Planong Pangkomunidad ng UnitedHealthcare na QUEST Integration Program

Medicaid

UnitedHealthcare Community Plan QUEST Integration is a managed care plan offered through Hawai‘i’s Department of Human Service Med-QUEST. Ang UnitedHealthcare Community Plan ay isang planong pangkalusugan para sa mga miyembrong kwalipikado para sa mga benepisyo sa Medicaid na may tulong ng Estado. Kabilang dito ang mga babaeng nagdadalantao, bata, nasa hustong gulang, matanda, may espesyal na pangangailangan at pamilya. Sa UnitedHealthcare Community Plan QUEST Integration, nasa mas magandang landas kayo tungo sa inyong pangangalagang pangkalusugan.

Ang pangunahing layunin namin ay tulungan kayong manatiling malusog at nagsasarili. Ang plan na UnitedHealthcare Community Plan QUEST Integration ay nag-aalok ng mga medikal na serbisyong pangkalusugan at serbisyong pangkalusugan para sa pag-iisip kabilang na ang para sa paningin, gamot at mga supply. Tumawag na sa UnitedHealthcare Community Plan QUEST Integration upang madagdagan ang nalalaman tungkol sa kung paano kayo makakakuha ng mahusay na gabay at pag-aayos ng serbisyo. 

Makikipagtulungan ang aming lokal na kawani sa inyo upang isaayos ang inyong mga serbisyo at partikular na pangangailangan. Tutulong kami sa paggabay sa inyo sa kumplikadong sistema ng pangangalaga sa kalusugan at makikipagtulungan kami sa inyong mga doktor at miyembro ng pamilya upang tulungan kayong matugunan ang inyong mga layuning may kaugnayan sa kalusugan.  Ang UnitedHealthcare Community Plan ay narito para sa inyo, sa bawat hakbang na gagawin.

Matagal nang nagsasagawa ang UnitedHealthcare Community Plan ng pamamahala sa pangangalaga.  

Ipagkatiwala ang kalusugan ng inyong pamilya sa UnitedHealthcare Community Plan.

 

Public Health Event – Pharmacy Response

IMPORTANT INFORMATION REGARDING

UnitedHealthcare Community & State, UnitedHealthcare Employee & Individual, and UnitedHealthcare Medicare & Retirement members covered under Medicaid, Medicare, and Part D prescription drug plans.

Due to Hurricane Flossie approaching Hawai‘i, UnitedHealthcare is authorizing a one-time override of the refill too soon (RTS) edit for members who reside in or may be visiting the following areas. These members may be in need of medication when traveling and mail delivery could be compromised. 

Hawai‘i

Entire State

This authorization should allow impacted UnitedHealthcare Community & State, UnitedHealthcare Employee & Individual, and UnitedHealthcare Medicare & Retirement members covered under Medicaid, Medicare, and Part D prescription drug plan to obtain early refills of their prescription medications if they have refills remaining on file at a participating retail or mail-order pharmacy. 

This policy will be reinforced through the dates listed below, unless conditions continue to warrant.

Line of Business Response Type Timeframe Membership Type

UHC C&S

 

Self-Identify

 

07/31/2019 – 08/14/2019

 

All Products

 

UHC E&I

 

Self-Identify

 

07/31/2019 – 08/14/2019

 

Fully Insured (including NIHPs) and ASO Business

 

UHC M&R Self-Identify 07/31/2019 – 08/14/2019 Fully Insured and ASO
Business

If you should receive a call from a member impacted by this emergency, please follow the standard process for administering refills during a disaster. The OptumRx Help Desk is available to assist in this process should it be needed.

 

UnitedHealthcare Community Plan provides free aids and services to people with disabilities to communicate effectively with us, such as: written information in other formats (large print, audio, accessible electronic formats, other formats). If you need these services, contact us toll-free at 1-888-980-8728 (TTY: 711).  We will provide you with the requested information, at no cost to you within five (5) business days.

Available ang planong ito sa lahat ng county.

Mga Pakinabang at Feature

Pagpili ng Doktor

Each member can choose a primary care provider (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.

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:

  • Home care providers.
  • Specialists.
  • Mga doktor.
  • Mga parmasya.
  • Mga ospital o iba pang mga pasilidad na pangkalusugan.
  • Mga lokal na mapagkukunan.

There is no cost for covered prescriptions. We make getting your child's medicine easy. We'll provide a list of covered medicines if you have questions about what prescriptions are covered.

You can fill the prescriptions at local pharmacies in the UnitedHealthcare Community Plan network.

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

Hospitalization coverage includes:

  • Pangangalaga ng isang nurse.
  • Kwarto at matutuluyan.
  • Mga supply at kagamitan.
  • Panggagamot at mga therapy.
  • Mga diagnostic na pagsusuri at eksaminasyon.

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

Build a healthier 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.

Once you sign up, you can choose a $20 Old Navy gift card or a stylish diaper bag. The choice is yours.

Diabetic Support

If you have diabetes, we'll make life a little easier for you. You'll get medicine, supplies and education to help you reach and stay your best. 

Matibay na Medikal na Kagamitan

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

Our plan covers medical equipment ordered by your child's doctor or case manager. This can include supplies like:

  • Oxygen tanks.
  • Mga kama sa ospital.
  • Wheelchairs or walkers.

Healthy Rewards

An ounce of prevention can be worth a pound of cure. It can also be worth great rewards.

You can earn great gifts for you or your child by doing things like:

  • Completing well-child exams.

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 upang matulungang protektahan ang iyong pandinig.

Sinasaklaw namin ang:

  • Exams, therapy and tests.
  • Hearing aids and batteries.

In-Home Care

After surgery or a serious illness, you may need extra help with day-to-day tasks like cleaning, cooking or dressing. You may even need an in-home medical visit to check on how well you are healing. With approval, our plan covers:

  • An in-home medical visit.
  • Medical equipment like hospital beds, walkers or wheelchairs.
  • Disposable medical supplies.
  • Help with personal care or housekeeping.

Interpreters

Your doctor and you need to understand each other. Not speaking English well makes this difficult. We can arrange for a medical interpreter to be at your appointments.

We also have people in member services who speak more than one language. Chances are, we have someone who speaks your language.

Kidney Disease Care

Kidney disease is a serious medical condition. After the kidneys stop working, regular treatments (called renal dialysis) or an organ transplant are necessary. Dialysis uses a machine to clean the blood, just like healthy kidneys do.

Kasama ng aming plano ang:

  • Dialysis.
  • Medications.
  • Health education and support.
  • Organ transplant if needed.

Laboratoryo at mga X-ray

Napakainam na malaman nang maaga pa lang kung ano ang problema. 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 can get information in another language. Magtanong lang. This is provided at no cost to you.

Member Advocates

Pinapahalagahan namin ang iyong kapakanan. Member advocates can help solve problems, provide training and education, and work on issues that concern members.

They can:

  • Provide information about your plan.
  • Teach you to get the care you need.
  • Help with doctor issues or complaints.

Kalusugan ng Pag-iisip

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

This includes:

  • Therapy para sa kalusugan ng pag-iisip na apektado ng pag-uugali.
  • Panggagamot sa pang-aabuso sa gamot.
  • Medications.

NurseLine℠

Medical questions and situations can come at inconvenient times. When you have questions about your health, you can call a nurse 24 hours a day, 7 days a week.

Our nurses 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.

Nurse Visits

Sometimes continued care is needed after leaving the hospital or urgent care. For example, after a serious illness, surgery or injury. In these cases, a nurse will make home visits to:

  • Provide medical care.
  • Answer any questions and concerns.

Nutrition Coaching

Healthy eating goes a long way to helping you stay at your best. A nutritionist can meet with you to review your eating habits and food choices.

You'll come away with new ideas for:

  • Making good choices for quick meals and snacks.
  • Preparing healthy meals on a budget.

Outpatient Services

Napakainam na malaman nang maaga pa lang kung ano ang problema.

Sinasaklaw ng aming plano ang:

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

We'll help you get the information needed to help improve your health or be your best.

Personal Care

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

  • Dressing.
  • Bathing.
  • Feeding.

Mga Pagpapatingin Habang Nagbubuntis

A pregnancy is a journey that’s better 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 mom and baby are healthy.
  • Ipapaliwanag kung ano ang dapat asahan sa bawat yugto ng iyong pagbubuntis.
  • Answer questions.

Quitting Tobacco

Most people know the bad health effects of smoking. And they know they need to quit. We support our members while they quit, with coaches and supplies. The only thing they won’t get from us is a lecture.

Rehabilitation Care

After a serious illness, surgery or injury you may need extra nursing and therapy. If needed, our plan covers short stays in a rehabilitation center where you can heal. Included are:

  • Nursing home services.
  • 24-hour nursing care.
  • Help with activities of daily living.
  • Physical, occupational and speech therapy.

Respite na Pangangalaga

Mayroon ka bang mga kapamilya o kaibigan na nag-aalaga sa iyo sa tahanan?

Kung mayroon, hinihiling naming suportahan sila sa kanilang pagsusumikap. That's why we provide respite care to give your caregivers a rest. Ang respite na pangangalaga ay nag-aalok sa mga caregiver ng pansamantalang bakasyon malayo sa kanilang mga mahal sa buhay na may karamdaman o mga espesyal na pangangailangan sa pangangalaga.

Shots and Vaccines

Routine shots help protect you from illness.

So, our plan covers:

  • Recommended shots and vaccines.
  • Influenza shots.

Social Services

Many communities offer additional benefits for children in this plan. Social Services helps members connect to these local programs and services, such as:

  • WIC and financial support.
  • School services.
  • Respite na pangangalaga.

Speech Therapy

Speech therapy visits and exercises can help those who have difficulty speaking.

Prior authorization needed except for  physical, occupational,  or speech therapy.

Text4baby

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

You'll get text messages 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 you recover from a serious injury or illness, or simply reach your full potential.

Our plan provides:

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

Unlimited Doctor Visits

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

Urgent Care

You may have an injury or sudden illness that is not life-threatening but needs immediate attention. So our plan covers care at:

  • Mga center ng agarang pangangalaga.
  • Medical aid units.
  • Other walk-in clinics.

Mga Pagpapatingin Habang Walang Sakit

Well visits with your doctor are important for good health. 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.

There are no copayments for preventive care.

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Matuto Nang Higit Pa

Planong Pangkomunidad ng UnitedHealthcare na QUEST Integration Program

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