UHA - Managed Care Contracts
University HealthCare Alliance (UHA) contracts with various Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO).
UHA also participates in government programs such as traditional Medicare, traditional Medi-Cal, and TriCare.
Always check with your health plan to confirm participation.
University HealthCare Alliance’s (UHA) participation in Managed Care Plans for 2017
Aetna
HMO, PPO, POS, and EPO
Anthem Blue Cross
HMO, PPO, and EPO
(UHA is not considered in-network with Anthem Blue Cross Covered California or Cal MediConnect plans)
Blue Shield of California
HMO, PPO, and POS
(UHA is not considered in-network with Blue Shield Covered California plans)
CIGNA
HMO, PPO, POS & OAP
Health Net
HMO, Medicare Advantage, PPO, POS, & EPO
HealthSmart (formerly Interplan)
PPO, EPO, and POS
Humana
PPO
Stanford Health Care Alliance (SHCA)
Group Plan
United Health Care
HMO, Medicare Advantage, POS, PPO, & EPO
Stanford Health Care Advantage (SHCA)
Medicare Advantage
Individual/Family Plans and Covered California Plans
Not all health plans are available in every county. For further information, please contact Covered California or a licensed insurance broker to determine if a specific plan is available for purchase in your region.
University HealthCare Alliance’s (UHA) participation in Individual/Family Plans for 2017
UHA participates in the CIGNA Individual/Family PPO and EPO plans which are not available for purchase through the Covered California Exchange. A CIGNA Individual/Family plan product may be purchased directly from CIGNA or through a licensed insurance agent. UHA’s participation includes specialist and primary care/general pediatrician services.
UHA participates in the Health Net HMO/HCSP/HSP Individual/Family plan which is available to residents of Santa Clara County. UHA’s participation includes specialist and primary care/general pediatrician physician services. Only UHA primary care physicians that are in Santa Clara County may be selected as your PCP.
UHA Participates in the Health Net Individual/Family EPO plan which is available in Contra Costa and San Mateo counties. UHA’s participation includes specialist and primary care/general pediatrician services.
UHA also participates in the Health Net Individual/Family PPO plan which is not available for purchase through the Covered California Exchange. A Health Net Individual/Family PPO plan may be purchased directly from Health Net or through a licensed insurance agent. UHA’s participation includes specialist and primary care/general pediatrician physician services.
Have further questions? Email the Managed Care Department at managedcare@stanfordhealthcare.org or call the Stanford Health Care Patient Billing Customer Service at 1-888-924-1036
Please contact your health plan directly to confirm your eligibility and to verify participation of your physician in the plan/product you have selected.
Helpful Web sites for information on health insurance and managed care are:
- California Patient's Guide
- California Department of Managed Health Care
- Covered California - 1-800-300-1506
Health Insurance Glossary
For more glossary terms, please go to Healthcare Glossary.
Preferred Provider Organization
A type of health insurance plan that contracts with medical providers such as hospitals and physicians to create a network of participating providers. There is a financial incentive to use in-network providers by offering higher benefit coverage than out of network providers. Health care services received from providers that are “in-network” are covered at an in-network benefit level, while out of network providers are covered by out of network benefits, which are typically more expensive. Patients can typically self-refer to specialists, but are responsible themselves for making sure that all providers are in-network.
Exclusive Provider Organization
A type of health insurance plan in which choosing a primary care provider is not required but providers seen must be within the predetermined network. Out of network care is not covered except in an emergency. Patients can typically self-refer to specialists, but are responsible themselves for making sure that all providers are in-network.
Health Maintenance Organization
A type of health insurance plan that limits coverage to primary care providers and specialists who work for or are contracted with the HMO. You typically must have a referral and authorization for any specialist services. It generally does not cover out of network care except in emergency.
Deductible
The amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself.
Co-insurance
The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible.
Out of Pocket Maximum
The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance, your health plan pays 100% of the costs of covered benefits. The out-of-pocket limit doesn't include your monthly premiums. It also doesn't include anything you may spend for services your plan doesn't cover.
Referral
A written order from your primary care doctor for you to see a specialist or get certain medical services. In many Health Maintenance Organizations (HMOs), you need to get a referral before you can get medical care from anyone except your primary care doctor. If you don’t get a referral first, the plan may not pay for the services.
Authorization
An approval from your health plan for a specific service, usually within a certain window of time. Many plans, including HMOs, require authorizations for all specialist services/procedures.
Primary Care Provider
Health provider that cover a range of prevention, wellness, and treatment for common illnesses. Primary care providers include doctors, nurses, nurse practitioners, and physician assistants. They often maintain long-term relationships with you and advise and treat you on a range of health related issues. They may also coordinate your care with specialists.
Specialist
A physician that focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care.
View sample monthly statement summary (front of billing statement)
