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UnitedHealthcare Community Plan of California Medi-Cal

Medicaid

UnitedHealthcare Community Plan of 加利福尼亞 includes a range of benefits. Children, pregnant women, families, adults and seniors and people with disabilities may qualify based on income. View the benefits below to see what our plan covers.

If you have Medi-Cal benefits, your coverage will need to be renewed every year. The county will send you a Medi-Cal renewal form. Complete this form and return it to your local county human services agency. You can also visit or call your local human services agency. To find an office near you, visit the San Diego Health & Human Service Agency website.

If you lose Medi-Cal coverage, you may enroll in health insurance coverage through Covered 加利福尼亞 in the special-enrollment period due to a loss of coverage.

在過去兩年中,您的聯絡資訊是否有所變更?Give your county office your updated contact information so you can stay enrolled. Find your local county office.

承保福利和特點

康復與生病照護

Get the assistance you need to be at your best — or to get better if you are injured or sick. 這包括:

  • 保健門診。 Annual checkups to help keep you healthy. 
  • 醫師選擇。 在我們的網路中找到您可以信任的醫生。
  • 預防針和疫苗. Routine shots to help protect against illness. 
  • 緊急護理. Convenient care for a sudden illness or injury. 
  • 護士熱線。Speak with a registered nurse 24/7. Call 1-866-270-5785.
  • 檢驗室檢驗和 X 光檢查. 涵蓋檢驗室檢驗、x 光檢查和影像診斷。

Nothing is more important than the health and well-being of a mother and your baby. 這就是為何我們的承保福利包括:

  • Choice of Doctor. Find a doctor or OB/GYN you trust in our network. 
  • Prenatal Visits. Care for you before your baby is born.
  • Healthy First Steps®. Get extra support and rewards to keep you and your baby healthy.
  • Text4Baby. Receive text messages with helpful tips and reminders.

醫療問題和狀況有時在不方便的時間發生。當您有關於健康方面的疑問時,可致電護士,服務時間一週 7 天,一天 24 PR_BXODFV小時:1-855-366-5032.

Our Nurse Hotline will:

  • 聽取您的症狀。
  • 協助自我照護。
  • 建議您看醫生或到緊急護理中心看診。
  • 幫助您了解什麽時間應該掛急診。

If you have a life threatening emergency, go immediately to the emergency room or call 911.

如果您有氣喘、糖尿病或其他長期疾病,您可以信賴我們。Our plan makes sure you get the care and services you need. 承保福利範圍包括:

  • Care Manager. If you qualify, get personal help managing health conditions. 
  • 疾病管理. Focused care for those with chronic health needs, like asthma and diabetes. 
  • 精神健康. 承保醫療諮詢和其他治療。
  • Residential Care. Brief stay at a care facility while you recover from sickness or injury.

UnitedHealthcare Community Plan of 加利福尼亞, Inc. covers Enhanced Care Management (ECM) services for members with highly complex needs. ECM is a benefit that provides extra services to help you get the care you need to stay healthy. It coordinates the care you get from different doctors. ECM helps coordinate primary care, acute care, behavioral health, developmental, oral health, community-based long-term services and supports (LTSS), and referrals to available community resources.

If you qualify, you may be contacted about ECM services. You can also call UnitedHealthcare Community Plan of 加利福尼亞, Inc. to find out if and when you can receive ECM. Or talk to your health care provider who can find out if you qualify for ECM and when and how you can receive it.

Covered ECM services

If you qualify for ECM, you will have your own care team, including a care coordinator. This person will talk to you and your doctors, specialists, pharmacists, case managers, social services providers and others to make sure everyone works together to get you the care you need. A care coordinator can also help you find and apply for other services in your community. ECM includes:

  • Outreach and engagement
  • Comprehensive assessment and care management
  • Enhanced coordination of care
  • Health promotion
  • Comprehensive transitional care
  • Member and family support services
  • Coordination and referral to community and social supports

To find out if ECM may be right for you, talk to your UnitedHealthcare Community Plan of 加利福尼亞, Inc. representative or health care provider. 

Call Member Services at 1-866-270-5785 (TTY 711).

UnitedHealthcare Community Plan of 加利福尼亞, Inc. is here 07:00 to 19:00 PST, Monday through Friday, except State holidays. The call is toll free. Or call the 加利福尼亞 Relay Line at 711. Visit online at myuhc.com/CommunityPlan.

 

 

The plan covers: 

  • Routine eye exam once every 24 months; UnitedHealthcare Community Plan of 加利福尼亞, Inc. 
    may pre-approve (prior authorization) additional services as medically necessary. 
  • Eyeglasses (frames and lens) once every 24 months; contact lens when required for medical 
    conditions such as aphakia, aniridia and keratoconus. 

If you are recovering from a serious illness or surgery, you may need extra support. Our plan includes the care and equipment needed to recover safely at home. Some benefits include:

  • 設備和用品. In-home medical and safety equipment. 
  • 家庭醫療護理. Medical and personal care in your home, if medically needed.

Sometimes members need a little extra help using their health plan. 此時,您可以依靠:

  • Transportation. Get rides to and from doctor appointments and more. 
  • 語言幫助。 Translated materials and interpreters who are ready to help you 24/7. 
  • 保戶服務。 Available 7 a.m. to 7 p.m. PT, Monday – Friday. 
  • Member Advocate. Local advocates to get you information, services and care. 
  • Nurse Hotline℠. 向合格註冊的護理人員諮詢,服務時間每天24小時一週7天全年無休。請致電 1-866-270-5785


UnitedHealthcare Community Plan of 加利福尼亞, Inc. has health education programs, services and materials to help you improve your health and manage illness at no cost to you. 

  • Health Education Resource Library: Many of the materials are offered in different languages and/or in formats for the hard of hearing and visually impaired.
  • Health Education Classes: UnitedHealthcare is partnering with Champions for Health to sponsor virtual health education classes about multiple topics such as Chair Yoga, Childhood Health, Cooking Demo, Women’s Health, and Diabetes. The classes will be offered to our members and the community at no cost in 英文 and Spanish.

To enroll in a class, download the Health Education Class Schedule in 英文 or Spanish or visit championsforhealth.org/virtual-health-education-classes to register.
For questions about our health education programs, please call 866-782-2037 or email uhchealthed@uhc.com.

照護管理員

Do you have a serious health problem? If so, our case managers are in your corner. They will:

  • Explain medical terms in plain language.
  • Coordinate your doctor appointments.
  • Provide your care team with your medical records.

The care manager will stay with you throughout your medical journey. He or she will:

  • Think beyond your medical needs.
  • Make sure you have support at home.

 

醫師選擇

Each member can choose a primary care physician (PCP). Use the “Doctor Lookup” tool to see if your doctor is in our network. 

您的主要照護醫師 (PCP) 就是為您提供下列服務的主治醫師:

  • 預防照護。
  • 在您生病或受傷時為您治療。
  • 針對您的特殊健康問題,將您轉診給專科醫生。

如果保戶還沒有主治醫師,或是其主治醫師不在我們的網路內,我們可以協助找到附近的醫師。

Community supports

加利福尼亞 Advancing and Innovating Medi-Cal (CalAIM) establishes the framework to address social determinants of health and improve health equity statewide.

A key feature of CalAIM is the introduction of a menu of in lieu of Community Supports.

What Are Community Supports?
Community Supports are services or settings that the Plan may offer in place of services or settings covered under the 加利福尼亞 Medicaid State Plan and that are medically appropriate, cost-effective alternatives to a State Plan covered service.
Community Supports are optional for the Plan to offer and for Members to utilize. The Plan will not require Members to use Community Supports instead of a service or setting.

Community Supports that may be offered are:

  • Housing Transition and Navigation Services
  • Housing Deposits
  • Housing Tenancy and Sustaining Services
  • Short-Term Post-Hospitalization Housing
  • Recuperative Care (Medical Respite)
  • Respite Services
  • Medically Supportive Food/ Meals/Medically Tailored Meals
  • Sobering Centers

For more information, call Member Services at 1-877-650-1477 (TTY 711)

Diabetes Prevention Program

Diabetes Prevention Program is a covered benefit offered to our eligible members designed to assist in preventing or delaying the onset of Type 2 Diabetes by making lifestyle changes.

UnitedHealthcare Community Plan is pleased to offer a healthy lifestyle program at no cost to qualified members. The program can help you make small changes to live a healthy life, lose weight and lower your chance of developing type 2 diabetes.

To see if you qualify:

疾病管理

如果您有慢性或高風險疾病,我們還可為您提供疾病管理服務。

我們有針對以下狀況的特別方案:

  • 慢性阻塞性肺病 (COPD)
  • Coronary artery disease (CAD)
  • Congestive heart failure (CHF)
  • 糖尿病
  • High Risk Pregnancy and Neonatal Intensive Care Unit
  • 鐮狀細胞病

 

 

設備和用品

部分保戶可能需要更多的支持協助,使居家生活更安全。

Our plan covers medical equipment ordered by a member's doctor or care manager. 這些可能包括下列用品:

  • 氧氣罐。
  • 助行器或輪椅。

足部照護承保

We provide the exams needed to help keep feet in great shape. And for those with diabetes, good foot care can help prevent much more serious problems.

我們的足科承保包含:

  • Routine foot exams.
  • 提供足部照護以及如何選擇合適鞋類的有用秘訣。
  • 提供神經受損警兆的相關資訊。

 

健康首要步驟 (Healthy First Steps®)

加入「Healthy First Steps」計劃,爲您和您的寶寶創造健康的未來,並賺取豐厚獎勵。我們的計劃將幫助您採取正確的步驟來保持您和寶寶的健康。此外,註冊還可以賺取$20獎勵。

我們將幫助您:

  • 選擇懷孕服務提供者和兒科醫師(孩子的醫師)。
  • 預約就診和檢查,並安排就診接送服務。
  • 您在整個懷孕期間和寶寶 15 個月大之前參與就診可獲得獎勵。
  • 獲取用品,包括哺乳媽媽的擠奶器。
  • 與社區資源聯繫,例如女性、嬰兒和兒童 (Women, Infants and Children, WIC) 服務。

家庭醫療護理

After surgery or a serious illness, you may need extra help with day-to-day tasks. 您甚至可能需要居家醫療訪視,以檢查您的復原情況。With approval from your doctor, our plan covers:

  • In-home medical visits.
  • 醫療設備,如病床、助行器或輪椅。
  • 一次性醫療用品。
  • Help with personal care.

住院

This plan pays for all expenses related to a hospital stay - the member will never be changed. 我們的計劃承保:

  • 病房與餐宿。
  • 用品與設備。
  • 治療。
  • 診斷檢驗和檢查。

And after leaving the hospital, you are not alone. We make sure the follow-up care is available to continue healing at home.

翻譯人員

UnitedHealthcare offers services to help you talk with your doctor or other health care workers. You can get this service if you do not speak 英文 or have hearing and speech barriers. You do not need a referral from your doctor to get these services.

Interpreter services are offered free of charge.

Labs and X-Rays

知道健康出了什麼問題,並及早找出問題所在,可能是成功治療的關鍵。我們的計劃承保:

  • 檢驗室檢驗。
  • X 光、掃描和其他影像技術。

我們會協助您取得所需資訊,幫助改善您的健康或達到最佳狀態。

語言幫助

You may be able to receive information in your preferred language or format, including Braille. 你只需提出來。We also have people at our member service centers who speak more than one language. 我們可請到能夠說您的語言的人員,All languages required by the State of 加利福尼亞 are covered, plus more.

藥物

Prescriptions and certain over-the-counter items are covered by our plan.

You may receive a prescription from a UnitedHealthcare doctor or specialist. You can fill your prescription at any UnitedHealthcare contracted pharmacy. Just show your State Benefit Identification Card (BIC) and your UnitedHealthcare Identification card to the pharmacy when you get your prescriptions filled. 

保戶權益維護人員

We’re looking out for you. Our local member advocates can help solve problems, provide training and education, and work on issues that concern you.

他們能夠:

  • Answer your questions about your benefits.
  • 協助有關醫師的問題或不滿。
  • Help you clarify your health care benefits.

保戶服務

有時候您可能需要一些協助,以瞭解您的健康照護選擇。加入我們的計劃,有問題時便可打電話詢問。We’ll answer your questions simply and completely.

我們還可以協助您尋找:

  • Find a doctor.
  • Change your primary care physician.
  • Questions on benefits.

Just call 1-866-270-5785, TTY: 711 Monday - Friday, 07:00 – 19:00 PT.

 

No Copays

承保服務無需支付任何費用。

While your health care is low-cost or free, the care quality is high. 將可獲得:

  • Care from highly skilled and compassionate doctors.
  • Treatments at respected hospitals and clinics.
  • Prescription drugs and over-the-counter medicines.

On My Way

UnitedHealthcare OMW™ (On My Way) is a mobile-friendly website aimed at helping young adults through the process of transitioning into adulthood. This interactive website also makes it fun to learn as you go. Register at www.uhcomw.com and begin the journey.

Outpatient Mental Health

心理健康與身體健康一樣重要。這就是我們對兩方面均提供承保的原因。

Mental Health Screening:

  • A mental health screening will be completed to determine if you are in mild or moderate distress or have acute impairment of mental, emotional or behavioral functioning.
  • This screening can be completed by a PCP, UnitedHealthcare Community Plan of 加利福尼亞, Inc. or county mental health plan.

Outpatient Mental Health Services- Covered by UnitedHealthcare Community Plan of 加利福尼亞:

  • If your mental health screening results determine you are in mild to moderate distress, UnitedHealthcare Community Plan of 加利福尼亞 covers the following outpatient mental health services:
    • Outpatient mental health services
    • Individual and group mental health evaluation and treatment (psychotherapy)
    • Psychological testing when clinically indicated to evaluate a mental health condition
      Psychiatric consultation for medical management
    • Screening and Brief Intervention (SBI)
    • Outpatient laboratory, supplies and supplements
    • Drugs (excluding anti-psychotic drugs which are covered by Medi-Cal fee-for-service)
    • Family Counseling
    • Neuro behavioral testing
    • Neuro psychological testing
  • Outpatient mental health services do not require a referral from your PCP.
  • For help finding more information on mental health services provided by UnitedHealthcare Community Plan of 加利福尼亞, Inc., call 1-866-270-5785, TTY 711.

Specialty Mental Health Services- Covered by County Mental Health Plan

  • If your mental health screening results determine you have acute impairment of mental, emotional or behavioral functioning, you may be eligible for specialty mental health services.
  • Your PCP or UnitedHealthcare Community Plan of 加利福尼亞, Inc. can refer you to the county mental health plan to receive an assessment.
  • County mental health plans cover specialty mental health services for Medi-Cal beneficiaries who meet criteria.
  • Specialty mental health services may include the following inpatient and outpatient services:
    • Outpatient specialty mental health services:
      • Mental health services (assessments, plan development, therapy, rehabilitation, and collateral)
      • Medication support services
      • Day treatment intensive services
      • Day rehabilitation services
      • 危機介入服務
      • Crisis stabilization services
      • Targeted case management services
      • Therapeutic behavioral services
      • Intensive care coordination (ICC)
      • Intensive home-based services (IHBS)
      • Therapeutic foster care (TFC)
    • Residential services:
      • Adult residental treatment services
      • Crisis residental treatment services
    • Inpatient services:
      • Acute psychiatric inpatient hospital services.
      • Psychiatric inpatient hospital professional services.
      • Psychiatric health facility services.
  • For help finding more information on specialty mental health services provided by the county mental health plan, call the county at 1-888-724-7240.

個人照護

在生病或受傷後,有時會難以自行完成基本的日常事情。If needed, we provide help with:

  • 更衣。
  • 沐浴。
  • 餵食。

產前看診

Your pregnancy is a journey you'll want to make with the help of friends, family and a pregnancy doctor, or OB-GYN. 

我們的計劃承保推薦的產前檢查和檢驗,

在看診時,診所將:

  • Make sure both you and your baby are healthy.
  • 說明您在懷孕期各個階段可能會有的症狀。
  • 回答您的問題。

戒煙

大部分人都瞭解吸菸對健康有害,且自己知道需要戒菸。We support our members to help them quit. 我們絕對不會對他們說教。

Text4baby

Text4baby 協助新手媽媽和孕婦維持自己和寶寶的健康。

You’ll get text messages each week throughout your pregnancy and your baby’s first year. 每份簡訊提供有健康和安全訣竅,主題包括:

  • 產前照護。
  • 產程與分娩。
  • 哺乳。
  • 睡眠安全。
  • 營養。
  • 汽車座椅安全。

  • 讓您和您的寶寶展開美好人生。

    治療服務

    Physical, occupational and speech therapy can help members recover from a serious injury or illness, or simply reach their full potential.
    Our plan covers limited visits for:

    • 職業治療。
    • 物理治療。
    • 語言治療。
    • 家內治療。

    載送

    Rides can be scheduled at least 30 days in advance, and no later than 3 business days before your appointment. Scheduling your ride at least 3 business days in advance will help you to have the best experience. Urgent care and other urgent types of trips, like dialysis or chemotherapy, can be scheduled on the same day.

    Members can get round trip transportation to and from health care locations as needed, including rides to:  

    • 看醫生或治療就診
    • Pickup prescription drugs that cannot be mailed directly to the member
    • Pickup medical supplies, prosthetics, orthotics and other equipment
    • Specialty mental health services
    • 物質使用疾患服務
    • Dental and any other benefits covered through Medi-Cal  

    眼科服務

    The plan covers: 

    • Routine eye exam once every 24 months; UnitedHealthcare Community Plan of 加利福尼亞, Inc. 
      may pre-approve (prior authorization) additional services as medically necessary. 
    • Eyeglasses (frames and lens) once every 24 months; contact lens when required for medical 
      conditions such as aphakia, aniridia and keratoconus. 

    康復看診

    Well visits with your doctor can help keep you and your family healthy. 這些檢查可以及早發現健康問題並進行治療。預防保健服務包括:

  • 成人和兒童的健康檢查。
  • 健康寶寶照護。
  • 孕婦照護。
  • 施打例行預防針和檢測。
  • 乳房攝影檢查。
  • To File a Complaint or Grievance, Download the GRIEVANCE FORM - 英文 | Español| 阿拉伯語 | 漢語 | FarsiTagalog | 越南語

    NONDISCRIMINATION NOTICE - 英文 | Español| 阿拉伯語 | 漢語 | FarsiTagalog | 越南語

    保戶資源

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