UnitedHealthcare 社區計劃 QUEST 整合計劃

Medicaid

UnitedHealthcare Community Plan QUEST Integration is a managed care plan offered through Hawai‘i’s Department of Human Service Med-QUEST. UnitedHealthcare 社區計劃是一項健康計劃,適用對象為有資格獲得州政府補助 Medicaid 承保福利的保戶。適用對象包括懷孕婦女、兒童、成人、老年人、有特殊需求的民眾,以及家庭。投保 UnitedHealthcare 社區計劃 QUEST 整合計劃,您將有更好的途徑,獲得您需要的健康照護。

我們的首要目標是幫助您維持健康和自理能力。UnitedHealthcare 社區計劃 QUEST 整合計劃提供包括視力、藥物和用品的醫療和行為健康服務。請立即致電 UnitedHealthcare 社區計劃 QUEST 整合計劃,進一步瞭解如何獲得專業的引導和服務協調。

我們的本地人員將與您共同協調您的服務和特別需求。我們將引導您因應複雜的醫療保健照護制度,並與您的醫師和家人一起幫助您實現自己的健康相關目標。 UnitedHealthcare 社區計劃在此為您提供協助,幫助您完成整個過程的每個步驟。

UnitedHealthcare 社區計劃在照護管理方面已有長久的經驗。

一切交由 UnitedHealthcare 社區計劃確保您全家的健康。

 

Public Health Event – Pharmacy Response

IMPORTANT INFORMATION REGARDING

UnitedHealthcare Community & State, UnitedHealthcare Employee & Individual, and UnitedHealthcare Medicare & Retirement members covered under Medicaid, Medicare, and Part D prescription drug plans.

Due to Hurricane Flossie approaching Hawai‘i, UnitedHealthcare is authorizing a one-time override of the refill too soon (RTS) edit for members who reside in or may be visiting the following areas. These members may be in need of medication when traveling and mail delivery could be compromised. 

Hawai‘i

Entire State

This authorization should allow impacted UnitedHealthcare Community & State, UnitedHealthcare Employee & Individual, and UnitedHealthcare Medicare & Retirement members covered under Medicaid, Medicare, and Part D prescription drug plan to obtain early refills of their prescription medications if they have refills remaining on file at a participating retail or mail-order pharmacy. 

This policy will be reinforced through the dates listed below, unless conditions continue to warrant.

Line of Business Response Type Timeframe Membership Type

UHC C&S

 

Self-Identify

 

07/31/2019 – 08/14/2019

 

All Products

 

UHC E&I

 

Self-Identify

 

07/31/2019 – 08/14/2019

 

Fully Insured (including NIHPs) and ASO Business

 

UHC M&R Self-Identify 07/31/2019 – 08/14/2019 Fully Insured and ASO
Business

If you should receive a call from a member impacted by this emergency, please follow the standard process for administering refills during a disaster. The OptumRx Help Desk is available to assist in this process should it be needed.

 

UnitedHealthcare Community Plan provides free aids and services to people with disabilities to communicate effectively with us, such as: written information in other formats (large print, audio, accessible electronic formats, other formats). If you need these services, contact us toll-free at 1-888-980-8728 (TTY: 711).  We will provide you with the requested information, at no cost to you within five (5) business days.

本計劃在所有郡別提供。


 

 

UnitedHealthcare 社區計劃 QUEST 整合,您能夠獲得:

下列照護服務

  • A Primary Care Provider (PCP) that you can choose from in our large list of providers. Here is the link to help you find one in your area
  • Referral specialty care from a Specialist Provider
  • Scheduled rides to health-related appointments
  • 24-hour/7 day NurseLineSM and on-line Nurse Chat to talk to a nurse any time you have a question
  • Language interpreter services (including Sign language)

幫助您保持健康的承保福利
根據您的承保福利計劃,所提供的任何服務是免費的

  • 處方藥物承保
  • Vision and eyewear coverage
  • Help with behavioral health issues such as mental, alcohol, or substance abuse
  • 預防性健康護理
  • Vaccines (such as for flu and other illnesses)
  • Child immunizations
  • Health education classes
  • Quarterly newsletters

Early Periodic Screening, Diagnostic, & Treatment (EPSDT) for Medicaid-Enrolled Individuals Under 21 Years of Age

承保福利和特點

醫師選擇

Each member can choose a primary care provider (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。

For members who don’t have a doctor or whose doctor is not in our network, we can help find a new one close by.

Sometimes you might need a little help understanding your health care options. With us, you have someone you can call. We'll answer your questions simply and completely.

我們還可以協助您尋找:

  • Home care providers.
  • Specialists.
  • 醫師。
  • 藥房。
  • 醫院或其他保健設施。
  • 當地資源。

There is no cost for covered prescriptions. We make getting your child's medicine easy. We'll provide a list of covered medicines if you have questions about what prescriptions are covered.

You can fill the prescriptions at local pharmacies in the UnitedHealthcare Community Plan network.

This plan pays for all expenses expenses related to a hospital stay, so you can rest and heal.

Hospitalization coverage includes:

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

在您離開醫院後仍可獲得關懷。我們保證您可獲得後續照護幫助您在家治癒。

Build a healthier future for you and your baby — and earn great rewards — through Baby Blocks. This program helps keep you and your baby healthy during your pregnancy and your baby's first 15 months of life.

Baby Blocks includes:

  • Email appointment reminders.
  • Fun program to keep track of appointments.
  • Reward cards for clothing and more.

Once you sign up, you can choose a $20 Old Navy gift card or a stylish diaper bag. The choice is yours.

Diabetic Support

If you have diabetes, we'll make life a little easier for you. You'll get medicine, supplies and education to help you reach and stay your best. 

耐用醫療設備

Some members may need extra support to live safely at home.

Our plan covers medical equipment ordered by your child's doctor or case manager. This can include supplies like:

  • Oxygen tanks.
  • 醫療用床
  • Wheelchairs or walkers.

Healthy Rewards

An ounce of prevention can be worth a pound of cure. It can also be worth great rewards.

You can earn great gifts for you or your child by doing things like:

  • Completing well-child exams.

聽力照護

聽力障礙會在很多方面對您的日常生活產生影響。我們的計劃包括幫助您保護聽力的服務和支援。

我們承保:

  • Exams, therapy and tests.
  • Hearing aids and batteries.

In-Home Care

After surgery or a serious illness, you may need extra help with day-to-day tasks like cleaning, cooking or dressing. You may even need an in-home medical visit to check on how well you are healing. With approval, our plan covers:

  • An in-home medical visit.
  • Medical equipment like hospital beds, walkers or wheelchairs.
  • Disposable medical supplies.
  • Help with personal care or housekeeping.

Interpreters

Your doctor and you need to understand each other. Not speaking English well makes this difficult. We can arrange for a medical interpreter to be at your appointments.

We also have people in member services who speak more than one language. Chances are, we have someone who speaks your language.

Kidney Disease Care

Kidney disease is a serious medical condition. After the kidneys stop working, regular treatments (called renal dialysis) or an organ transplant are necessary. Dialysis uses a machine to clean the blood, just like healthy kidneys do.

我們的計劃包含以下項目:

  • Dialysis.
  • Medications.
  • Health education and support.
  • Organ transplant if needed.

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。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 can get information in another language. 你只需提出來。This is provided at no cost to you.

Member Advocates

我們會協助您照顧健康。Member advocates can help solve problems, provide training and education, and work on issues that concern members.

They can:

  • Provide information about your plan.
  • Teach you to get the care you need.
  • Help with doctor issues or complaints.

精神健康

Mental health is as important as physical health. That's why we have coverage for both.

This includes:

  • 行為治療。
  • 物質濫用治療。
  • Medications.

NurseLine℠

Medical questions and situations can come at inconvenient times. When you have questions about your health, you can call a nurse 24 hours a day, 7 days a week.

Our nurses will:

  • 聽取您的症狀。
  • Help with self-care.
  • 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。

Nurse Visits

Sometimes continued care is needed after leaving the hospital or urgent care. For example, after a serious illness, surgery or injury. In these cases, a nurse will make home visits to:

  • Provide medical care.
  • Answer any questions and concerns.

Nutrition Coaching

Healthy eating goes a long way to helping you stay at your best. A nutritionist can meet with you to review your eating habits and food choices.

You'll come away with new ideas for:

  • Making good choices for quick meals and snacks.
  • Preparing healthy meals on a budget.

Outpatient Services

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。

We'll help you get the information needed to help improve your health or be your best.

Personal Care

Sometimes the basics are hard to do yourself after an illness or injury. If needed, we provide someone to help with:

  • Dressing.
  • Bathing.
  • Feeding.

產前看診

A pregnancy is a journey that’s better with the help of friends, family and a pregnancy doctor, or OB/GYN.

All recommended prenatal clinical visits and tests are covered by our plan.

在看診時,診所將:

  • Make sure both mom and baby are healthy.
  • 說明您在懷孕期各個階段可能會有的症狀。
  • Answer questions.

Quitting Tobacco

Most people know the bad health effects of smoking. And they know they need to quit. We support our members while they quit, with coaches and supplies. The only thing they won’t get from us is a lecture.

Rehabilitation Care

After a serious illness, surgery or injury you may need extra nursing and therapy. If needed, our plan covers short stays in a rehabilitation center where you can heal. Included are:

  • Nursing home services.
  • 24-hour nursing care.
  • Help with activities of daily living.
  • Physical, occupational and speech therapy.

留看護理

您家中有照護您的家人或朋友嗎?

如果是這樣,我們也希望能支援他們的辛苦工作。That's why we provide respite care to give your caregivers a rest. 留看護理為照護人員提供了時間,讓他們可以離開他們關愛的或需要特殊照護的家人。

Shots and Vaccines

Routine shots help protect you from illness.

So, our plan covers:

  • Recommended shots and vaccines.
  • Influenza shots.

Social Services

Many communities offer additional benefits for children in this plan. Social Services helps members connect to these local programs and services, such as:

  • WIC and financial support.
  • School services.
  • 留看護理。

Speech Therapy

Speech therapy visits and exercises can help those who have difficulty speaking.

Prior authorization needed except for  physical, occupational,  or speech therapy.

Text4baby

Text4baby can help new and expecting mothers keep themselves and their babies healthy.

You'll get text messages throughout your pregnancy and your baby's first year. Each text contains health and safety tips for topics like:

  • Prenatal care.
  • Labor and delivery.
  • Breastfeeding.
  • Safe sleep.
  • Nutrition.
  • Car seat safety.

So you and your baby can make a great start on life.

Therapy Services

Physical, occupational and speech therapy can help you recover from a serious injury or illness, or simply reach your full potential.

Our plan provides:

  • 職業治療。
  • 物理治療。
  • 語言治療。

Unlimited Doctor Visits

There may be times when your or a family member’s health requires repeated visits to a primary care provider (PCP). Our plan does not limit the number the number of times you can see your PCP. This way you get care need when you need it. And your doctor can see how your health is progressing.

Urgent Care

You may have an injury or sudden illness that is not life-threatening but needs immediate attention. So our plan covers care at:

  • 緊急護理中心。
  • Medical aid units.
  • Other walk-in clinics.

康復看診

Well visits with your doctor are important for good health. These visits can catch health problems early, so they can be treated. 預防保健服務包括:

  • Checkups for adults and children.
  • Well-baby care.
  • Care for women expecting a baby.
  • Routine shots and tests.
  • 乳房攝影檢查。

There are no copayments for preventive care.

保戶資源

檢視可利用的資源

深入了解

UnitedHealthcare 社區計劃 QUEST 整合計劃

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