Lumaktaw sa pangunahing nilalaman
Pangunahing Nilalaman

UnitedHealthcare Community Plan KanCare

Medicaid

This plan offers a range of benefits along with extras that other KanCare plans don't offer. We also offer extra support and care to adults and children who need help with daily activities. You qualify based on income and health needs. View the benefits below to see all that it offers.

Mga Benepisyo at Feature

Pangangalaga Habang Walang Sakit at Kapag May Sakit

Get the care needed to stay healthy — or to be at your best. Kasama rito:

  • Choice of Doctors. Find a doctor you know and trust in our network.
  • Medicines. Fill your prescriptions at local pharmacies.
  • Lab and X-rays. Lab tests, x-rays and diagnostic imaging are covered.
  • Therapy Services. Physical or other therapy to help be your best.
  • Shots and Vaccines. Routine shots help protect against illness.
  • Hospitalization. You pay nothing for care in a hospital.
  • Nurse Hotline. Speak with a registered nurse 24/7.
  • Foot Care. We provide more visits to keep your feet healthy.
  • Community Rewards. You can earn rewards for going to important wellness exams.

Wala nang mas mahalaga pa sa kalusugan at kapakanan mo at ng iyong sanggol. Ito ang dahilan kung bakit kabilang sa aming mga benepisyo sa plano ang:

  • Choice of Birth Center. You can choose a licensed community birth center or pick from 100s of hospitals across Kansas.
  • Choice of Doctors. Find a certified nurse midwife, licensed midwife, doctor or OB/GYN you trust in our network.
  • 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. Earn reward for completing first prenatal visit in the first trimester.

If you or a family member has special health care needs, you can count on us. Our plan will provide the needed extra care and services. Kabilang sa mga benepisyo ang:

  • Behavioral Health. Counseling and other treatments are covered.
  • Diabetic Support. Medicine needles and wipes for managing diabetes.
  • Asthma and COPD Support. Exams, testing and supplies are covered.
  • Care Management. If you qualify, get personal help managing health conditions.
  • Kidney Disease Care. Dialysis, medicine and treatments are covered.
  • Health Rewards Program. Earn debit card rewards for well care visits and immunizations.

Make sure your sight, smile and hearing are at their best. Kabilang sa mga benepisyo ang:

  • Vision Care. Yearly eye exams and eyeglasses as needed.
  • Dental Care. Exams, x-rays and cleaning for kids and adults.
  • Hearing Care. Tests, checkups and hearing aids, if needed.

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. Kabilang sa mga benepisyo ang:

  • Equipment and Supplies. In-home medical and safety equipment are covered.

Kung minsan, maaaring kailanganin mo ng kaunting karagdagang tulong sa paggamit ng iyong planong pangkalusugan. Para sa mga pagkakataong iyon, maaari kang umasa sa:

  • Transportation. We provide rides to and from medical visits.
  • Community Rewards. Your can earn rewards for going to important wellness exams.
  • Programs for Kids and Teens. Free activities at local youth organizations.
  • Member Services. Your benefit questions are answered Monday – Friday 8 am – 6 pm 1-877-542-9238.
  • Quitting Tobacco. Coaches and supplies to help you quit using tobacco.
  • Interpreters. Interpreters are available over the phone for you at your doctor visits.

If you're elderly or living with a disability or illness, your health needs are unique. Our job is to make it as easy as possible for you to meet those needs and more. Benefits may include:

  • Care Coordinator. Someone to get you the services to be at your best.
  • Disease Management. Focused care for those with critical health needs.
  • In-Home Care. Medical and personal care at home, if needed.
  • Equipment and Supplies. In-home medical and safety equipment are covered.
  • Emergency Response System. Sends an urgent request for someone to help you.
  • Adult Day Care. Friendship and social activities in a safe setting.
  • Home Meal Delivery. If you cannot safely make meals, we'll provide them.
  • Respite Care. In-home help to give your caregivers a rest.

Adult Day Care

Companionship is important. Adult day care provides care and companionship for frail elderly waiver members who need extra help during the day. Caregivers also benefit, knowing their loved one is well cared for and safe during the day.

Adult day care can provide:

  • Social connections and friendship.
  • Bathing and personal care.
  • Meals.

Suporta sa Hika at COPD

Do you or a family member have trouble managing asthma or COPD symptoms? A nurse who specializes in breathing issues can really help. You will get a customized treatment plan and medicine to:

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

Attendant Care Services

If you live with a disability or chronic health condition, you may need extra help to stay in your own home. Our plan gives members who qualify the services needed to be safe and comfortable. An attendant can provide:

  • Companionship.
  • Homemaking services.
  • Personal care.

You and your caregiver can decide which chores you want your care attendant to do in your home.

Behavioral Health

Kasinghalaga ng behavioral health ang physical health. Kaya mayroon kaming coverage para sa dalawang ito.

Ang kinakailangang pangangalaga ay 100% sinasaklaw nang walang copay. Kasama rito ang:

  • Behavioral therapy.
  • Paggagamot ng pag-abuso sa substance.
  • Mga gamot.
  • Peer Coaching program.

Coordinator ng Pangangalaga

The daily care and safety of our members is important. That’s why we conduct home visits for eligible waiver members who need extra help staying at home. 

During this visit we:

  • Understand your personal needs.
  • See if your home needs minor modifications, such as ramps and bathroom safety devices.
  • Set up emergency monitoring.
  • Arrange for personal care attendants.

Pamamahala sa pangangalaga

Do you have a disability or a serious health problem? If your health needs qualify then our care coordinators are in your corner. They will:

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

Your care coordinator will stay with you throughout the medical journey. He or she will:

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

Pagpili ng Birth Center

Mahalagang pumili ng ospital kung saan ka manganganak. That's why you can pick from hospitals across Kansas and surrounding states.

We also encourage you to tour the hospital's birthing center. Nang sa gayon ay maging pamilyar ka rito. And be more relaxed when you have your baby.

Cell Phone Program

Contact Member Services for help applying for a cell phone plan.

Choice of Doctors

Magkakaroon ka ng doktor ng pangunahing pangangalaga (primary care physician, PCP) na iyong pangunahing doktor. Gamitin ang tool na Maghanap ng Doktor para makita kung nasa aming network ang iyong doktor.

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.

Ang iyong PCP ay ang iyong pangunahing doktor para sa:

  • Preventive care.
  • Paggagamot kung mayroon kang sakit o injury.
  • Mga referral sa mga espesyalista para sa ilang partikular na kondisyon.

Pangangalaga sa Ngipin

Child members up to age 20 receive Preventative exams and cleaning 2 times a year. This helps keep teeth and gums strong and healthy.

Adults over 20 can visit participating dental provider for exams, x-rays, cleanings and fillings. Covers up to $500 per year*.

*The $500 coverage that includes fillings begins in 2019

Suporta sa Mga Diabetic

Kung may diyabetis ka, gagawin naming mas maginhawa ang buhay para sa iyo. Makakatanggap ka ng gamot, supply, at edukasyon para matulungan kang maging at manatiling pinakamalusog.

Our diabetes program also includes self-care training and classes focused on:

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

Pamamahala sa Sakit

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

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

Emergency Response System

If you are on one of the waiver programs and at risk for a fall or sudden illness, an emergency call system can really help. It sends an urgent request for someone to check on you and help you.

Kagamitan at Mga Medikal na Supply

Ang iyong kalusugan at kaligtasan sa tahanan ay mahalaga.

Sakop ng aming plano ang kagamitang medikal na ibinilin ng iyong doktor. This might include supplies like:

  • Mga oxygen tank.
  • Mga kama sa ospital.
  • Mga wheelchair or walker.

Pangangalaga sa Paa

Children can get the exams needed to help keep your feet in great shape. And if you have diabetes, good foot care can help prevent much more serious problems.

Kasama ng aming saklaw sa podiatry ang:

  • Routine foot exams.
  • Mga tip tungkol sa pangangalaga sa paa at pagpili ng mga tamang sapatos.
  • Impormasyon tungkol sa mga senyales ng babala sa pinsala sa nerve.

Healthy First Steps®

Bumuo ng malusog na kinabukasan para sa iyo at sa iyong sanggol at makakuha ng magagandang reward sa pamamagitan ng Healthy First Steps. Tutulungan ka ng aming programang magawa ang mga tamang hakbang para mapanatiling malusog ang iyong sarili at ang iyong sanggol. At maaari kang makakuha ng reward na $20 para lang sa pag-sign up. 

Tutulungan ka namin:

  • Pumili ng provider sa pagbubuntis at isang pediatrician (doktor ng bata).
  • Mag-iskedyul ng mga pagpapatingin at pagsusulit at ayusin ang mga pagbiyahe papunta sa mga pagpapatingin mo.
  • Makakuha ng mga reward para sa pagpunta sa mga pagpapatingin sa kabuuan ng iyong pagbubuntis at sa unang 15 (na) buwan ng buhay ng sanggol.
  • Kumuha ng mga supply, kabilang ang mga breast pump para sa mga nagpapasusong ina.
  • Kumonekta sa mga mapagkukunan sa komunidad tulad ng mga serbisyo sa Women, Infants and Children (WIC).

Pangangalaga sa Pandinig

Ang problema sa pandinig ay maaaring makaapekto sa iyong pang-araw-araw na pamumuhay sa maraming paraan. Kabilang sa aming plano ang mga serbisyo at suporta para matulungang protektahan ang iyong pandinig.

Sinasalo namin ang:

  • Mga eksaminasyon, therapy, at test.
  • Hearing aids when ordered by your doctor.

Home Meal Delivery

If you are on the PD or TBI waiver and live with a disability or chronic health condition, we may be able to arrange home meal deliver. You will not be eligible if you are getting home meals through different program.

Pagkakaospital

Nagbabayad ang planong ito para sa lahat ng gastusing kaugnay ng pananatili sa ospital nang sa gayon, makapagpahinga at makapagpagaling ka.

Kasama sa coverage ng pagkakaospital ang:

  • Pangangalaga ng isang nurse.
  • Kuwarto at matutuluyan.
  • Mga supply at kagamitan.
  • Paggagamot at mga therapy.
  • Mga diagnostic na test at eksaminasyon.

At pagkalabas mo sa ospital, hindi ka mag-iisa. Titiyakin naming makakakuha ka ng follow-up na pangangalaga para maipagpatuloy ang pagpapagaling sa tahanan.

In-Home Care / Skilled Home Health Care Services

If you have health or mobility challenges, you may need extra help with day-to-day tasks. You may even need an in-home medical visit to check on how well you are healing. If ordered by a doctor for medical reasons, our Plan covers: 

  • In-home medical visits.
  • Medikal na kagamitan tulad ng mga kama sa ospital, walker o wheelchair.
  • Mga disposable na medical supply.
  • Tulong sa personal na pangangalaga o housekeeping.

Mga interpreter

Kailangan magkaunawaan kayo ng iyong doktor. Magiging mahirap ito kung hindi ka magaling magsalita ng Ingles. We can arrange for a medical interpreter to be available for you over the telephone at your appointments.

Mayroon din kaming mga tao sa mga serbisyo sa miyembro na nagsasalita ng higit sa isang wika. Sa malamang, mayroon kaming taong nagsasalita ng wika mo.

Pangangalaga para sa Sakit sa Kidney

Malubhang medikal na kondisyon ang sakit sa kidney. Pagkatapos hindi gumana ng mga kidney, kakailanganin ng mga regular na paggagamot (na tinatawag na renal dialysis) o pag-transplant ng organ. Ang dialysis ay gumagamit ng makinarya para linisin ang dugo, tulad ng ginagawa ng malulusog na kidney. Kasama sa aming plano ang:

  • Dialysis.
  • Mga gamot.
  • Edukasyong pangkalusugan at suporta.
  • Pag-transplant ng organ kung kinakailangan.

Laboratoryo at mga X-ray

Mainam na malaman nang maaga pa lang kung ano ang problema. Sakop ng aming plano ang:

  • Mga laboratoryo at pagte-test.
  • Mga x-ray, scan at iba pang imaging.

Tutulungan ka naming makuha ang impormasyong kailangan mo upang mapabuti ang iyong kalusugan o maibalik ka sa pinakamalusog mong kundisyon.

Mga Gamot

There are no copays for covered drugs. You can fill your prescriptions at local pharmacies. 

The medical card will cover many services and items. In order for a service to be covered, you must use a Kansas Medicaid provider. The type of coverage you have will determine how you receive coverage.

Specific limits and guidelines apply to all services, and these change often. Before getting any service or item, contact KMAP/MCO Customer Service. A general list of KMAP/MCO covered services is included on our website at https://www.kmap-state-ks.us/Public/Beneficiary/default.asp.

Medicaid requires some services to be approved before you get them. Your provider knows which services need prior authorization and is responsible for obtaining it for you. Medicaid will send you and your provider a letter approving or denying the prior authorization request.

Mga Advocate na Miyembro

Pinapahalagahan namin ang iyong kapakanan. Makakatulong ang mga advocate na miyembro na malutas ang mga problema, magbigay ng pagsasanay at edukasyon, at ayusin ang mga isyung nauugnay sa mga miyembro.

Magagawa nilang:

  • Magbigay ng impormasyon tungkol sa iyong plano.
  • Teach you how to get the care you need.
  • Makatulong sa mga isyu sa doktor o reklamo.
  • Call Member Services and ask for a Member Advocate to help you.

Mga Serbisyo para sa Miyembro

Minsan kailangan mo ng tulong para maunawaan ang iyong mga opsyon sa pangangalagang pangkalusugan. With us, you have someone you can call Monday-Friday 8 AM - 6 PM at 1-877-542-9238. Sasagutin namin ang iyong mga tanong sa simple at kumpletong paraan.

Maaari ka rin naming tulungang humanap ng:

  • Mga doktor.
  • Mga parmasya.
  • Mga ospital o iba pang mga pasilidad na pangkalusugan.
  • Mga lokal na resource.

NurseLine

Dumarating paminsan-minsan ang mga medikal na tanong at sitwasyon sa mga hindi regular na oras. Kapag may mga tanong ka tungkol sa iyong kalusugan, puwede kang tumawag sa nurse 24 (na) oras sa isang araw, 7 (na) araw sa isang linggo. Call 1-855-575-0136.

Gagawin ng aming mga nurse ang sumusunod:

  • Pakinggan ang mga sintomas.
  • Tutulong sa pangangalaga sa sarili.
  • Papayuhan ka tungkol sa pagkuha ng pangangalaga sa pagpapatingin sa isang doktor o sa isang center ng agarang pangangalaga.
  • Tutulungan kang malaman kung kailan dapat pumunta sa emergency room.

Mga Pagpapatingin Habang Nagbubuntis

Your pregnancy is a journey and you will need help along the way. You can visit a family doctor or pregnancy doctor (OB-GYN) to get the care you need.  

Sakop ng aming plano ang lahat ng inirerekomendang prenatal clinical visit at test.

Sa mga pagpapatinging ito, ang klinika ay:

  • Make sure both you and your baby are healthy.
  • Ipapaliwanag kung ano ang dapat asahan sa bawat yugto ng iyong pagbubuntis.
  • Sasagutin ang iyong mga tanong.

Programs for Kids and Teens

Positive role models can make a big difference in a child's life. That's why we provide one free activity each year at local youth organizations, like:

  • YMCA.
  • Boys & Girls Clubs.
  • 4-H.
  • Select Kansas Park and Recreation Departments.

Paghinto sa Paninigarilyo

You know the bad health effects of smoking. You know you need to quit. We support you while you quit with coaches and supplies. The only thing you won't get from us is a lecture.

You can also call the KanQuit smoking line at 1-800-784-8669 for support. 

Respite na Pangangalaga

Are you a waiver member who has family members or friends who care for you in your home? Kung mayroon, hinihiling naming suportahan sila sa kanilang pagsusumikap. Kaya kami nagbibigay ng pansamantalang pangangalaga para makapagpahinga ang iyong mga tagapag-alaga. Ang respite na pangangalaga ay nag-aalok sa mga tagapag-alaga ng pansamantalang bakasyon malayo sa kanilang mga mahal sa buhay na may karamdaman o mga espesyal na pangangailangan sa pangangalaga. Some members can get extra respite care. Ask your Care Coordinator if you qualify.

Mga Iniksyon at Bakuna

Nakakatulong ang mga regular na iniksyon para maprotektahan ka mula sa sakit. Kung kaya, sakop ng aming plano ang:

  • Pneumonia, influenza and shingles shots.
  • Tetanus, diphtheria, pertussis.
  • HPV.

Mga Serbisyo sa Therapy

Makakatulong ang physical, occupational at speech therapy sa iyo na gumaling mula sa malubhang injury o sakit, o maabot ang buo mong potensyal.

When approved by a doctor, covered therapies include:

  • Occupational therapy.
  • Physical therapy.
  • Speech therapy.

Transportasyon

Our plan provides needed rides to and from health care locations for medical appointments. That includes trips to:

  • Doctor or therapy visits.
  • Health departments.
  • Vision clinics.
  • Rides to job activities for members who qualify.

Call 1-877-524-9238.

Non-emergency Medical Transportation (NEMT) benefits name change notice.

Pangangalaga sa Paningin

You'll get the care, eyeglasses and treatment that let you see life more clearly. Kasama sa saklaw ang:

  • Annual eye exams.
  • Mga inireresetang lens.

This benefit is offered by OptiCare.

Mga Pagpapatingin Habang Walang Sakit

Makakatulong sa iyo ang mga pagpapatingin habang walang sakit sa iyong doktor na manatiling malusog. Maaaring matukoy kaagad ang mga problema sa kalusugan sa mga pagpapatinging ito para magamot ang mga ito. Kabilang sa mga serbisyong pang-iwas sa sakit ang:

  • Mga checkup para sa mga adult at mga bata.
  • Mga regular na iniksyon at pagte-test.
  • Mga mammogram.

There are no copayments for preventive care. Earn Community Rewards points for getting exams.

Mga Resource ng Miyembro

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