UnitedHealthcare Community Plan of California Medi-Cal

Medicaid

UnitedHealthcare Community Plan of California includes a range of benefits. Children, pregnant women, families, adults and seniors and people with disabilities may qualify based on income. View the benefits below to see what our plan covers.

Mga Pakinabang at Feature

Pangangalaga Habang Walang Sakit at Kapag May Sakit

Get the assistance you need to be at your best — or to get better if you are injured or sick. That includes:

  • Mga Pagpapatingin Habang Walang Sakit. Annual checkups to help keep you healthy. 
  • Pagpili ng Doktor. Find a doctor you trust in our network. 
  • Shots and Vaccines. Routine shots to help protect against illness. 
  • Urgent Care. Convenient care for a sudden illness or injury. 
  • NurseLine℠. Speak with a registered nurse 24/7. 
  • Laboratoryo at mga X-ray. Ang mga pagsusuri sa laboratoryo, x-ray at diagnostic imaging ay sinasaklaw. 
  • Medicines. Fill prescriptions at local pharmacies.

Nothing is more important than the health and well-being of a mother and your baby. That's why our plan benefits include:

  • Choice of Doctor. Find a doctor or OB/GYN you trust in our network. 
  • Prenatal Visits. Care for you before your baby is born.
  • Baby Blocks™. Earn rewards for completing checkups on time during and after your pregnancy.
  • Text4Baby. Receive text messages with helpful tips and reminders.

Kung mayroon kang hika, diabetes o isa pang pangmatagalang kundisyon, maaasahan mo kami. Our plan makes sure you get the care and services you need. Kabilang sa mga benepisyo ang:

  • Care Manager. If you qualify, get personal help managing health conditions. 
  • Pamamahala sa Sakit. Focused care for those with chronic health needs, like asthma and diabetes. 
  • Kalusugan ng Pag-iisip. Saklaw ang pagpapayo at iba pang mga panggagamot. 
  • Residential Care. Brief stay at a care facility while you recover from sickness or injury.

Tiyaking nasa pinakamagandang kundisyon ang iyong paningin at pandinig. Kabilang sa mga benepisyo ang:

  • Vision Care. Routine eye exams every two years. 
  • Eyeglasses. For members under 21 and pregnant women, 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. Some benefits include:

  • Mga Kagamitan at Supply. In-home medical and safety equipment. 
  • Home Health Care. Medical and personal care in your home, if medically needed.

Sometimes members need a little extra help using their health plan. Para sa mga pagkakataong iyon, maaari kang umasa sa:

  • Transportation. Get rides to and from doctor appointments and more. 
  • Tulong sa Wika. Translated materials and interpreters who are ready to help you 24/7. 
  • Mga Serbisyo sa Miyembro. Available 7 a.m. to 7 p.m. PT, Monday – Friday. 
  • Member Advocate. Local advocates to get you information, services and care. 
  • NurseLine℠. Speak with a registered nurse 24/7.

UnitedHealthcare Community Plan of California, Inc. has health education programs, services and materials to help you improve your health and manage illness. 

These are available to you for free. Many of the materials are offered in 
different languages and/or in formats for the hard of hearing and visually impaired. 

Diabetes Prevention Program is a covered benefit offered to our eligible members designed to assist in preventing or delaying the onset of Type 2 Diabetes by making lifestyle changes.

Baby Blocks™

Build a healthy 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.

Tagapamahala ng Pangangalaga

Do you have a serious health problem? If so, our case managers are in your corner. They will:

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

  • The care manager will stay with you throughout your medical journey. He or she will:
  • Think beyond your medical needs.
  • Make sure you have support at home.
  • Pagpili ng Doktor

    Each member can choose a primary care physician (PCP). Use the “Doctor Lookup” tool to see if your doctor is in our network. 

    Ang iyong PCP ay ang iyong pangunahing doktor para sa:

    • Pampigil na pangangalaga.
    • Panggagamot kung mayroon kang sakit o pinsala.
    • Mga referral sa mga espesyalista para sa ilang partikular na kundisyon.

    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.  

    Pamamahala sa Sakit

    Kung mayroon kang mga pabalik-balik o lubhang mapanganib na sakit, idinisenyo ang aming mga serbisyo sa pamamahala ng sakit upang suportahan ka.

    Mayroon kaming mga espesyal na programa para sa:

  • Chronic obstructive pulmonary disease (COPD)
  • Coronary artery disease (CAD)
  • Congestive heart failure (CHF)
  • Diabetes
  • High Risk Pregnancy and Neonatal Intensive Care Unit
  • Sickle Cell Disease
  • Mga Kagamitan at Supply

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

    Our plan covers medical equipment ordered by a member's doctor or care manager. This can include supplies like:

    • Oxygen tanks.
    • Mga walker o wheelchair.

    Pangangalaga sa Paa

    We provide the exams needed to help keep feet in great shape. And for those with 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.
  • Health Homes Program (HHP)

    UnitedHealthcare Community Plan of California covers Health Homes Program (HHP) services for Members with certain chronic health conditions. These services are to help coordinate physical health services, behavioral health services, and community-based long term services and supports (LTSS) for Members with chronic conditions.

    You may be contacted if you qualify for the program. You can also call UnitedHealthcare Community Plan of California, or talk to your doctor or clinic staff, to find out if you can receive HHP services.

    You may qualify for HHP if:

    • You have certain chronic health conditions. You can call UnitedHealthcare Community Plan of California, to find out the conditions that qualify; and
    • You meet one of the following:
      • You have three or more of the HHP eligible chronic conditions;
      • You stayed in the hospital in the last year;
      • You visited the emergency department three or more times in the last year; or
      • You do not have a place to live.

    You do not qualify to receive HHP services if:

    • You receive hospice services; or
    • You have been residing in a skilled nursing facility for longer than the month of admission and the following month.

    Covered HHP Services:

    HHP will give you a care coordinator and care team that will work with you and your health care providers, such as your doctors, specialists, pharmacists, case managers, and others, to coordinate your care. UnitedHealthcare Community Plan of California provides HHP services, which include:

    • Comprehensive Care Management
    • Care Coordination
    • Health Promotion
    • Comprehensive Transitional Care
    • Individual and Family Support Services
    • Referral to Community and Social Supports

    Cost to Member:

    There is no cost to the Member for HHP services.

    Home Health Care

    After surgery or a serious illness, 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. With approval from your doctor, our plan covers:

    • In-home medical visits.
    • Medical equipment like hospital beds, walkers or wheelchairs.
    • Disposable medical supplies.
    • Help with personal care.

    Pagkakaospital

    This plan pays for all expenses related to a hospital stay - the member will never be changed. Sinasaklaw ng aming plano ang:

    • Kwarto at matutuluyan.
    • Mga supply at kagamitan.
    • Panggagamot at mga therapy.  
    • Mga diagnostic na pagsusuri at eksaminasyon.

    And after leaving the hospital, you are not alone. We make sure the follow-up care is available to continue healing at home.

    Interpreter

    UnitedHealthcare offers services to help you talk with your doctor or other health care workers. You can get this service if you do not speak English or have hearing and speech barriers. You do not need a referral from your doctor to get these services.

    Interpreter services are offered free of charge.

    Laboratoryo at mga X-ray

    Makakapagdulot ng pagbabago kapag alam kung ano ang mali at kapag nalaman ito nang maaga. Sinasaklaw ng aming plano ang:

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

  • Tutulungan ka naming makuha ang impormasyong kailangan upang makatulong na mapabuti ang iyong kalusugan at maibalik ka sa pinakamalusog na kundisyon.

    Tulong sa Wika

    You may be able to receive information in your preferred language or format, including Braille. Magtanong lang. We also have people at our member service centers who speak more than one language. Chances are, we have someone who speaks your language. All languages required by the State of California are covered, plus more.

    Medicines

    Prescriptions and certain over-the-counter items are covered by our plan.

    You may receive a prescription from a UnitedHealthcare doctor or specialist. You can fill your prescription at any UnitedHealthcare contracted pharmacy. Just show your State Benefit Identification Card (BIC) and your UnitedHealthcare Identification card to the pharmacy when you get your prescriptions filled. 

    Member Advocates

    We’re looking out for you. Our local member advocates can help solve problems, provide training and education, and work on issues that concern you.

    They can:

    • Answer your questions about your benefits.
    • Help with doctor issues or complaints.
    • Help you clarify your health care benefits.

    Mga Serbisyo para sa Miyembro

    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.

    Maaari ka rin naming tulungang humanap ng:

  • Find a doctor.
  • Change your primary care physician.
  • Questions on benefits.

  • Just call 1-866-270-5785, TTY: 711 Monday - Friday, 7:00 am – 7:00 pm PT.

    No Copays

    Wala kang babayaran para sa mga sinasaklaw na serbisyo.

    While your health care is low-cost or free, the care quality is high. Magkakaroon ka ng: 

    • Care from highly skilled and compassionate doctors.
    • Treatments at respected hospitals and clinics.
    • Prescription drugs and over-the-counter medicines.

    NurseLine℠

    Medical questions and situations sometimes happen at inconvenient times. When you have questions about your health, you can call a nurse 24 hours a day, 7 days a week: 1-877-543-3409 (TTY 711).

    Our NurseLineSM will:

    • Tutukuyin ang mga sintomas.
    • Help with self-care.
    • 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.

    If you have a life threatening emergency, go immediately to the emergency room or call 911.

    Outpatient Mental Health

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

    Mental Health Screening:

    • A mental health screening will be completed to determine if you are in mild or moderate distress or have acute impairment of mental, emotional or behavioral functioning.
    • This screening can be completed by a PCP, UnitedHealthcare Community Plan of California, Inc. or county mental health plan.

    Outpatient Mental Health Services- Covered by UnitedHealthcare Community Plan of California:

    • If your mental health screening results determine you are in mild to moderate distress, UnitedHealthcare Community Plan of California covers the following outpatient mental health services:
      • Outpatient mental health services
      • Individual and group mental health evaluation and treatment (psychotherapy)
      • Psychological testing when clinically indicated to evaluate a mental health condition
        Psychiatric consultation for medical management
      • Screening and Brief Intervention (SBI)
      • Outpatient laboratory, supplies and supplements
      • Drugs (excluding anti-psychotic drugs which are covered by Medi-Cal fee-for-service)
      • Family Counseling
      • Neuro behavioral testing
      • Neuro psychological testing
    • Outpatient mental health services do not require a referral from your PCP.
    • For help finding more information on mental health services provided by UnitedHealthcare Community Plan of California, Inc., call 1-866-270-5785, TTY 711.

    Specialty Mental Health Services- Covered by County Mental Health Plan

    • If your mental health screening results determine you have acute impairment of mental, emotional or behavioral functioning, you may be eligible for specialty mental health services.
    • Your PCP or UnitedHealthcare Community Plan of California, Inc. can refer you to the county mental health plan to receive an assessment.
    • County mental health plans cover specialty mental health services for Medi-Cal beneficiaries who meet criteria.
    • Specialty mental health services may include the following inpatient and outpatient services:
      • Outpatient specialty mental health services:
        • Mental health services (assessments, plan development, therapy, rehabilitation, and collateral)
        • Medication support services
        • Day treatment intensive services
        • Day rehabilitation services
        • Mga serbisyo sa pamamahala sa krisis
        • Crisis stabilization services
        • Targeted case management services
        • Therapeutic behavioral services
        • Intensive care coordination (ICC)
        • Intensive home-based services (IHBS)
        • Therapeutic foster care (TFC)
      • Residential services:
        • Adult residental treatment services
        • Crisis residental treatment services
      • Inpatient services:
        • Acute psychiatric inpatient hospital services.
        • Psychiatric inpatient hospital professional services.
        • Psychiatric health facility services.

     

    • For help finding more information on specialty mental health services provided by the county mental health plan, call the county at 1-888-724-7240.
       

    Personal Care

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

    • Dressing.
    • Bathing.
    • Feeding.

    Mga Pagpapatingin Habang Nagbubuntis

    Your pregnancy is a journey you'll want to make 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.

    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.

    Quitting Tobacco

    Most people know the bad health effects of smoking. And they know they need to quit. We support our members to help them quit. The only thing they won’t get from us is a lecture.

    Text4Baby

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

    You’ll get text messages each week 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 members recover from a serious injury or illness, or simply reach their full potential.

    Our plan covers limited visits for:

     

  • Occupational therapy.
  • Physical therapy.
  • Speech therapy.
  • In-home therapy.
  •  

    Transportasyon

    Transportation services are provided by LogistiCare.
    Members can get round trip transportation to and from health care locations as needed. That includes trips to:

    • Doctor or therapy visits.
    • Vision clinics.

    To schedule a ride with LogistiCare, members should call LogistiCare at 1-844-772-6623 Monday through Friday from 7:00 a.m. to 7:00 p.m. PT. Rides should be scheduled at least 3 business days before your appointment.

     

    Pangangalaga sa Paningin

    Members can get the care, eyeglasses and treatment that let them see life more clearly.
    Kabilang sa mga benepisyo ang:

  • Mga eksaminasyon sa mata.
  • Prescription lenses and frames for member under 21 years of age or pregnant.
  • Mga Pagpapatingin Habang Walang Sakit

    Well visits with your doctor can help keep you and your family healthy. These visits can catch health problems early, so they can be treated. Kabilang sa mga serbisyong pang-iwas sa sakit ang:

  • Checkups for adults and children.
  • Well-baby care.
  • Care for women expecting a baby.
  • Routine shots and tests.
  • Mga mammogram.
  • Mga Mapagkukunan ng Miyembro

    Tingnan ang Mga Available na Mapagkukunan

    Matuto Nang Higit Pa

    UnitedHealthcare Community Plan of California Medi-Cal

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