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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.

If you have Medi-Cal benefits, your coverage will need to be renewed every year. The county will send you a Medi-Cal renewal form. Complete this form and return it to your local county human services agency. You can also visit or call your local human services agency. To find an office near you, visit the San Diego Health & Human Service Agency website.

If you lose Medi-Cal coverage, you may enroll in health insurance coverage through Covered California in the special-enrollment period due to a loss of coverage.

Nagbago ba ang iyong impormasyon sa pag-contact sa nakalipas na dalawang taon? Give your county office your updated contact information so you can stay enrolled. Find your local county office.

Mga Benepisyo 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. Kasama rito:

  • Mga Regular na Medikal na Pagbisita. Annual checkups to help keep you healthy. 
  • Pagpili ng Doktor. Humanap ng doktor na pinagkakatiwalaan mo sa aming network. 
  • Mga Iniksyon at Bakuna. Routine shots to help protect against illness. 
  • Agarang Pangangalaga. Convenient care for a sudden illness or injury. 
  • Nurse Hotline. Speak with a registered nurse 24/7. Call 1-866-270-5785.
  • Laboratoryo at mga X-ray. Ang mga pagsusuri sa laboratoryo, x-ray at diagnostic imaging ay sinasaklaw. 

Nothing is more important than the health and well-being of a mother and your baby. Ito ang dahilan kung bakit kabilang sa aming mga benepisyo sa plano ang:

  • Choice of Doctor. Find a doctor or OB/GYN you trust in our network. 
  • Prenatal Visits. Care for you before your baby is born.
  • Healthy First Steps®. Get extra support and rewards to keep you and your baby healthy.
  • Text4Baby. Receive text messages with helpful tips and reminders.

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 nars 24 oras sa isang araw, 7 araw sa isang linggo: 1-855-366-5032.

Our Nurse Hotline will:

  • Tutukuyin 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.

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

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. 
  • Mental Health. Saklaw ang pagpapayo at iba pang mga panggagamot. 
  • Residential Care. Brief stay at a care facility while you recover from sickness or injury.

UnitedHealthcare Community Plan of California, Inc. covers Enhanced Care Management (ECM) services for members with highly complex needs. ECM is a benefit that provides extra services to help you get the care you need to stay healthy. It coordinates the care you get from different doctors. ECM helps coordinate primary care, acute care, behavioral health, developmental, oral health, community-based long-term services and supports (LTSS), and referrals to available community resources.

If you qualify, you may be contacted about ECM services. You can also call UnitedHealthcare Community Plan of California, Inc. to find out if and when you can receive ECM. Or talk to your health care provider who can find out if you qualify for ECM and when and how you can receive it.

Covered ECM services

If you qualify for ECM, you will have your own care team, including a care coordinator. This person will talk to you and your doctors, specialists, pharmacists, case managers, social services providers and others to make sure everyone works together to get you the care you need. A care coordinator can also help you find and apply for other services in your community. ECM includes:

  • Outreach and engagement
  • Comprehensive assessment and care management
  • Enhanced coordination of care
  • Health promotion
  • Comprehensive transitional care
  • Member and family support services
  • Coordination and referral to community and social supports

To find out if ECM may be right for you, talk to your UnitedHealthcare Community Plan of California, Inc. representative or health care provider. 

Call Member Services at 1-866-270-5785 (TTY 711).

UnitedHealthcare Community Plan of California, Inc. is here 7:00 AM to 7:00 PM PST, Monday through Friday, except State holidays. The call is toll free. Or call the California Relay Line at 711. Visit online at myuhc.com/CommunityPlan.

 

 

The plan covers: 

  • Routine eye exam once every 24 months; UnitedHealthcare Community Plan of California, Inc. 
    may pre-approve (prior authorization) additional services as medically necessary. 
  • Eyeglasses (frames and lens) once every 24 months; contact lens when required for medical 
    conditions such as aphakia, aniridia and keratoconus. 

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. 
  • Pambahay na pangangalagang pangkalusugan. 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. 
  • Nurse Hotline℠. Makipag-usap sa rehistradong nars 24/7. Tumawag sa 1-866-270-5785.


UnitedHealthcare Community Plan of California, Inc. has health education programs, services and materials to help you improve your health and manage illness at no cost to you. 

  • Health Education Resource Library: Many of the materials are offered in different languages and/or in formats for the hard of hearing and visually impaired.
  • Health Education Classes: UnitedHealthcare is partnering with Champions for Health to sponsor virtual health education classes about multiple topics such as Chair Yoga, Childhood Health, Cooking Demo, Women’s Health, and Diabetes. The classes will be offered to our members and the community at no cost in Ingles and Spanish.

To enroll in a class, download the Health Education Class Schedule in Ingles or Spanish or visit championsforhealth.org/virtual-health-education-classes to register.
For questions about our health education programs, please call 866-782-2037 or email uhchealthed@uhc.com.

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:

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

Para sa mga miyembrong walang doktor o wala sa aming network ang doktor, puwede kaming tumulong sa paghahanap ng bagong doktor na malapit.  

Community supports

California Advancing and Innovating Medi-Cal (CalAIM) establishes the framework to address social determinants of health and improve health equity statewide.

A key feature of CalAIM is the introduction of a menu of in lieu of Community Supports.

What Are Community Supports?
Community Supports are services or settings that the Plan may offer in place of services or settings covered under the California Medicaid State Plan and that are medically appropriate, cost-effective alternatives to a State Plan covered service.
Community Supports are optional for the Plan to offer and for Members to utilize. The Plan will not require Members to use Community Supports instead of a service or setting.

Community Supports that may be offered are:

  • Housing Transition and Navigation Services
  • Housing Deposits
  • Housing Tenancy and Sustaining Services
  • Short-Term Post-Hospitalization Housing
  • Recuperative Care (Medical Respite)
  • Respite Services
  • Medically Supportive Food/ Meals/Medically Tailored Meals
  • Sobering Centers

For more information, call Member Services at 1-877-650-1477 (TTY 711)

Diabetes Prevention Program

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.

UnitedHealthcare Community Plan is pleased to offer a healthy lifestyle program at no cost to qualified members. The program can help you make small changes to live a healthy life, lose weight and lower your chance of developing type 2 diabetes.

To see if you qualify:

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)
  • Diyabetis
  • High Risk Pregnancy and Neonatal Intensive Care Unit
  • Sickle Cell Disease

 

 

Mga Kagamitan at Supply

Posibleng mangailangan ng karagdagang suporta ng ilang miyembro para ligtas na mabuhay sa bahay.

Our plan covers medical equipment ordered by a member's doctor or care manager. Puwedeng kasama sa mga supply ang:

  • Mga oxygen tank.
  • 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.

 

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).

Pangangalagang Pangkalusugan sa Tahanan

After surgery or a serious illness, you may need extra help with day-to-day tasks. Posibleng kailanganin mo rin ng medikal na pagbisita sa bahay para matingnan kung maaayos ba ang paggaling mo. With approval from your doctor, our plan covers:

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

Pagkakaospital

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

  • Kuwarto at matutuluyan.
  • Mga supply at kagamitan.
  • Paggagamot at mga therapy.  
  • Mga diagnostic na test 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.

Mga 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 Ingles 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.

Labs and X-Rays

Makakapagdulot ng pagbabago kapag alam kung ano ang mali at kapag nalaman ito nang maaga. 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 para makatulong na mapabuti ang iyong kalusugan at maibalik ka sa pinakamalusog na kondisyon.

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. Sa malamang, mayroon kaming taong nagsasalita ng wika mo. All languages required by the State of California are covered, plus more.

Mga Gamot

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. 

Mga Advocate na Miyembro

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.

Magagawa nilang:

  • Answer your questions about your benefits.
  • Makatulong sa mga isyu sa doktor o reklamo.
  • Help you clarify your health care benefits.

Mga Serbisyo para sa Miyembro

Minsan kailangan mo ng tulong para maunawaan ang iyong mga opsyon sa pangangalagang pangkalusugan. Sa amin, mayroon kang matatawagan. 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.

On My Way

UnitedHealthcare OMW™ (On My Way) is a mobile-friendly website aimed at helping young adults through the process of transitioning into adulthood. This interactive website also makes it fun to learn as you go. Register at www.uhcomw.com and begin the journey.

Outpatient Mental Health

Ang mental health ay kasinghalaga ng physical health. Kung kaya’t mayroon kaming coverage para sa dalawang ito.

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 na Pangangalaga

Minsan mahirap gawin nang mag-isa ang mga pangunahing kaalaman pagkatapos magkaroon ng sakit o injury. If needed, we provide help with:

  • Pagbibihis.
  • Pagligo.
  • Pagpapakain.

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. 

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. We support our members to help them quit. Sermon lang ang hindi mo makukuha sa amin.

Text4baby

Makakatulong ang Text4baby sa mga bagong nanay at magiging nanay na panatilihing malusog ang kanilang mga sarili at kanilang mga anak.

You’ll get text messages each week throughout your pregnancy and your baby’s first year. Naglalaman ang bawat ng text ng mga tip pangkalusugan at pangkaligtasan para sa mga paksa tulad ng:

  • Pangangalaga sa pagbubuntis.
  • Pagle-labor at panganganak.
  • Pagpapasuso.
  • Ligtas na pagtulog.
  • Nutrisyon.
  • Kaligtasan sa pagsakay sa kotse.

  • Para magkaroon ka at ang iyong anak ng magandang umpisa sa bahay.

    Mga Serbisyo sa Therapy

    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

    Rides can be scheduled at least 30 days in advance, and no later than 3 business days before your appointment. Scheduling your ride at least 3 business days in advance will help you to have the best experience. Urgent care and other urgent types of trips, like dialysis or chemotherapy, can be scheduled on the same day.

    Members can get round trip transportation to and from health care locations as needed, including rides to:  

    • Mga pagpapatingin sa doktor o therapy
    • Pickup prescription drugs that cannot be mailed directly to the member
    • Pickup medical supplies, prosthetics, orthotics and other equipment
    • Specialty mental health services
    • Mga serbisyo sa substance use disorder
    • Dental and any other benefits covered through Medi-Cal  

    Mga serbisyong pang-vision

    The plan covers: 

    • Routine eye exam once every 24 months; UnitedHealthcare Community Plan of California, Inc. 
      may pre-approve (prior authorization) additional services as medically necessary. 
    • Eyeglasses (frames and lens) once every 24 months; contact lens when required for medical 
      conditions such as aphakia, aniridia and keratoconus. 

    Mga Pagpapatingin Habang Walang Sakit

    Well visits with your doctor can help keep you and your family healthy. 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.
  • Pangangalaga sa sanggol nang walang sakit.
  • Pangangalaga para sa mga babaeng nagbubuntis.
  • Mga regular na iniksyon at pagte-test.
  • Mga mammogram.
  • To File a Complaint or Grievance, Download the GRIEVANCE FORM - Ingles | Español| Arabic | Chinese | FarsiTagalog | Vietnamese

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    Mga Resource ng Miyembro

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