UniCare Health Insurance - UNICARE is redefining health care through a new generation of affordable, friendly products that put you back in control of your health care and financial future. We call it "The Cure for Health Care.""

UNICARE is an innovative company with innovative ideas about health care. We have a revolutionary vision of putting individuals in control of their health care through the creation of quality, affordable and flexible health plans. If you are looking for a health plan for yourself, your family or your employees.

Individual & Families
 

There's a UNICARE plan that is right for you, one that offers peace of mind health care coverage at a price you can afford. These plans are currently offered in Georgia!

Georgia Individual And Family Health Plans

UNICARE is a subsidiary of WellPoint Health Networks Inc., one of the largest managed care companies in the United States and one of the most financially sound. WellPoint and its family of companies provide health coverage for over 6.5 million people and have over 12.9 million pharmacy customers.
Benefits of Insurance

When you purchase insurance, you commit a defined amount of money now to guard against an unpredictable, potentially enormous financial loss later.  Health insurance plans

  • promote your good health through preventive programs and services,
  • provide affordable access to emergency care and routine health services over an extended period, and
  • reduce the risk of extreme financial loss in the event of severe illness or injury.

Why You Need It

Health coverage helps shield you against the full cost of care for illness and accidents.  Consider what the cost of a typical hospital stay (3 days and 2 follow-up visits) may be:

$350 - Follow-up care
 
$1,230 - Physician charges


 
$10,530 - Hospital charges




 
Total - $12,110

 

Affordable plans

UNICARE Life & Health Insurance Company offers a wide choice of plans designed to deliver the benefits you want at an appealing price.  If you are self-employed, you may be able to deduct a percentage of your health care premiums from your total taxable income for both state and  federal taxes-making coverage even more affordable.

Freedom to choose your health care providers

With UNICARE, you are in charge of your health care choices.  You choose your doctor, the health plan that best suits your lifestyle and budget, and even your premium payment option.  You decide the amount of your health costs to assume, understanding that the more you assume, the less you'll pay in premiums.

Access to quality care at discounted fees

When you choose providers (independent hospitals, physician, and other medical specialists) from our Classic network, costs to you are reduced.  These providers accept a specially negotiated UNICARE rate-what we term "The UNICARE Advantage,"  You will usually pay more for the services of out-of-network providers.

For a better idea of how you save money by using in-network providers, see the example cost comparison.

A Choice of Plans
  • Individual UNICARE Saver 2000 Plan
    Catastrophic in-hospital and limited outpatient benefits with a $2,000 deductible
  • Individual UNICARE 5000, 2000, 1500, 1000 and 500 Plans
    Five separate plans with broad benefits and deductible from $5,000 to $500
  • Individual UNICARE Plus No Deductible Plan
    Rich in benefits and deductible-free
  • UNICARE Individual Dental PPO Plan
    Choose any dentist, but save through preferred providers

Which Plan is best for you?

For many, premium determines the plan they purchase, UNICARE provides you with a broad selection of prices.  But premium is just one part of a plan's overall cost.  Other elements that may influence your overall cost are the annual plan deductible, copayments and coinsurance.  These are your share of your health care costs-up to the annual maximum.  Raising or lowering your share of health costs or the annual out-of-pocket maximum affects the premium you will be charged for the plan, as the following diagrams demonstrate.

     

Each example demonstrates value, but the combination of price and features determines how much value a particular plan holds for you.  See Medical Plans At a Glance to see which UNICARE plan solutions complement your lifestyle and budget.

 
The UNICARE Advantage

Example using UNICARE 500 Plan

In-Network Charges   Out-of-Network Charges
If the billed charges are
$1,000		   If the billed charges are
$1,000
And UNICARE's negotiated rate is
$650		   And the reasonable charge is $800

If a deductible applies and has been met and you have not reached your annual out-of-pocket maximum for out-of-network providers, UNICARE will pay 60% of the reasonable charges for a total payment of
$480
You get a discount of
$350		   Therefore, you pay 40% of the reasonable charges
$320
If a deductible applies and has been met and you have not reached your annual out-of-pocket maximum for in-network providers, UNICARE will pay 80% of this rate for a total payment of
$520		   Plus, the difference between the billed charges and the reasonable charges which is
$200
You pay only
$130		   You pay a total of
$520

(Note:  If your annual out-of-pocket maximum has been met for both preferred and nonpreferred providers, UNICARE will pay 100% of the negotiated rate for in-network providers and 100% of the reasonable charges only for out-of-network providers.)

With UNICARE, you get attractive pricing, the features you want, and access to the providers of your choice.

UNICARE:  A Health Care Provider You Can Feel Good About

UNICARE Life & Health Insurance Company is a subsidiary of WellPoint Health Networks Inc., one of the largest and most financially sound health care companies in the nation.  More Americans purchase their individual medical coverage through the WellPoint family of companies than any other individual carrier in the United States.

  • UNICARE is rated "A+" by Standard & Poor's Financial Strength Rating Analysis and "A-" (excellent) for claims paying ability by A.M. Best, an independent insurance industry analyst that bases its rating on operating performance and financial stability.
  • Fortune magazine ranked UNICARE's parent company, WellPoint, as America's Most Admired Health Care Company in 2000 for the second consecutive year.

 

Waiting periods

The UNICARE 5000, 2000, 1500, 1000 and 500 and UNICARE Premier No Deductible Plans provide benefits for pregnancy and maternity care only for you and your insured spouse after a 10-month waiting period from the effective date of these policies. The waiting period applies to all benefits related to pregnancy and maternity care, including normal deliveries, cesarean sections, and elective abortions. No maternity or pregnancy benefits are available under the UNICARE Saver 2000 Plan.

An insured person must be covered by one of the UNICARE plans for 12 consecutive months to be eligible for benefits concerning all services related to sterilization. This includes, but is not limited to all tests, consultations, examinations, medications and invasive medical, laboratory or surgical procedures that are related to the evaluation or treatment of sterilization.

Preexisting conditions

Coverage will not be provided for the 12 months following the effective date of this policy for medical conditions that existed in the 12 months prior to the effective date.

Emergency care

UNICARE covers emergency services necessary to screen and stabilize your condition. No utilization review or authorization is required if you reasonably believe an emergency medical condition exists. A medical emergency is an unexpected acute illness, injury or condition that could endanger your health if not treated immediately.

When you consider a medical condition to be an emergency, immediately call 911 or go to the nearest hospital emergency room. Once your condition is stabilized, it is important for the hospital, you or a family member to contact UNICARE about authorization of additional services.

Utilization review, authorization and penalties

This program provides you with valuable information about the medical necessity of services, helping you avoid both unexpected out-of-pocket costs and unnecessary procedures. Utilization review may take place prior to admission to a hospital or ambulatory surgical center, during a hospital stay or following a discharge from a hospital or ambulatory surgical center.

An important aspect of this program is preservice review. The following medical procedures must be reviewed for medical necessity through a preservice review: All nonemergency inpatient hospital stays, and nonemergency outpatient surgeries at an ambulatory surgical center. You must initiate preservice review at least three working days prior to admission. There are additional penalties without a preservice review as described below.

In addition to preservice review, certain services require authorization to be eligible for maximum benefits. There will be a 50 percent reduction in benefits for these services unless UNICARE authorizes benefits: organ/tissue transplants, infusion therapy, home health services, skilled nursing facilities, and hospice. For the UNICARE Premier No Deductible Plan and the UNICARE 500 Plan, this also applies to self-administered injectable drugs and injectable drugs administered in an outpatient setting, except insulin.

All surgical services of an ambulatory surgical center require preservice review or you will be subject to a $50 penalty. Ambulatory surgical centers must be licensed and accredited, and meet all requirements of state and local laws and agencies. For the UNICARE Premier No Deductible Plan and the UNICARE 500 Plan, specified outpatient surgeries and diagnostic procedures regardless of place of service also require preservice review or you will be subject to a $50 penalty.

All inpatient medical care requires preservice review or you will be subject to a $500 penalty. This penalty is waived on emergency admissions; however, utilization review is still required.

To receive maximum benefits, infusion therapy must be authorized by UNICARE. Covered expenses include professional services, compounding fees, incidental supplies, medications, drugs, solutions, durable medical equipment and training related to infusion therapy. Covered expenses will not exceed: total parenteral nutrition (with or without lipids), $250 per day; antibiotics, average wholesale price (AWP)+$125 per day; chemotherapy, AWP+$150 per day; pain management, $125 per day; aerosol therapy, AWP+$70 per day; tocolytic therapy, $250 per day; special items, AWP; intravenous hydration, $75 per day. Failure to obtain authorization will result in a 50 percent reduction in benefits for covered expenses.

Emergency room visits that do not result in inpatient admissions will be subject to a $60 penalty.

Certain prescription drugs may require prior authorization. Please refer to your certificate of coverage for details.

Easy Guide to the Rates

  Click here if you are eligible for or currently enrolled in Medicare parts A & B

Step 1

Enter your 5 digit zip code
Subscriber Gender Male    Female
Enter the age of the subscriber
Enter the age of the spouse
(if appropriate)
Smoker Yes    No
   
MedCall

UNICARE offers-at no additional cost to you-clinically accurate medical information and resources, available 24 hours per day, 7 days a week through MedCall.  This telephone hotline provides nurse counselors who will answer your health questions about

  • symptoms or procedures and alternatives
  • medications and side effects
  • a diagnosis
  • referrals for doctors and medical facilities
  • referrals for local, state and national self-help agencies

The MedCall nurses provide information relative to your health questions by using a database covering

  • 125 complex medical problems
  • 135 symptoms
  • 500 health topics
  • 600 medical tests and procedures
  • 5,000 self-help/support groups
  • 120 CancerNet topics
  • 5,000 drug treatments

Designed to assist consumers in health care decision making, the MedCall system also provides customized information.  MedCall nurses can relay customized information via mail or fax.

In addition to personalized calls, MedCall provides you with recorded information on more than 200 health topics.

Shortly after your new plan is issued, you will receive a MedCall packet in the mail.  The packet will contain a brochure and all the information necessary for you to access MedCall.
Enrollment Guidelines

Eligibility for coverage

To be eligible for enrollment, you must be

  • age 64½ or younger
  • the applicant's spouse, age 64½ or younger
  • the applicant's unmarried child up to age 19
  • the applicant's unmarried child who is a full-time student (12 units), age 19 through 25
  • a resident of the United States for at least six months
  • able to meet UNICARE's underwriting requirements
  • not eligible for Medicare
  • not enrolled under any other individual or group or health plan or insurance policy
  • unmarried stepchildren who reside with the applicant up to age 19 or if a full-time student (12 units), age 19 through 25

How to enroll

Each individual and family member who applies for coverage in any of the UNICARE plans must submit an individual application for UNICARE underwriting review.  If any applicant does not qualify based on UNICARE’s underwriting standards, the application will not be approved.  Certain conditions, subject to UNICARE’s underwriting guidelines may qualify the applicant for the plan at a premium that is higher than the Level I (Preferred) premium and/or coverage for a particular medical condition may be excluded from coverage by a waiver. Follow the instructions on the Individual Application form.

Medical Plan Limitations & Exclusions

The primary limitations and exclusions for each of the plans are listed below.  Please take a few moments to review this information.  We want you to understand what your coverage doesn’t include before you buy.  These listings are an overview only.  A comprehensive list of each plan’s limitations and exclusions can be found in the plan-specific certificate of coverage booklet.

Limitations & Exclusions for the UNICARE 5000, 2000, 1500, 1000, and 500, UNICARE Premier No Deductible, and UNICARE Saver Plans
  • Services for any condition for which benefits are excluded by a waiver.
  • Any amounts in excess of maximum amounts of covered expenses stated in this policy.
  • Services that do not medically treat a condition as stated in this policy.
  • Services or supplies that are not medically necessary.
  • Services or supplies that are considered to be experimental or investigative procedures.
  • Services received before the effective date of coverage or during an inpatient stay that began before that effective date of coverage.
  • Services received after coverage ends.
  • Services for which you have no legal obligation to pay, or for which no charge would be made if you did not have a health plan or insurance coverage.
  • Any condition for which benefits are recovered or can be recovered, either by adjudication, settlement or otherwise, under any workers’ compensation, employer’s liability law or occupational disease law, even if you do not claim those benefits.
  • Conditions caused by or contributed by (a) an act of war; (b) the inadvertent release of nuclear energy when government funds are available for treatment of illness or injury arising from such release of nuclear energy; (c) services received for any condition resulting from your participation in the military service of any country; (d) your participation in an insurrection, rebellion, or riot; (e) services received for any condition caused by your commission of, or attempt to commit a felony or to which a contributing cause was the insured being engaged in an illegal occupation; (f) an insured, being under the influence of illegal narcotics or nonprescribed controlled substances unless administered on the advice of a physician
  • Any services provided by a local, state or federal government agency except when payment under this plan is expressly required by federal or state law.
  • If you are eligible for Medicare, any services covered by Medicare under Parts A or B are excluded regardless of actual enrollment in Medicare or payment by Medicare for those services.
  • Any services for which payment may be obtained from any local, state or federal government agency (except Medicaid).Veterans Administration hospitals and military treatment facilities will be considered for payment according to current legislation.
  • Professional services received or supplies purchased from yourself, a person who lives in the insured’s home or who is related to the insured by blood, marriage or adoption, or the insured person’s employer.
  • Inpatient or outpatient services of a private duty nurse.
  • Inpatient room and board charges in connection with a hospital stay primarily for environmental change, physical therapy or treatment of chronic pain; custodial care or rest cures; services provided by a rest home, a home for the aged, a nursing home or any similar facility service.
  • Inpatient room and board charges in connection with a hospital stay primarily for diagnostic tests which could have been performed safely on an outpatient basis.
  • Treatment of mental, emotional or functional nervous disorders (including nicotine use) or psychological testing, except as specifically stated in this policy. However, medical conditions that are caused by your behavior and that may be associated with these mental conditions are not subject to these limitations.
  • Treatment of drug, alcohol, or other substance addiction or abuse.
  • Dental services.
  • Orthodontic services.
  • Dental implants or any associated procedures.
  • Hearing aids.
  • Routine hearing tests except as provided under well baby and well child care.
  • Optometric services, eye exercises, including orthoptics, eyeglasses, contact lenses, routine eye exams, and routine eye refractions, except as specifically stated in this policy.
  • An eye surgery solely for the purpose of correcting refractive defects of the eye, such as near-sightedness (myopia), astigmatism and/or farsightedness (presbyopia).
  • Outpatient speech therapy.
  • Any drugs, medications, or other substances dispensed or administered in any outpatient setting except as specifically stated in this policy. This includes, but is not limited to, items dispensed by a physician.
  • Any intentionally self-inflicted injury or illness.
  • Cosmetic surgery or other services for beautification, including any medical complications that are generally predictable and associated with such services by the organized medical community. This exclusion does not apply to medically necessary reconstructive surgery to restore a bodily function; or to correct a deformity caused by injury; or congenital defect of a newborn child; or to breast reconstruction performed to restore or achieve breast symmetry incident to a mastectomy.
  • Procedures or treatments to change characteristics of the body to those of the opposite sex.
  • Treatment of sexual dysfunction, impotence and/or inadequacy.
  • All services related to the treatment of fertility and/or infertility, including sterilization reversals.
  • Cryopreservation of sperm or eggs.
  • Orthopedic shoes (except when joined to braces) or shoe inserts, including orthotics.
  • Services primarily for weight reduction or treatment of obesity.
  • Routine physical exams or tests that do not directly treat an actual illness, injury or condition, including those required by employment or government authority except as specifically stated under the professional, well baby and well child care, and other preventive care services sections of this policy.
  • Charges by a provider for telephone consultations.
  • Items which are furnished primarily for your personal comfort or convenience.
  • Educational services except as specifically provided or arranged by UNICARE.
  • Nutritional counseling or food supplements.
  • Any services received on or within twelve months after the effective date of coverage if they are related to a preexisting condition
  • All foreign country provider charges are excluded under this policy, except as specifically stated under the benefits section of this policy.
  • Growth hormone treatment.
  • Routine foot care.
  • Charges for which we are unable to determine our liability because you failed, within 60 days, or as soon as reasonably possible to (a) authorize us to receive all the medical records and information we requested, or (b) provide us with information we requested regarding the circumstances of the claim or other group or blanket accident and sickness insurance coverage.
  • Charges for the services of a standby physician.
  • Charges for animal to human organ transplants.

Additional Limitations & Exclusions for the UNICARE Saver 2000 Plan
  • Any services of a physician, except as specifically stated under limited professional and other services.
  • Surgical procedures for sterilization (i.e., vasectomy, and/or tubal ligation).
  • Charges for pregnancy or maternity care, including normal delivery, elective abortions, cesarean sections, or complications of pregnancy.
  • All contraceptive services and supplies, including but not limited to, all consultations, examinations, evaluation, medications, medical, laboratory, devices, prescription drugs, or surgical procedures.
  • Physical and/or occupational therapy/medicine, except when provided during an inpatient hospital confinement.
  • Acupuncture/acupressure.
  • Charges for any smoking cessation program or pharmaceuticals related to smoking cessation.
  • Durable medical equipment.
Forms & Documents

Individual Enrollment Application

Member Claim Form

These forms are in the PDF format. In order to print a form, you must have Adobe Acrobat Reader. This software is available for FREE from the Adobe Acrobat Web Site. Click the icon below and verify that your version of Acrobat Reader is the most current version available. Please note that UNICARE does not provide Technical Support for Acrobat Reader Software.  For technical support, contact Adobe.

To use this form:

1.  Download and install Acrobat Reader.
2.  Use Acrobat Reader and your printer to print the form.

 
Provider Finder
 
 
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Important Note:

The listing of providers in this area does not constitute a recommendation of any hospital, physician, or other professional provider or facility. While we strive to keep this information complete and up-to-date, the information displayed is subject to change. Please review Not all networks service your benefit plan.  Please review your ID Card for more information, or contact your plan administrator.

 

About Us

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UNICARE is a national organization dedicated to the delivery of quality health care plans and products working together with its customers, consultants, brokers, providers and employers. Providing managed care and specialty health care services throughout the United States, UNICARE Life & Health Insurance Company is an operating affiliate of WellPoint 
Health Networks Inc. (NYSE:WLP www.wellpoint.com), one of the nation's largest publicly traded managed care companies serving the health care needs of 9.8 million medical and over 42 million specialty products members.

UNICARE offers a comprehensive array of healthcare plans and specialty products that preserve member choice at competitive prices. UNICARE currently serves 2.3 million medical members.

UNICARE recognizes that what works for one doesn't necessarily work for another. That's why our full portfolio of health, pharmacy, dental, life and disability benefits products can be tailored to meet your specific needs.

Our focus is on putting our clients and their associates back in control of their health care and financial future. Through exceptional sales and account management staff who listen to our clients and their associates, we can create benefits that evolve over time to meet changing needs and add the most value. 

UNICARE isn't just a solution for the moment-we're a trusted partner for the long term.

History | Structure and Management | Products and Services | Principle Medical Products 

History
In 1995, UNICARE became the brand name for most of the WellPoint businesses operated outside of California. WellPoint acquired the group health and related life business of Massachusetts Mutual Life Insurance Company(r) in 1996, filling a strategic requirement in the group market of employers with 250 to 2,000 employees. The 1997 acquisition of the group health and related life business of John Hancock Mutual Life Insurance Company(r) services the large group market segment of employers with 2,000+ employees. In early 2000, WellPoint acquired Rush Prudential Health Plans of Illinois. This acquisition brings together Rush Prudential and WellPoint's existing UNICARE business, and enables UNICARE to offer a broad array of products and services in Illinois ranging from traditional PPO products to HMO products.

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Structure & Management
UNICARE has assembled a senior management team comprising successful and creative individuals from commercial health insurance, specialty products firms, financial services organizations and other Fortune 500 companies.

UNICARE is structured around WellPoint's unique Market Business Unit (MBU) concept. Each MBU is organized to serve specific customers and consists of a full-service organization with sales and service functions dedicated exclusively to meeting the needs of customers in a particular segment.

The large employer group businesses, acquired in the MassMutual and John Hancock acquisitions, have a national focus as a result of the multi-state needs of employers in those customer segments. Other business units, such as those focusing on the individual, senior, and small employer group have a regional focus as a result of the localized nature of customers in these segments. Each UNICARE business unit is responsible for marketing, enrolling, underwriting and servicing its specific customers and members. 

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UNICARE Products and Services
Consumers want choice of products and providers, and they want more control over their health care decisions. Employers also want the maximum amount of cost control but are more sensitive to employee needs in today's high employment economy. UNICARE creates products that combine the attributes consumers find attractive with our cost control techniques. Extensive health care provider networks enable UNICARE to offer a comprehensive array of products and services that reflect the company's philosophy of working together with members and providers, affordability for members and their families and choice of health care providers. Employer groups and individual members can select from basic as well as comprehensive plans to meet their specific needs.

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Principle Medical Products
UNICARE's strategy is to offer a diversified mix of traditional managed care products while focusing on the development of new hybrid plans which take advantage of the best characteristics of traditional managed care and traditional open access models. The company will offer a continuum of managed health care plans which provide incentives to select more tightly managed plans. UNICARE believes that it is better able to predict and control health care costs and provide greater patient choice. Members more needy of care are incented to select more intensively managed health care plans and members less needy of care are allowed to select plans with greater personal freedoms. Such plans are typically offered to provide greater control of care and access in exchange for additional cost-maintenance measures.

Specialty Products
UNICARE also provides a broad array of specialty managed care products, including pharmacy, dental, life, disability, behavioral health, COBRA and flexible benefits account administration. In addition, UNICARE offers managed care services for self-funded employers, including underwriting, actuarial services, network access, medical management services and claims processing. UNICARE's unique assortment of products and services has been developed to meet the needs of a broad range of individuals, employer groups and their employees.