OneNet PPO Identification Card Example
Health plan ID cards for OneNet Participants can vary in appearance because each Payer issues its own ID card.
However, OneNet requires that Payers include certain information on the card to help you identify and provide
services to OneNet Participants. OneNet reviews and approves each card design to verify this information
is included. Below is a sample card illustrating these requirements.
XYZ Payer
1
2
Insured / Participant’s Name
5
Insured / Participant’s ID No.
Group Name
Coverage Effective
Group Number
6
3
4
Service Area: DE, DC, MD, NC, PA, VA, WV
7
Hospitalization—Prior Notification Required: Our UM company must be
notified prior to any hospital admission. In case of emergency, notify our UM
company within one working day of admission.
UM Company: 1-800-555-1234.
To the Employee: You will receive greater benefits and may lower your
out-of-pocket expenses when you use a OneNet PPO provider or hospital.
To the Provider: For eligibility and benefits call: 1-800-555-5678
8
9
11
10
Claims should be directed to:
OneNet PPO Claims
P.O. Box 934
Frederick, MD 21705-0934
OneNet Customer Care:
1-800-342-3289
EDI #: 52149
All Other Claims
XYZ Payer
123 Spring Lane
Anytown, PA 12345
OneNet PPO Card Requirements
1 Insured / Participant’s name
6 Group number on the front of the card
2 Insured / Participant’s identification number
7 Utilization Management information and
toll-free telephone number (when applicable)
3 Name or logo for the networks that the Participant
is authorized to access: OneNet PPO; OneNet
PPO and MAPSI; and/or OneNet Dental PPO or
OneNet Dental Discount. PLEASE NOTE: ID cards
are not used or required for the OneNet PPO
Workers Compensation Network.
4 If more than one network appears on the ID card,
the OneNet service area must be identified, or the
additional network(s) must be listed as applying
“Out of the OneNet Service Area Only”
5 Group name on the front of the card
8 Eligibility and benefits toll-free telephone
number (including weekend and off-hour
telephone number if applicable)
9 OneNet Customer Care telephone number
(1-800-342-3289). Please have your Tax ID
number available when you call.
10 OneNet PPO claims address and address for
non-OneNet claims (e.g. out-of-network)
11 OneNet PPO EDI number (52149) for
electronic claims submission
OneNet PPO is a wholly owned subsidiary of UnitedHealthcare Insurance Company, a part of UnitedHealth Group, Incorporated © 2014 4/14
OneNet PPO Network Logos
Below are the most common OneNet PPO logos used on health plan ID cards of OneNet Participants. Please
note that ID cards are not used or required for the OneNet Workers Compensation Network.
E
PL
M
A
S
E
PL
M
A
S
E
PL
M
A
S
- OR-
E
PL
M
A
S
E
PL
DNTA=MDIS6
S
Indicates access to the
OneNet PPO Network
Indicates access to the
OneNet PPO Network and OneNet’s
MAPSI Behavioral Health Network
OneNet offers two versions of the OneNet / MAPSI logo to
accommodate different space limitations payers may have on
their health plan ID cards.
Indicates access to the
OneNet Dental PPO Network
Indicates access to the
OneNet Dental Discount Network.
NOTES: OneNet requires that health plans identify the OneNet networks they access on the Participant’s ID card.
In some cases, payers may list the names OneNet PPO or OneNet PPO and MAPSI in place of logo usage.
These logos may also appear in color on some ID cards.
OneNet PPO is a wholly owned subsidiary of UnitedHealthcare Insurance Company, a part of UnitedHealth Group, Incorporated © 2014 4/14