%
Delivery and All Inpatient Services for Maternity Care
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00% Childbirth/delivery professional services follow inpatient physician/surgeon fees.
Mental/Behavioral Health Outpatient Services
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00% Cost share applies to office visits, please see SBC for Mental Health Outpatient Services.
Mental/Behavioral Health Inpatient Services
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Substance Abuse Disorder Outpatient Services
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Substance Abuse Disorder Inpatient Services
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Generic Drugs
Covered
$3.00 Not ApplicableNot Applicable 100.00%30.0 Days per Month Members can obtain a 1 month supply through network pharmacies or home delivery. Members also have the option to receive a 3 month supply through network pharmacy or home delivery. Other quantity limits may apply. Check the plan’s Summary of Benefits or Prescription Drug List for more information.
Preferred Brand Drugs
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%30.0 Days per Month Members can obtain a 1 month supply through network pharmacies or home delivery. Members also have the option to receive a 3 month supply through network pharmacy or home delivery. Other quantity limits may apply. Check the plan’s Summary of Benefits or Prescription Drug List for more information.
Non-Preferred Brand Drugs
Covered
Not Applicable 45.00% Coinsurance after deductibleNot Applicable 100.00%30.0 Days per Month Members can obtain a 1 month supply through network pharmacies or home delivery. Members also have the option to receive a 3 month supply through network pharmacy or home delivery. Other quantity limits may apply. Check the plan’s Summary of Benefits or Prescription Drug List for more information.
Specialty Drugs
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%30.0 Days per Month Specialty medications are limited to a 1-month supply. Other quantity limits may apply. Check the plan’s Summary of Benefits or Prescription Drug List for more information.
Outpatient Rehabilitation Services
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%30.0 Visit(s) per Year Limited to 30 visits for any combination of physical therapy, occupational therapy, and manipulative treatment including chiropractic care.
Habilitation Services
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%30.0 Visit(s) per Year Limited to 30 visits for any combination of physical therapy, occupational therapy, and manipulative treatment, including chiropractic care.
Chiropractic Care
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%30.0 Visit(s) per Year Limited to 30 visits for any combination of physical therapy, occupational therapy, and manipulative treatment including chiropractic care.
Durable Medical Equipment
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Hearing Aids
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%1.0 Item(s) per 3 Years One hearing aid per hearing impaired ear every 36 months.
Imaging (CT/PET Scans, MRIs)
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Preventive Care/Screening/Immunization
Covered
Not Applicable No ChargeNot Applicable 100.00%
Routine Foot Care
Not Covered
Covered as medically necessary for the prevention of complications associated with metabolic, neurologic, or peripheral vascular disease
Acupuncture
Not Covered
Weight Loss Programs
Not Covered
Routine Eye Exam for Children
Covered
Not Applicable No ChargeNot Applicable 100.00%1.0 Visit(s) per Year
Eye Glasses for Children
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%1.0 Item(s) per Year
Dental Check-Up for Children
Covered
Not Applicable No ChargeNot Applicable 100.00%1.0 Visit(s) per 6 Months
Rehabilitative Speech Therapy
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%30.0 Visit(s) per Year
Rehabilitative Occupational and Rehabilitative Physical Therapy
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%30.0 Visit(s) per Year Limited to 30 visits for any combination of physical therapy, occupational therapy, and manipulative treatment including chiropractic care.
Well Baby Visits and Care
Covered
Not Applicable No ChargeNot Applicable 100.00%
Laboratory Outpatient and Professional Services
Covered
$20.00 Not ApplicableNot Applicable 100.00%
X-rays and Diagnostic Imaging
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Basic Dental Care – Child
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00% Benefit limitations may apply to individual services.
Orthodontia – Child
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00% Coverage is for medically necessary orthodontia only.
Major Dental Care – Child
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00% Benefit limitations may apply to individual services.
Basic Dental Care – Adult
Not Covered
Orthodontia – Adult
Not Covered
Major Dental Care – Adult
Not Covered
Abortion for Which Public Funding is Prohibited
Not Covered
Transplant
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Accidental Dental
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Dialysis
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Allergy Testing
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Chemotherapy
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Radiation
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Diabetes Education
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Prosthetic Devices
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Infusion Therapy
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Treatment for Temporomandibular Joint Disorders
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00% Excludes Treatment for periodontal disease; Dental implants or root canals; Crowns and bridges; Orthodontic brace; Occlusal (bite) adjustments; Extractions.
Nutritional Counseling
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00%
Reconstructive Surgery
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00% Reconstructive procedures are covered when the primary purpose of the procedure is either treatment of a medical condition or required to improve or restore physiologic function.
Gender Affirming Care
Covered
Not Applicable 40.00% Coinsurance after deductibleNot Applicable 100.00% Covered when medically necessary.

Free Preventive Services

There is no copayment or coinsurance for any of the following UHC Bronze Value ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) preventive services. This is true even if you haven’t met your yearly deductible.

Please note, these services are free only when delivered by a doctor or other provider in your plan’s network.

Additional Resources

Below are additional resources for UHC Bronze Value ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) including the Summary of Benefits & Coverage (SBC), plan brochure, formulary link, and a link to the website to pay your monthly premium after you enroll.

Summary of Benefits: Summary of Benefits Link
Plan Brochure: Plan Brochure Link
Formulary: Formulary Link
Premium Payment Website: Premium Payment Link
Ready to sign up for UHC Bronze Value ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

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