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.

Pamamahala sa pangangalaga

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.

Pangangalagang Chiropractic

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.

Pagpili ng Birth Center

Mahalagang pumili ng ospital kung saan ka manganganak. 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.

Pagpili ng Doktor

Ang bawat miyembro ay maaaring pumili ng provider ng pangunahing pangangalaga (PCP). Gamitin ang tool na Maghanap ng Doktor para makita kung nasa aming network ang iyong doktor.

Ang iyong PCP ay ang iyong pangunahing doktor para sa:

• Preventive care.
• Paggagamot kung mayroon kang sakit o injury.
• 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.

Pangangalaga sa Ngipin

Ang pagkuha ng taunang pagsusuri sa ngipin ay mahalaga sa iyong kalusugan. Kasama sa aming saklaw ang: 

• 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.

Minsan ang mga tao ay nahihirapang pumunta sa dentista. Maaaring sensitibo silang hawakan. Maaaring kailanganin nila ng karagdagang oras o banayad na pangangalaga. Hayaan kaming tulungan kang mahanap ng tamang dentista para sa iyo o sa iyong pamilya. Tumawag sa Mga Serbisyo sa Miyembro sa 1-800-641-1902, TTY 711.

Suporta sa Mga Diabetic

Kung may diyabetis ka, gagawin naming mas maginhawa ang buhay para sa iyo. 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.

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.

Mga Kagamitan at Supply

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

Our plan covers medical equipment ordered by the doctor or care manager. Puwedeng kasama sa mga supply ang:

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

Pangangalaga sa Paa

Ibinibigay namin ang mga pagsusuri na kailangan mo upang makatulong na mapanatili sa maayos na katayuan ang iyong mga paa. 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. 

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

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

Sinasalo namin ang:

• Exams, aids and tests.
• Mga hearing aid at baterya.

Home Care

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

Kapag naaprubahan, sakop ng aming plano ang:

• In-home medical visit(s).
• Medikal na kagamitan tulad ng mga kama sa ospital, walker o wheelchair.
• Mga disposable na medical supply.

Pagkakaospital

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

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.

And after leaving hospital, we can provide transitional care services. Titiyakin naming makakakuha ka ng follow-up na pangangalaga para maipagpatuloy ang pagpapagaling sa tahanan.

Mga Serbisyo ng Hospice

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

Laboratoryo at mga X-ray

Knowing what’s wrong and finding it early can make all the difference.  Our plan covers:

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

Tutulungan ka naming makuha ang impormasyong kailangan para makatulong na mapabuti ang iyong kalusugan at maibalik ka sa pinakamalusog na kondisyon. 

Tulong sa Wika

Nagbibigay kami sa iyo ng mga materyales para sa miyembro sa wika o format na mas madali mong maunawaan. Kasama sa network ng aming tagapagbigay ng serbisyo ang maraming doktor na nagsasalita ng iba't ibang wika. Ipinapakita ng aming direktoryo ng provider ng serbisyo kung aling mga wika ang sinasalita ng mga doktor. Additionally, many of our Member Service Advocates speak multiple languages. Kapag tumawag ka, magagawa naming kumonekta sa aming serbisyo ng interpreter na nag-aalok ng suporta sa mahigit 240 na mga wika. Tumutulong kami sa mga serbisyo ng interpreter, kabilang ang American Sign Language.

Kung nahihirapan kang makarinig sa telepono, maaari kang gumamit ng text na telepono. Ang libreng serbisyong ito ay nagbibigay-daan sa mga taong may kapansanan sa pandinig o pagsasalita na tumawag at tumanggap ng mga tawag sa telepono. Tumawag sa 711. Ibigay sa kanila ang numerong 1-800-641-1902, at iuugnay ka nila sa amin.

Maaari ka ring makakuha ng impormasyon sa malalaking printa, Braille, o mga audio file.

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

Member Services Advocates

Ang pamamahala sa iyong pangangalagang pangkalusugan ay maaaring maging mahirap, lalo na kung marami kang kinakaharap na problema sa kalusugan nang sabay-sabay. Kung kailangan mo ng karagdagang suporta upang lumusog at manatiling malusog, makakatulong kami. 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, 7:00 AM–7:00 PM CT (6:00 AM–6:00 PM MT), Monday–Friday

Mental Health and Substance Use Services

Ang behavioral health ay tungkol sa iyong nararamdaman at pagkilos. Tinatawag din itong mental health. 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.

Sinasalo namin ang:

Behavioral/Mental Health Services 

• Therapy sa indibidwal, grupo, at pamilya 
• Mga serbisyo sa behavioral health ng outpatient 
• Mga serbisyo sa behavioral health ng inpatient 
• Specialized behavioral health services for children with autism.
• Behavioral health rehabilitation services

Mga Serbisyo sa Substance Use Disorder 

• Paggagamot sa outpatient gamit ang opioid (gamot sa pananakit) 
• Paggagamot sa tahanan

Additional health resources can be found at myuhc.com/CommunityPlan. Hanapin ang balanse, suporta, at pangangalaga na kailangan mo upang mabuhay ng pinakamalusog na posible.

Mga Serbisyo sa Krisis sa Kalusugan ng Pag-uugali

Paano kung mayroon akong krisis sa kalusugan ng pag-uugali?

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.

Ang mga serbisyong pang-emergency ay saklaw saanman sa Estados Unidos. Kung iniisip mong mayroon kang emergency na maaaring humantong sa pagkamatay, tawagan ang 911 o pumunta sa pinakamalapit na ospital kung saan matutulungan ka ng mga provider ng serbisyo sa emergency.

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

Mga Serbisyo sa Krisis:

Kung sa tingin mo ay mayroon kang emergency, saan ka man naroroon, tawagan ang 911 o pumunta sa pinakamalapit na ospital kung saan matutulungan ka ng mga provider ng serbisyo sa emergency. Sa lalong madaling panahon, tawagan ang iyong doktor o provider ng serbisyo sa kalusugan ng pag-uugali upang mag-iskedyul ng follow-up na pangangalaga pagkatapos ng emergency.

Kung kailangan mo ng makakausap, narito kami para sa iyo. Kung pakiramdam mo ay hindi pa oras para tumawag 911 ngunit nangangailangan ka ng tulong sa lalong madaling panahon, maaari kang tumawag sa aming Hotline sa Krisis ng Pag-uugali 24/7 sa 1-800-641-1902.

Online: http://www.suicidepreventionlifeline.org

No Copays

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

Hotline ng Nars

Minsan may mga medikal na tanong at sitwasyon sa mga hindi magandang 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.

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.

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.

Pharmacy

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. Sa 90-araw na supply, hindi mo na kakailanganing kumuha ng refill bawat buwan. 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, 7:00 AM–7:00 PM CT (6:00 AM–6:00 PM MT), Monday–Friday

Mga Pagpapatingin Habang Nagbubuntis

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

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.

Paghinto sa Paninigarilyo

Alam ng karamihan ng mga tao ang masasamang epekto ng paninigarilyo. At alam nilang kailangan nilang huminto. That’s why we encourage members to talk to their doctor about getting smoking cessation support. Counseling is covered when you enroll with the Nebraska Tobacco-Free Quit Line.  Medication for smoking cessation are available through Nebraska 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. 

Kabilang ang:

• Mga serbisyo ng pangangalaga sa bahay.
• 24 na oras ng pangangalaga.
• Tulong sa mga aktibidad sa pang-araw-araw na pamumuhay.
• Physical, occupational at speech therapy.

Mga Iniksyon at Bakuna

Routine shots help protect members and their family from illness. Sakop ng aming plano ang:

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

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. 

Nagbibigay ang aming plano ng:

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

Transportasyon

Kung kailangan mo ng masasakyan, kasama sa iyong mga benepisyo ang transportasyon. We cover trips for Nebraska Medicaid coverable services within a 20-mile radius of your home. Kabilang dito ang: medical, mental health, dental and vision appointments along with trips to the pharmacy.

Ang pagsunod sa mga simpleng panuntunang ito ay makakatulong sa iyong makakuha ng masasakyan: 

• Tumawag nang maaga nang 3+ araw ng negosyo 
• 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. 
• Maging partikular sa kung saan mo kailangan ang masasakyan 
• 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).   
• Kung bibigyan ka ng iyong doktor ng reseta, maaari kang dumaan sa botika upang kunin ito 
• 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.

Ang serbisyong ito ay para sa mga sasakyan na naplano nang maaga. Kung mayroon kang emergency na nakamamatay, tumawag sa 911. Maibibigay ang ambulansya kung kailangan mong madala sa ospital.

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.

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.
·  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.

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.

Walang copayment para sa pangangalagang pang-iwas sa sakit.