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UnitedHealthcare Community Plan - Heritage Health

Medicaid

UnitedHealthcare Community Plan offers a range of benefits. It’s for pregnant women, children, families and adults who meet income requirements. There are no costs to you for Medicaid benefits and services. View the benefits below to see all that our plan offers.

This is a current summary of health services and drug coverage provided by UnitedHealthcare Community Plan of 內布拉斯加. A detailed description of the benefits can be found in the Member Handbook.

承保福利和特點

康復與生病照護

Get the care you and your children need to stay healthy — or to be at your best. 這包括:

  • Unlimited PCP Visits. See your primary care provider (PCP) as needed.
  • Shots and Vaccines. Routine shots help protect against illness.
  • Nurse Hotline. Speak with a registered nurse 24/7.
  • Lab and X-rays. Lab tests, x-rays and diagnostic imaging are covered.
  • Therapy Services. Physical or other therapy to help you be your best.
  • Foot Care. We provide special care to keep your feet healthy.
  • Hospitalization. You pay nothing for care in a hospital.
  • Chiropractor Services. Limited chiropractic visits are covered
  • Lead Screening. Can be done in the doctor’s office or local health department.
  • Prescriptions. Many preferred Brand and Genetic Prescriptions are covered.

沒有什麽比您和您的孩子的健康更重要。That’s why our plan benefits include: 

  • Choice of Birth Centers. Pick from our large network of hospitals or Birthing Center.
  • Choice of Doctors. Find a doctor you trust for your pregnancy care.
  • Healthy First Steps®. Get extra support and rewards to keep you and your baby healthy.
  • Prenatal Visits. Care for you before your baby is born.
  • Text4baby. Text messages with helpful tips and reminders for you and your baby.. 
  • Community Baby Showers. Education on prenatal and postpartum care.
  • Electric Breast Pumps covered.

If you or a family member has special health care needs, you can count on us. Our plan will provide the extra care and services you need. 承保福利範圍包括:

  • Asthma, Allergy, Heart Failure, CAD, Depression, Diabetes and COPD Care. Exams, testing and supplies are covered.
  • Care Management. Get personal help managing health conditions.
  • Mental Health and Substance Use Services. Get caring help to meet your recovery goals.

確保您的視力和聽力都健康。承保福利範圍包括:

  • Hearing. Tests, checkups and hearing aids, if needed.
  • Vision. Routine eye exams, plus frames and prescription lenses are covered. 

Vision Provider Lookup

 

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. 承保福利範圍包括:

  • Equipment and Supplies. In-home medical and safety equipment are covered.
  • Home Health Care. Medical care in your home, if needed.
  • Skilled Nursing Facility. Brief stay at a skilled nursing facility while you recover from sickness or injury.

有時在使用您的健康計劃時您可能需要少許額外幫助。此時,您可以依靠:

  • Nurse Hotline℠. Speak with a registered nurse 24/7.
  • Member Services. Your benefit questions are answered Monday - Friday, 7:00 a.m. - 7:00 p.m. CT or 6:00 a.m. – 6:00 p.m. MT
  • Language Help. Connect to an interpreter through Member Services at no cost to you.
  • 戒煙。 Enroll with the 內布拉斯加 Tobacco - Free Quit Line and ask your doctor about support to help you quit.

Asthma, Allergy and COPD Care

Do you or a family member have trouble managing asthma or COPD symptoms?
You will get a customized treatment plan and medicine to:

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

照護管理

When a member has complex health care needs, a care manager can really help. He or she will:

  • Work with you and family members and friends on a plan of care.
  • Explain medical terms in plain language.
  • Coordinate your doctor appointments.
  • Provide your care team with your medical records. 
  • Make a referral to community social service programs.
  • Offer rewards like a gift card for chronic care checkups or well care visits.

Cell Phone Program

Eligible members can get health support with mobile phone service at NO COST to you from select Lifeline service providers. We want to help you stay connected!  Apply Now! Call Member Services at 1-800-641-1902, TTY 711 for assistance.. 

Children's Health Support

  • Rewards program for well-child visits.
  • Dr. Health E. Hound® provides nutritional education and promotes fitness and healthy habits.

整脊照護

Medicaid limits coverage of chiropractic services to: (i) Certain spinal X-rays; (ii) Manual manipulation of the spine; (iii) Certain evaluation and management services; (iv) Traction; (v) Electrical stimulation; (vi) Ultrasound; and (vii) Certain therapeutic procedures, activities, and techniques designed and implemented to improve, develop, or maintain the function of the area treated.

選擇生產中心

在哪裡生孩子是一項重要決定。That’s why you can pick from our large network of hospitals or Birthing Center.

We also encourage you to tour the hospital’s birthing center. This way you will be familiar with it and be better informed when you have your baby.

醫師選擇

每位保戶均可選擇一位主要照護提供者 (PCP)。使用醫師查詢來查看您的醫師是否在我們的網路內。

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。
  • Care coordination with specialists.

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

牙齒保健

接受年度牙科檢查對您的健康很重要。我們的承保包括:

  • Two exams and cleanings per year for children and adults.
  • Bitewing X-ray once every 12 months and one complete set of X-rays every three years. 
  • Minor restorations such as filling. 
  • Major restorations such as crowns and root canals (one of each per 12 months). 
  • Deep cleanings and surgical treatment for gum disease. 
  • Partial or full dentures, and repairs to partials or full dentures. 
  • Sedation and nitrous oxide (known as laughing gas) if medically necessary.

有時人們很難看牙醫。他們可能對碰觸敏感。他們可能需要額外的時間或溫和的照護。讓我們幫助您找到適合您或您家人的牙醫。請致電會員服務部 1-800-641-1902,聽障專線 (TTY)711。

糖尿病患者支持

如果您患有糖尿病,我們將幫助讓您的生活更輕鬆。You'll get medicine, supplies and education to help you reach and stay your best. Our diabetes program also includes self-care training and classes focused on:

  • Managing stress.
  • Living a healthy lifestyle.
  • Wellness Rewards for getting needed exams.

疾病管理

If you have chronic or high-risk illnesses, our disease management services may help you. We provide support for:

  • Congestive heart failure.
  • 氣喘。
  • HIV.
  • Chronic obstructive pulmonary disease (COPD).
  • Coronary artery disease.

設備和用品

Our member’s health and safety at home are important.

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

  • 氧氣罐。
  • 醫療用床
  • 輪椅或助行器。

足部照護承保

我們提供您需要的足部檢查,幫助您維持足部的最佳健康狀態。And if you have 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。

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。

聽力照護

Trouble hearing can affect your everyday life in many ways.  Our plan includes services and support to help protect your hearing. 

我們承保:

  • Exams, aids and tests.
  • 助聽器及電池。

Home Care

After surgery or a serious illness, you may need  in-home medical visit(s) to check on how well you are healing.

在核准後,我們的計劃會承保:

  • In-home medical visit(s).
  • 醫療設備,如病床、助行器或輪椅。
  • 一次性醫療用品。

住院

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

住院承保包括:

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

And after leaving hospital, we can provide transitional care services. 我們保證您可獲得後續照護幫助您在家治癒。

安寧照護服務

Hospice services are covered when they are ordered by a physician.

檢驗室檢驗和 X 光檢查

Knowing what’s wrong and finding it early can make all the difference.  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

我們以讓您更容易理解的語言或格式為您提供會員資料。我們的提供者網路包括許多講不同語言的醫生。我們的提供者名錄顯示醫生使用的語言。Additionally, many of our Member Service Advocates speak multiple languages. 當您致電時,我們將能為您轉接至我們的口譯員服務,其提供超過 240 種語言的支援。我們幫助提供口譯服務,包括美國手語。

如果您有聽力障礙無法接聽電話,您可以使用文字電話。這項免費服務讓聽力或說話障礙人士能夠撥打和接聽電話。請致電 711。向他們提供會員服務號碼 1-800-641-1902,他們就會將您轉接給我們。

您也可以索取大字版、點字版或錄音檔案格式的資訊。

All of the language interpretation and material translations/alternate formats are available at no cost to you. 

Member Services Advocates

單獨管理您的健康照護可能很困難,尤其是當您同時處理許多健康問題時。如果您需要額外支持來獲得和保持健康,我們可以提供協助。All our UnitedHealthcare members have access to Member Service Advocates.

Your Advocate can help you:

  • Understand the Heritage Health program.
  • Get information in a different format, like audio (CD or flash drive), large print, or Braille.
  • Find a doctor, dentist or eye doctor.
  • Explain your benefits and coverage.
  • Talk to you about special programs that are available to you.
  • Connect you with a Clinical Coordinator if needed.
  • Find resources located near you to help you with other problems like food, housing, transportation, employment, feeling safe or getting an education.
  • Make sure you are aware of other State programs and services available to you, such as SNAP (Supplemental Nutrition Assistance Program) or WIC (Women, Infants and Children) program benefits.
  • Help you update your personal contact information like address, phone number, or email.
  • Make sure we know how you would like to be contacted (email, phone, or mail).
  • Resolve issues with providers, including specialty care and behavioral health.
  • Assist with challenges due to prior approval, payment for services, care delivery, and family welfare.

Remember, answers to any questions you have are just a click away at myuhc.com/CommunityPlan. Or you can call Member Services at 1-800-641-1902, TTY 711, 07:00–19:00 CT (06:00–18:00 MT), Monday–Friday

 

Mental Health and Substance Use Services

行為健康是關於您的感受和行為。它也稱為心理健康。Your behavioral/mental health is important. All Heritage Health members can get behavioral/mental health and substance use services. You may see any in-network behavior/mental health doctor without a referral for outpatient treatment.

You can get behavioral/mental health services without a referral from your Primary Care Provider. Sometimes it makes sense to talk to your Primary Care Provider about any behavioral/mental health problems you believe you may have. That way, your Primary Care Provider can help to refer you to an appropriate provider in our network. If you want to find a provider on your own, you can search for one at any time and make an appointment. You can also call Member Services at 1-800-641-1902, TTY 711, for help or visit liveandworkwell link.

我們承保:

Behavioral/Mental Health Services 

  • 個人、團體和家庭治療 
  • 門診行為健康服務 
  • 住院行為健康服務 
  • Specialized behavioral health services for children with autism.
  • Behavioral health rehabilitation services

物質使用疾患服務 

  • 門診類鴉片(止痛藥)治療 
  • 療養院治療

Additional health resources can be found at myuhc.com/CommunityPlan. 獲得您所需的均衡、支援和照護,過最健康的生活。

行為健康危機服務

如果我發生行為健康危機,該怎麼辦?

You are always covered for a behavioral health, mental health, and substance use emergency. An emergency means a condition that comes on suddenly, is life threatening, is painful, or other severe symptoms that cannot wait to be treated.

急診服務在美國任何地方都屬於承保範圍。如果您認為自己發生危及生命的緊急情況,請撥打 911,或前往最近的醫院,讓急診醫療提供者幫助您。

As soon as it is possible, please call us to arrange for follow-up care after an emergency.

危機處理服務:

如果認為自己發生緊急情況,不論您身在何處,請撥打 911,或前往最近的醫院,讓急診醫療提供者幫助您。在緊急事件之後,請儘快致電您的醫師或行為健康服務提供者,以便安排後續照護。

如果您需要與某人交談,我們隨時為您服務。如果您覺得還不到致電 911 的時機,但需要立即協助,您可以撥打我們的行為健康危機熱線,服務時間:24/7 全年無休,電話:1-800-641-1902

線上:http://www.suicidepreventionlifeline.org

No Copays

You will not have a copayment for care and services covered by our plan.

護士熱線

醫療問題和疾病可能會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 小時。

我們的護士將:

  • 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。

Over-The-Counter Drugs/Supplies

Select over-the-counter drugs and supplies are covered 100% with your doctor’s prescription.  

Your health care costs may include non-prescription medicines and supplies like aspirin, cough medicine or diabetic testing supplies. Covered 100% with your doctor’s prescription.

 

藥房

Our plan includes prescription drugs and refills, and we make getting your medicine easy. Medicare and other insurance copays may apply. You can fill your prescriptions at:

  • Local pharmacies.
  • Services that deliver right to your door.

When you have a prescription filled, be sure to check that:

  • It’s included on the Preferred Drug List (PDL). 
  • It’s written by a network provider. 
  • It’s filled at a network pharmacy. 
  • You show your member ID card when you have it filled. 

Prescription Drug Copays

You can receive many available PREFERRED brand name and generic drugs with no copay. Brand NON-PREFERRED prescriptions drugs have a $3 copay.

If the Center of Medicare and Medicaid Services (CMS) shows you’re copay exempt, you will not have to pay the $3 copay. You may be copay exempt if you are:

  • 18 years old or younger.
  • Pregnant or gave birth within the last 60 days.
  • Staying in an inpatient hospital, long-term care facility, residential facility, adult family home or center for the developmentally disabled.
  • Staying in a medical facility and spending most of your income on medical costs.
  • A Native American getting services from an Indian Health Center.
  • Receiving waiver services under a 1915(c) waiver.
  • Receiving assistance from the State Disability Program.

90 Day Supply

You will be able to get a 90-day supply of select prescription medications from a retail pharmacy. 有了 90 天藥量,您將不必再每個月續配。You’ll have three months between refills.

  • Talk with your pharmacist - Your pharmacist can call your doctor to get a new prescription for a 90-day supply. 
  • Talk with your doctor - Your doctor can write you a new 90-day supply prescription for the medicine above. We’ve let your doctor know about this change to your pharmacy benefit.  

If you have any questions, please call Member Services at 1-800-641-1902, TTY 711, 07:00–19:00 CT (06:00–18:00 MT), Monday–Friday

產前看診

Your pregnancy is a journey you’ll want to make with the help of friends, family and a pregnancy doctor.

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。That’s why we encourage members to talk to their doctor about getting smoking cessation support. Counseling is covered when you enroll with the 內布拉斯加 Tobacco-Free Quit Line.  Medication for smoking cessation are available through 內布拉斯加 Medicaid. Call 1-800-784-8669

Residential Care

After a serious illness, surgery or injury, you may need extra nursing and therapy.  If needed, our plan covers short stays in a skilled facility 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。

預防針和疫苗

Routine shots help protect members and their family from illness. 我們的計劃承保:

  • Pneumonia, influenza and shingles shots.
  • Vaccines and Immunizations.  Routine shots to help keep your child healthy.
  • Other recommended shots and vaccines.

治療服務

物理、職能和語言治療可協助您自嚴重傷害或疾病中恢復,或只是發揮您的全部潛力復原。

我們的計劃提供:

  • 職業治療。
  • 物理治療。
  • 語言治療。

載送

如果需要搭車,您的承保福利包括交通接送。We cover trips for 內布拉斯加 Medicaid coverable services within a 20-mile radius of your home. 包括:medical, mental health, dental and vision appointments along with trips to the pharmacy.

遵循這些簡單的規則將有助於您獲得接送服務:

  • 提前 3+ 個工作日致電 
  • Call Transportation Services at 1-833-583-5683 (TTY 1-866-288-3133) 7:00 a.m.–7:00 p.m. CT (6:00 a.m.–6:00 p.m. MT), Monday–Friday or visit www.modivcare.com.
  • Have your Medicaid ID card available. 
  • Know the name and address of your health care provider and the date and time of your appointment. 
  • 具體說明您需要搭乘前往的目的地 
  • If you’re not sure how long your appointment will take, the return ride will be scheduled for “Call for Pickup.”That means you need to give Transportation Services a call when you’re ready to go home at 1-833-583-5683 (TTY 1-866-288-3133).   
  • 如果您的醫生給您處方,您可以到藥房配藥 
  • Let us know if you have special needs like a wheelchair, cane, or walker. 
  • Members under the age of 13 must have a parent or guardian with them. 
  • Transportation may be limited to a provider near you.
  • If you cancel your visit, call 1-833-583-5683 to cancel your ride.

You may also qualify for a bus pass. Give Modivcare a call to schedule a ride or ask questions about getting transportation services.

此服務適用於事先規劃的乘車。如果有危及生命的緊急情況,請致電 911。若需要被送往醫院,將提供救護車。

Transplant Services

Covered when ordered by a network physician.

Unlimited Primary Care Provider Visits

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

視力照護

You'll get the care, eyeglasses and treatment that let you see life more clearly. 承保範圍包括:

·  Annual eye exams.
·  Prescription lenses.

This benefit is offered by March Vision.

Wandering and Elopement

We will provide members and families with door and window alarms (up to six per household) to help reduce wandering without caregiver awareness.

康復看診

康復看診可以幫助您保持健康。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。
  • 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。

保戶資源

檢視可利用的資源 (開啟範本視窗)
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