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UnitedHealthcare Community Plan

Medicaid

UnitedHealthcare Community Plan of Ohio

Our Ohio Medicaid plan covers eligible families, pregnant women of any age, infants, children and young adults. The plan also offers extra support and care to adults and children with a disability, long-term illness or special health care needs. Members can choose a primary care doctor from our network. Plus get access to a 24/7 nurse advice hotline, health education materials and extras that other plans don't offer. View the benefits below to see all that it offers.

More information on eligibility and enrollment can be found on the Ohio Medicaid website, or by calling the Medicaid Hotline at 1-800-324-8680, TTY users should call Ohio Relay at 7-1-1.

OhioRISE

Ohio Resilience through Integrated Systems and Excellence (OhioRISE) program is a managed care program for youth with behavioral health needs. OhioRISE increases access to in-home and community-based services to ensure OhioRISE members and families have help with systems such as juvenile justice, child protection, developmental disabilities, mental health and addiction, education, and others.

An individual who is enrolled in the OhioRISE program will also keep their managed care enrollment for the physical health benefit. To be eligible for OhioRise, you must be: enrolled in Ohio Medicaid, under the age of 21 and meet a functional needs threshold for behavioral health care, as identified by the Child and Adolescent Needs and Strengths (CANS) assessment. 

Beginning November 1, Ohio Medicaid managed care members will be able to select their plan by calling the Ohio Medicaid Consumer Hotline at 1-866-693-0898 or utilizing the Ohio Medicaid Consumer Hotline Member Portal at https://members.ohiomh.com/Login.aspx. You do not have to do anything if you want to keep your current Medicaid Managed Care Plan.

Visit the Ohio Medicaid Consumer Hotline website at www.ohiomh.com for information.

After you receive your renewal form from the Ohio Department of Medicaid (ODM) you will need to take a few steps to keep UnitedHealthcare as your health insurance company.

Click here to learn how to renew your Medicaid coverage.

承保福利和特點

For OhioRISE, please refer to the OhioRISE handbook

康復與生病照護

Get the care you need to get better if you are injured or sick — or to reach your full potential. 承保福利範圍包括:

  • NurseLine. Speak with a registered nurse 24/7.
  • No Copays. You pay nothing for your care or services.
  • Medicines. Fill your prescriptions, including over the counter drugs at local pharmacies.
  • Therapy Services. Physical or other therapy to recover and heal.
  • Chiropractor Services. We provide up to 15 chiropractic visit per year.
  • Well Visits. Annual checkups can help keep you healthy.
  • Urgent Care. Convenient care for a sudden illness or injury.

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

  • Choice of Doctors and Birthing Center. Find a doctor and hospital 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. Get helpful tips and links to free health and wellness items for you and your baby.
  • Wellhop for Mom & Baby. Connect with a community of moms. Get support and information as you welcome your baby.

If you have asthma, diabetes or another chronic condition, you can depend on us. 我們的計劃可以保證您得到所需的照護、支援與服務。承保福利範圍包括:

  • Mental Health and Substance Abuse Services. With prior approval counseling and other treatments are covered.
  • Care Management. Personal support from an experienced professional.
  • Asthma Care. Exams, testing and supplies are covered for asthma and other lung diseases.
  • Kidney Disease Care. Dialysis, medicine and treatments are covered.
  • Obesity Care. We cover screenings and counseling for obesity.

We help members keep their vision, smile and hearing at their best. 承保福利範圍包括:

  • Vision. Covers exams, glasses or $150 toward contact lenses.
  • Dental. We pay for cleanings, checkups and some dental work.
  • Hearing. Tests, checkups and with prior approval hearing aids are provided.

Earning a reward for taking care of yourself or your child is easy. The following programs offer incentives:

  • Healthy First Steps®  -  Earn $20 for signing up. Our program will help keep you and your baby healthy. 
  • Healthy Rewards -  Earn gifts for you or your child with preventive care.  

You get the medical care and equipment needed to live safely at home. 承保福利範圍包括:

  • Equipment and Supplies. With prior approval, in-home medical and safety equipment are covered.
  • Nurse Visits. Medical care to help with a safe recovery at home.
  • Respite Care. In-home help to give caregivers taking care of children under age 21 a rest.
  • Care Coordinator. Someone to get you the services you need after surgery or illness.
  • Home Health Care. With prior approval, medical and personal care in your home, if needed.

Sometimes members need a little extra help using their health plan. For those times, they can rely on:

  • Transportation. We pay for up to 30 one way or 15 round trip rides to medical visits or the pharmacy.
  • Language Help. Connect to a translator through Member Services.
  • Member Services. Someone to help you get the most from your plan.
  • Quitting Tobacco. Coaches and supplies to help quit using tobacco.
  • My Advocate. We help members connect to community services.
  • Healthy Rewards. Earn up to $100 in credits for completing healthy activities.
  • Mileage Reimbursement. Mileage reimbursement is now available for those members or their representative that would prefer to use their own vehicle for trips to medical appointments. Members must call for trips in 5 days in advance.

Asthma and COPD Care

Individual care to help control asthma or COPD symptoms.

Some members may have trouble managing asthma or COPD symptoms. For them, a nurse who specializes in breathing issues can really help. They get a customized treatment plan and medicine to:

  • Manage flare-ups.
  • Reduce symptoms.
  • Help you stay active.

照護管理

Members who need extra help get a Personal Care Manager. The care manager is there for you throughout your medical journey. He or she will:

  • Work with you to develop a plan of care that meets your individual needs.
  • Coordinate with family members, caregivers and health care providers.
  • Help get additional services or support you may need.

整脊服務

Our plan includes visits for chiropractic care.

  • Members of all ages can get up to 15 visits per year.
  • Members under 21 may get additional visits with prior authorization.

醫師選擇

From regular checkups to preventive health screenings, we want to make sure you get access to the right care at the right time.

You get a primary care physician (PCP), who is your main doctor. If you don't have a doctor or if your doctor is not in our network, we can help you find a new one close to you.

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。

選擇生產中心

Where a mother has her baby is an important choice. That's why pregnant moms can pick from hundreds of hospitals across Ohio.

We encourage mothers-to-be to tour the hospital's birthing center. This way they will be familiar with it. And be more relaxed when they have their baby.

牙齒保健

Checkups and cleanings are covered.

Exams and cleanings every six months help keep teeth and gums strong and healthy. If you obtain prior approval for a dental problem that needs to be fixed, that's covered as well.

Employment Physicals

Some employers or training programs require a physical before a person can start work. Our plan covers pre-employment physical exams.

設備和用品

The health and safety of our members at home are important.

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

  • 醫療用床
  • 氧氣罐。
  • 輪椅或助行器。

For some of these services prior approval is required. Please check your member handbook for these details.

足部照護承保

We provide the exams and treatments needed to help keep your 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。

聽力照護

Trouble hearing can affect a person's everyday life in many ways. 我們的計劃包括幫助您保護聽力的服務和支援。

我們承保:

  • 檢查、治療和檢測。
  • With prior approval, hearing aids and batteries.

Healthchek

Healthchek covers medical exams, immunizations (shots), health education, and laboratory tests for Medicaid eligible individuals under the age of 21. Healthchek also covers medical, vision, dental, hearing, nutritional, developmental, and behavioral health exams, in addition to other care to treat physical, behavioral or other problems or conditions found by an exam. Learn more information about Healthchek. 

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。

健康獎勵

預防勝於治療,也可獲得豐厚獎勵。

Earn great gifts for you or your child by doing things like:

  • 完成優生保健檢查。
  • Getting lab tests.
  • Recording the family's health activities.

家庭醫療護理

If you are living with a long-term health condition, disability or leaving the hospital after surgery or a serious illness, you may need extra support. This can include help with day-to-day tasks like cleaning, cooking or dressing. 您甚至可能需要居家醫療訪視,以檢查您的復原情況。

在核准後,我們的計劃會承保:

  • 居家醫療訪視。
  • 醫療設備,如病床、助行器或輪椅。
  • 一次性醫療用品。
  • 個人照護或家務方面的協助。

住院

This plan pays for all medically necessary expenses related to a hospital stay. 您只管放心治癒即可。

我們的計劃承保:

  • 照護。
  • 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. 我們保證您可獲得後續照護幫助您在家治癒。

腎臟病照護

腎臟病是一種嚴重的疾病。After the kidneys stop working regular treatments, called renal dialysis, or an organ transplant are needed to live. 透析使用機器清潔血液,如同健康腎臟做的工作一樣。

我們的計劃包含以下項目:

  • 透析。
  • 藥物。
  • 健康教育和支持。
  • 器官移植(若需要)。

檢驗室檢驗和 X 光檢查

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。With prior approval, our plan covers:

  • 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 can receive information in your preferred language. 你只需提出來。We also have people at our service centers who speak more than one language. 我們可請到能夠說您的語言的人員,

藥物

Our plan includes prescription drugs and refills for prescriptions written by your doctor or specialist. Thousands of drugs are covered.

You pay a co-pay amount, if needed, and you can get your prescription drugs at any in-network pharmacy.

Member Services Representative

Meet your personal health plan assistant. Our job is to help you get the most of your benefits. 我們可幫助您:

  • Schedule doctor, dental and vision appointments.
  • Arrange for extra support services.
  • Complete a health risk assessment.
  • Stay in touch with you.

Mental Health and Substance Abuse Services

Get help with personal problems that may affect your mental or physical health. These may include stress, depression, anxiety or drugs and alcohol abuse. Our services also include:

  • Therapy
  • Counseling
  • 藥物

For some of these services prior approval is required. 請聯絡會員服務部以瞭解更多資訊。

No Copays

With our plan there are no copayments for covered services.

Members get:

  • Care from highly skilled and compassionate doctors.
  • Treatments at respected hospitals and clinics.
  • Home medical equipment and supplies to help them be their best.

護士諮詢專線

在不方便的時間發生醫療問題和疾病。For questions about health, call a nurse 24/7. Call:  1-866-801-4407, TTY 711.

Our NurseLine nurses will:

  • 聽取您的症狀。
  • Provide guidance on self-care.
  • Advise the member about getting care at a doctor visit or an urgent care center.
  • Help know when to go to the emergency room.

Obesity Care

Obesity is common and serious. It can also lead to other health problems. To help our members be their best, our plan includes:

  • Screening for obesity.
  • Counseling for obesity.

產前看診

懷孕是一段不可思議的旅程。It's a journey the new mother wants 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 mother and baby are healthy.
  • Explain what to expect at each stage of the pregnancy.
  • Answer any questions.

Residential Care

After a serious illness, surgery or injury, you may need extra nursing and therapy.

With prior approval, our plan covers short stays in a rehabilitation center where you can heal. 包括:

  • 療養院服務。
  • 24 小時護理照護。
  • 協助日常活動。
  • 物理、職能及語言治療。

Call Member Services for information on available providers.

留看護理

Caring for a child recovering from an illness, surgery or with special health needs is an act of love. It can also be physically and emotionally exhausting. This service is for SSI members under 21 years of age.

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 with coaching while they quit. 我們會在保戶戒菸時提供指導和用品方面的支持。The only thing they won't get from us is a lecture.

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.

With prior approvals, our plan covers visits for:

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

載送

Our plan provides up to 30 one way or 15 round trip rides to medical appointments and other needed services. Call 1-800-895-2017 (TTY 711) to schedule a ride. You must call at least 48 hours ahead of time..  

Rides are available to:

  • Dental and vision appointments.
  • 藥房。
  • Women, infants and children (WIC) visits.
  • Job and Family Services offices for benefits redetermination.

UnitedHealthcare OMW™

UnitedHealthcare On My Way™ is an engaging, interactive program that informs Ohio youth and helps prepare them for many real-world situations that lie ahead. UnitedHealthcare OMW™ teaches the practical skills of managing bank accounts, securing housing, creating a resume, finding job training and applying for college. It is a reliable, go-to resource they can use throughout their journey toward independent living.

緊急護理

您可能會發生不危及生命但需要立即診治的傷害或急症,因此,我們的計劃承保下列地點的照護:

  • 緊急護理中心。
  • Federally qualified health centers.
  • 其他無需預約的診間。

視力照護

You'll get the care, eyeglasses and treatment that let you see life more clearly.

承保福利範圍包括:

  • Annual eye exams.
  • Glasses and $150 toward contact lenses.

You also can chose from an expanded selection of frames.

This benefit is offered by March Vision.

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。

預防性護理無需支付共付額。

Wellhop for Mom & Baby

Connect with other expectant moms. Get support and information during your pregnancy and after you deliver. This program is part of your health plan and there is no extra cost to you.

Here’s how it works:

  • Join video conversations every other week with women who have similar due dates and a group leader.
  • Chat and share experiences with moms from your group on the Wellhop app or website.
  • Visit the Wellhop library. You’ll find articles, videos and more.

保戶資源

檢視可利用的資源 (開啟範本視窗)

深入了解

UnitedHealthcare Community Plan

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