North Carolina health plan · 2026

UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) · 54332NC0030039

UnitedHealthcare of North Carolina, Inc. offers this marketplace health insurance plan (Plan ID 54332NC0030039) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Silver Plan type: HMO CSR: Standard Silver Off Exchange Plan Issuer: UnitedHealthcare of North Carolina, Inc.
Telehealth Data pending HSA eligible No Dental Child Vision Child
Pay / Manage Plan View issuer site

Issuer actuarial value: 70.96%. Expect to pay roughly 29.04% of covered costs out of pocket, based on issuer reporting.

2026 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$452 – $2225

Before subsidies

Estimate after subsidies

Deductible

$2,500

$5000 per group

See deductible details

Max out-of-pocket

$10,150

$20300 per group

Review MOOP rules

Office visits

Primary care $30.00
Specialist $100.00
HSA Not eligible

Drug tiers

Generic $3.00
Preferred brand $50.00 Copay after deductible

View formulary tiers

$765 / mo before subsidies

≈ $9180 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$2324 / mo before subsidies

≈ $27886 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$2590 / mo before subsidies

≈ $31077 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1765 / mo before subsidies

≈ $21184 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

$1000.00 Copay after deductible

Durable Medical Equipment

30.00% Coinsurance after deductible

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Enrollment guidance

Stay on top of 2026 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2026 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in North Carolina). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • Standard Silver Off Exchange Plan plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

$1000.00 Copay after deductible

Durable Medical Equipment

30.00% Coinsurance after deductible

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 54332NC0030039
Coverage year 2026
State North Carolina
Issuer UnitedHealthcare of North Carolina, Inc.
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 54332NC0030039-00
Available variants

Standard Off Exchange Plan · 54332NC0030039-00

Standard On Exchange Plan · 54332NC0030039-01

Open to Indians below 300% FPL · 54332NC0030039-02

Open to Indians above 300% FPL · 54332NC0030039-03

73% AV Silver Plan · 54332NC0030039-04

87% AV Silver Plan · 54332NC0030039-05

94% AV Silver Plan · 54332NC0030039-06
Last plan update Wed, 15 Oct 2025 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in North Carolina 24448
PCPs in North Carolina 2938
Telehealth support Data pending
Nationwide providers 34411
24,448 doctors statewide 2,938 PCPs 143 OB/GYN

Provider network(s)

Providers North Carolina All US states
All 24448 34411
PCP 2938 3092
Allergy 6 6
OB/GYN 143 147
Dentists 23 25

Drug coverage overview

3,621 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
NON-PREFERRED-BRAND 1,365
PREFERRED-GENERIC 1,353
ZERO-COST-SHARE-PREVENTIVE 510
SPECIALTY 393
Prior authorization Drugs
Required 631
Not Required 2,990
Step therapy Drugs
Required 52
Not Required 3,569
Quantity limits Drugs
Has Limit 1,654
No Limit 1,967

Customer highlights

What stands out for members

  • Issuer: UnitedHealthcare of North Carolina, Inc. · Plan ID 54332NC0030039 · 2026 filing.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 54332NC0030039-00 (Standard Off Exchange Plan) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Limited to 30 visits for any combination of physical therapy, occupational therapy, and manipulative treatment including chiropractic care.

Diabetes Education

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Home Health Care Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Laboratory Outpatient and Professional Services

$15.00 Copay after deductible
Tier 1 in-network $15.00 Copay after deductible
Out-of-network 100.00%

Other Practitioner Office Visit (Nurse, Physician Assistant)

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Preventive Care/Screening/Immunization

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Primary Care Visit to Treat an Injury or Illness

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

Cost sharing for Virtual Primary Care matches in-person office visit.

Rehabilitative Occupational and Rehabilitative Physical Therapy

$80.00 Copay after deductible
Tier 1 in-network $80.00 Copay after deductible
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Limited to 30 visits for any combination of physical therapy, occupational therapy, and manipulative treatment including chiropractic care. Visit limits for therapies do not apply if the primary diagnosis code is for Mental Health, Substance Use Disorder, or Autism Spectrum Disorder.

Rehabilitative Speech Therapy

$80.00 Copay after deductible
Tier 1 in-network $80.00 Copay after deductible
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Visit limits for therapies do not apply if the primary diagnosis code is for Mental Health, Substance Use Disorder, or Autism Spectrum Disorder.

Specialist Visit

$100.00
Tier 1 in-network $100.00
Out-of-network 100.00%

Urgent Care Centers or Facilities

$100.00
Tier 1 in-network $100.00
Out-of-network 100.00%

$0 Virtual Urgent Care visits are available through vendor. See SBC for additional cost share details for in-person urgent care visits.

X-rays and Diagnostic Imaging

$35.00 Copay after deductible
Tier 1 in-network $35.00 Copay after deductible
Out-of-network 100.00%

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

$750.00 Copay after deductible
Tier 1 in-network $750.00 Copay after deductible
Out-of-network 100.00%

Delivery and All Inpatient Services for Maternity Care

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Childbirth/delivery professional services follow inpatient physician/surgeon fees.

Dialysis

$500.00 Copay after deductible
Tier 1 in-network $500.00 Copay after deductible
Out-of-network 100.00%

Durable Medical Equipment

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Emergency Room Services

$1000.00 Copay after deductible
Tier 1 in-network $1000.00 Copay after deductible
Out-of-network $1000.00 Copay after deductible

Emergency Transportation/Ambulance

$1000.00 Copay after deductible
Tier 1 in-network $1000.00 Copay after deductible
Out-of-network $1000.00 Copay after deductible

Hospice Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Inpatient Hospital Services (e.g., Hospital Stay)

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Inpatient Physician and Surgical Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Mental/Behavioral Health Inpatient Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Mental/Behavioral Health Outpatient Services

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

Cost share applies to office visits, please see SBC for Mental Health Outpatient Services.

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

$750.00 Copay after deductible
Tier 1 in-network $750.00 Copay after deductible
Out-of-network 100.00%

Outpatient Rehabilitation Services

$80.00 Copay after deductible
Tier 1 in-network $80.00 Copay after deductible
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Limited to 30 visits for any combination of physical therapy, occupational therapy, and manipulative treatment including chiropractic care. Limited to 30 visits for Speech Therapy. Visit limits for therapies do not apply if the primary diagnosis code is for Mental Health, Substance Use Disorder, or Autism Spectrum Disorder.

Outpatient Surgery Physician/Surgical Services

$375.00 Copay after deductible
Tier 1 in-network $375.00 Copay after deductible
Out-of-network 100.00%

Radiation

$100.00 Copay after deductible
Tier 1 in-network $100.00 Copay after deductible
Out-of-network 100.00%

Skilled Nursing Facility

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 60.0 Days per Year

Limit of 60 days will be any combination of Skilled Nursing Facility or Inpatient Rehabilitation Facility Services.

Substance Abuse Disorder Inpatient Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Substance Abuse Disorder Outpatient Services

$30.00
Tier 1 in-network $30.00
Out-of-network 100.00%

Transplant

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Benefit limitations may apply to individual services.

Hearing Aids

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 1.0 Item(s) per 3 Years

One hearing aid per hearing impaired ear every 36 months.

Major Dental Care - Child

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Benefit limitations may apply to individual services.

Prenatal and Postnatal Care

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Routine Eye Exam for Children

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Limit: 1.0 Visit(s) per Year

Well Baby Visits and Care

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$3.00
Tier 1 in-network $3.00
Out-of-network 100.00%

Limit: 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

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 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

$50.00 Copay after deductible
Tier 1 in-network $50.00 Copay after deductible
Out-of-network 100.00%

Limit: 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

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 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.

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Basic Dental Care - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Dental Check-Up for Children

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Limit: 2.0 Exam(s) per Year

Infusion Therapy

$100.00 Copay after deductible
Tier 1 in-network $100.00 Copay after deductible
Out-of-network 100.00%

Major Dental Care - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Nutritional Counseling

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Covered for all diagnoses.

Orthodontia - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Orthodontia - Child

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Coverage is for medically necessary orthodontia only.

Prosthetic Devices

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Routine Dental Services (Adult)

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Weight Loss Programs

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Acupuncture

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Allergy Testing

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Bariatric Surgery

$750.00 Copay after deductible
Tier 1 in-network $750.00 Copay after deductible
Out-of-network 100.00%

For surgical treatment of morbid obesity.

Cosmetic Surgery

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Eye Glasses for Children

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 1.0 Item(s) per Year

Gender Affirming Care

$750.00 Copay after deductible
Tier 1 in-network $750.00 Copay after deductible
Out-of-network 100.00%

Services that fall under CMS’ definition of sex trait modification procedures are not covered.

Habilitation Services

$80.00 Copay after deductible
Tier 1 in-network $80.00 Copay after deductible
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Limited to 30 visits for any combination of physical therapy, occupational therapy, and manipulative treatment including chiropractic care. Limited to 30 visits for Speech Therapy. Visit limits for therapies do not apply if the primary diagnosis code is for Mental Health, Substance Use Disorder, or Autism Spectrum Disorder.

Imaging (CT/PET Scans, MRIs)

$200.00 Copay after deductible
Tier 1 in-network $200.00 Copay after deductible
Out-of-network 100.00%

Infertility Treatment

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 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

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Private-Duty Nursing

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Reconstructive Surgery

$750.00 Copay after deductible
Tier 1 in-network $750.00 Copay after deductible
Out-of-network 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.

Routine Eye Exam (Adult)

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Routine Foot Care

Coverage details pending

Covered when done for the prevention of complications associated with metabolic, neurologic, or peripheral vascular disease

Treatment for Temporomandibular Joint Disorders

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Exclusions: Excludes Treatment for periodontal disease; Dental implants or root canals; Crowns and bridges; Orthodontic brace; Occlusal (bite) adjustments; Extractions.

Variant attributes

UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) · Variant 54332NC0030039-00

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2026

CSR Variation Type

Standard Silver Off Exchange Plan

HIOS Product ID

54332NC003

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

54332NC0030039-00

Plan Marketing Name

UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)

Plan Variant Marketing Name

UHC Silver-X Advantage $2,500 Indiv Ded ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)

Issuer & service area

Issuer-provided metadata for this variant.

Issuer Actuarial Value

70.96%

Issuer ID

54332

Issuer Marketplace Marketing Name

UnitedHealthcare

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

NCN011

Out of Country Coverage

No

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.

Service Area ID

NCS011

State Code

NC

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

Yes

Medical Drug Maximum Out of Pocket Integrated

Yes

SBC Scenario, Having a Baby, Coinsurance

$2,500

SBC Scenario, Having a Baby, Copayment

$40

SBC Scenario, Having a Baby, Deductible

$2,500

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$300

SBC Scenario, Having Diabetes, Deductible

$300

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$0

SBC Scenario, Treatment of a Simple Fracture, Copayment

$200

SBC Scenario, Treatment of a Simple Fracture, Deductible

$2,500

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

Not Applicable

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

30.00%

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$20300 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$10150 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$10,150

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

Not Applicable

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

NCF031

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$0

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Dental Only Plan

No

Design Type

Not Applicable

EHB Percent of Total Premium

1

First Tier Utilization

100%

Import Date

10/15/2025

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

No

Plan Effective Date

1/1/2026

Plan Level Exclusions

Some exclusions may apply. See the applicable Certificate of Coverage for details.

Plan Type

HMO

QHP/Non QHP

Both

Source Name

HIOS

Plan ID

54332NC0030039

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group

$5000 per group

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person

$2500 per person

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual

$2,500

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group

per group not applicable

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person

per person not applicable

Combined Medical and Drug EHB Deductible, Out of Network, Individual

Not Applicable

Unique Plan Design

Yes

Wellness Program Offered

No

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in North Carolina?

UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) (54332NC0030039) is a Silver HMO from UnitedHealthcare of North Carolina, Inc. in North Carolina for the 2026 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental add-ons: Child.

Vision add-ons: Child.

Does UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Is there out-of-country coverage for UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)?

No, out-of-country services are not covered for this plan.

Does UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) cover care outside the service area?

Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: 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.

How do I enroll in or manage payments for UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)?

Use the issuer portal https://sso.uhc.com/ext/sp/ACS.saml2 to pay premiums or start enrollment, then return to HealthPorta for benefit comparisons.

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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