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UnitedHealthcare Community Plan

Medicaid

UnitedHealthcare Community Plan of Ohio

Our Ohio Medicaid plan covers eligible families, pregnant women of any age, infants, children and young adults. The plan also offers extra support and care to adults and children with a disability, long-term illness or special health care needs. Members can choose a primary care doctor from our network. Plus get access to a 24/7 nurse advice hotline, health education materials and extras that other plans don't offer. View the benefits below to see all that it offers.

More information on eligibility and enrollment can be found on the Ohio Medicaid website, or by calling the Medicaid Hotline at 1-800-324-8680, TTY users should call Ohio Relay at 7-1-1.

OhioRISE

Ohio Resilience through Integrated Systems and Excellence (OhioRISE) program is a managed care program for youth with behavioral health needs. OhioRISE increases access to in-home and community-based services to ensure OhioRISE members and families have help with systems such as juvenile justice, child protection, developmental disabilities, mental health and addiction, education, and others.

An individual who is enrolled in the OhioRISE program will also keep their managed care enrollment for the physical health benefit. To be eligible for OhioRise, you must be: enrolled in Ohio Medicaid, under the age of 21 and meet a functional needs threshold for behavioral health care, as identified by the Child and Adolescent Needs and Strengths (CANS) assessment. 

Beginning November 1, Ohio Medicaid managed care members will be able to select their plan by calling the Ohio Medicaid Consumer Hotline at 1-866-693-0898 or utilizing the Ohio Medicaid Consumer Hotline Member Portal at https://members.ohiomh.com/Login.aspx. You do not have to do anything if you want to keep your current Medicaid Managed Care Plan.

Visit the Ohio Medicaid Consumer Hotline website at www.ohiomh.com for information.

After you receive your renewal form from the Ohio Department of Medicaid (ODM) you will need to take a few steps to keep UnitedHealthcare as your health insurance company.

Click here to learn how to renew your Medicaid coverage.

Mga Benepisyo at Feature

For OhioRISE, please refer to the OhioRISE handbook

Pangangalaga Habang Walang Sakit at Kapag May Sakit

Get the care you need to get better if you are injured or sick — or to reach your full potential. Kabilang sa mga benepisyo ang:

  • NurseLine. Speak with a registered nurse 24/7.
  • No Copays. You pay nothing for your care or services.
  • Medicines. Fill your prescriptions, including over the counter drugs at local pharmacies.
  • Therapy Services. Physical or other therapy to recover and heal.
  • Chiropractor Services. We provide up to 15 chiropractic visit per year.
  • Well Visits. Annual checkups can help keep you healthy.
  • Urgent Care. Convenient care for a sudden illness or injury.

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

  • Choice of Doctors and Birthing Center. Find a doctor and hospital 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. Get helpful tips and links to free health and wellness items for you and your baby.
  • Wellhop for Mom & Baby. Connect with a community of moms. Get support and information as you welcome your baby.

If you have asthma, diabetes or another chronic condition, you can depend on us. Tinitiyak ng aming plano na nakukuha mo ang pangangalaga, suporta at mga serbisyong kailangan mo. Kabilang sa mga benepisyo ang:

  • Mental Health and Substance Abuse Services. With prior approval counseling and other treatments are covered.
  • Care Management. Personal support from an experienced professional.
  • Asthma Care. Exams, testing and supplies are covered for asthma and other lung diseases.
  • Kidney Disease Care. Dialysis, medicine and treatments are covered.
  • Obesity Care. We cover screenings and counseling for obesity.

We help members keep their vision, smile and hearing at their best. Kabilang sa mga benepisyo ang:

  • Vision. Covers exams, glasses or $150 toward contact lenses.
  • Dental. We pay for cleanings, checkups and some dental work.
  • Hearing. Tests, checkups and with prior approval hearing aids are provided.

Earning a reward for taking care of yourself or your child is easy. The following programs offer incentives:

  • Healthy First Steps®  -  Earn $20 for signing up. Our program will help keep you and your baby healthy. 
  • Healthy Rewards -  Earn gifts for you or your child with preventive care.  

You get the medical care and equipment needed to live safely at home. Kabilang sa mga benepisyo ang:

  • Equipment and Supplies. With prior approval, in-home medical and safety equipment are covered.
  • Nurse Visits. Medical care to help with a safe recovery at home.
  • Respite Care. In-home help to give caregivers taking care of children under age 21 a rest.
  • Care Coordinator. Someone to get you the services you need after surgery or illness.
  • Home Health Care. With prior approval, medical and personal care in your home, if needed.

Sometimes members need a little extra help using their health plan. For those times, they can rely on:

  • Transportation. We pay for up to 30 one way or 15 round trip rides to medical visits or the pharmacy.
  • Language Help. Connect to a translator through Member Services.
  • Member Services. Someone to help you get the most from your plan.
  • Quitting Tobacco. Coaches and supplies to help quit using tobacco.
  • My Advocate. We help members connect to community services.
  • Healthy Rewards. Earn up to $100 in credits for completing healthy activities.
  • Mileage Reimbursement. Mileage reimbursement is now available for those members or their representative that would prefer to use their own vehicle for trips to medical appointments. Members must call for trips in 5 days in advance.

Asthma and COPD Care

Individual care to help control asthma or COPD symptoms.

Some members may have trouble managing asthma or COPD symptoms. For them, a nurse who specializes in breathing issues can really help. They get a customized treatment plan and medicine to:

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

Pamamahala sa pangangalaga

Members who need extra help get a Personal Care Manager. The care manager is there for you throughout your medical journey. He or she will:

  • Work with you to develop a plan of care that meets your individual needs.
  • Coordinate with family members, caregivers and health care providers.
  • Help get additional services or support you may need.

Mga serbisyo ng chiropractic

Our plan includes visits for chiropractic care.

  • Members of all ages can get up to 15 visits per year.
  • Members under 21 may get additional visits with prior authorization.

Pagpili ng Doktor

From regular checkups to preventive health screenings, we want to make sure you get access to the right care at the right time.

You get a primary care physician (PCP), who is your main doctor. 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.

Pagpili ng Birth Center

Where a mother has her baby is an important choice. That's why pregnant moms can pick from hundreds of hospitals across Ohio.

We encourage mothers-to-be to tour the hospital's birthing center. This way they will be familiar with it. And be more relaxed when they have their baby.

Pangangalaga sa Ngipin

Checkups and cleanings are covered.

Exams and cleanings every six months help keep teeth and gums strong and healthy. If you obtain prior approval for a dental problem that needs to be fixed, that's covered as well.

Employment Physicals

Some employers or training programs require a physical before a person can start work. Our plan covers pre-employment physical exams.

Mga Kagamitan at Supply

The health and safety of our members at home are important.

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

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

For some of these services prior approval is required. Please check your member handbook for these details.

Pangangalaga sa Paa

We provide the exams and treatments needed to help keep your 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.

Pangangalaga sa Pandinig

Trouble hearing can affect a person's everyday life in many ways. Kabilang sa aming plano ang mga serbisyo at suporta para matulungang protektahan ang iyong pandinig.

Sinasalo namin ang:

  • Mga eksaminasyon, therapy, at test.
  • With prior approval, hearing aids and batteries.

Healthchek

Healthchek covers medical exams, immunizations (shots), health education, and laboratory tests for Medicaid eligible individuals under the age of 21. Healthchek also covers medical, vision, dental, hearing, nutritional, developmental, and behavioral health exams, in addition to other care to treat physical, behavioral or other problems or conditions found by an exam. Learn more information about Healthchek. 

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).

Mga Reward sa Kalusugan

Mas madaling mapigilan ang sakit kaysa gamutin ito. Puwede rin itong maging magagandang reward.

Earn great gifts for you or your child by doing things like:

  • Pagkumpleto ng mga well-child na eksaminasyon.
  • Getting lab tests.
  • Recording the family's health activities.

Pangangalagang Pangkalusugan sa Tahanan

If you are living with a long-term health condition, disability or leaving the hospital after surgery or a serious illness, you may need extra support. This can include help with day-to-day tasks like cleaning, cooking or dressing. Posibleng kailanganin mo rin ng medikal na pagbisita sa bahay para matingnan kung maaayos ba ang paggaling mo.

Kapag naaprubahan, sakop ng aming plano ang:

  • Isang medikal na pagbisita sa bahay.
  • Medikal na kagamitan tulad ng mga kama sa ospital, walker o wheelchair.
  • Mga disposable na medical supply.
  • Tulong sa personal na pangangalaga o housekeeping.

Pagkakaospital

This plan pays for all medically necessary expenses related to a hospital stay. Sa paraang ito, makakapagpahinga ka at gagaling.

Sakop ng aming plano 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 the hospital, you are not alone. Titiyakin naming makakakuha ka ng follow-up na pangangalaga para maipagpatuloy ang pagpapagaling sa tahanan.

Pangangalaga para sa Sakit sa Kidney

Malubhang medikal na kondisyon ang sakit sa kidney. After the kidneys stop working regular treatments, called renal dialysis, or an organ transplant are needed to live. Ang dialysis ay gumagamit ng makina para linisin ang dugo tulad ng ginagawa ng malulusog na bato.

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. With prior approval, our plan covers:

  • 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.

Tulong sa Wika

You can receive information in your preferred language. Magtanong lang. We also have people at our service centers who speak more than one language. Sa malamang, mayroon kaming taong nagsasalita ng wika mo.

Mga Gamot

Our plan includes prescription drugs and refills for prescriptions written by your doctor or specialist. Thousands of drugs are covered.

You pay a co-pay amount, if needed, and you can get your prescription drugs at any in-network pharmacy.

Member Services Representative

Meet your personal health plan assistant. Our job is to help you get the most of your benefits. Pwede ka naming tulungan na:

  • Schedule doctor, dental and vision appointments.
  • Arrange for extra support services.
  • Complete a health risk assessment.
  • Stay in touch with you.

Mental Health and Substance Abuse Services

Get help with personal problems that may affect your mental or physical health. These may include stress, depression, anxiety or drugs and alcohol abuse. Our services also include:

  • Therapy
  • Counseling
  • Mga Gamot

For some of these services prior approval is required. Mangyaring makipag-ugnayan sa mga Serbisyo sa Miyembro para matuto pa.

No Copays

With our plan there are no copayments for covered services.

Members get:

  • Care from highly skilled and compassionate doctors.
  • Treatments at respected hospitals and clinics.
  • Home medical equipment and supplies to help them be their best.

NurseLine

Dumarating ang mga medikal na tanong at sitwasyon sa mga hindi magandang pagkakataon. For questions about health, call a nurse 24/7. Call:  1-866-801-4407, TTY 711.

Our NurseLine nurses will:

  • Tutukuyin ang mga sintomas.
  • Provide guidance on self-care.
  • Advise the member about getting care at a doctor visit or an urgent care center.
  • Help know when to go to the emergency room.

Obesity Care

Obesity is common and serious. It can also lead to other health problems. To help our members be their best, our plan includes:

  • Screening for obesity.
  • Counseling for obesity.

Mga Pagpapatingin Habang Nagbubuntis

Ang pagbubuntis ay isang hindi kapani-paniwalang karanasan. It's a journey the new mother wants 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 mother and baby are healthy.
  • Explain what to expect at each stage of the pregnancy.
  • Answer any questions.

Residential Care

After a serious illness, surgery or injury, you may need extra nursing and therapy.

With prior approval, our plan covers short stays in a rehabilitation center 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.

Call Member Services for information on available providers.

Respite na Pangangalaga

Caring for a child recovering from an illness, surgery or with special health needs is an act of love. It can also be physically and emotionally exhausting. This service is for SSI members under 21 years of age.

Paghinto sa Paninigarilyo

Alam ng karamihan ng mga tao ang masasamang epekto ng paninigarilyo. At alam nilang kailangan nilang huminto. We support our members with coaching while they quit. Sinusuportahan namin ang aming mga miyembro sa paghinto nila, sa pamamagitan ng mga coach at supply. The only thing they won't get from us is a lecture.

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.

With prior approvals, our plan covers visits for:

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

Transportasyon

Our plan provides up to 30 one way or 15 round trip rides to medical appointments and other needed services. Call 1-800-895-2017 (TTY 711) to schedule a ride. You must call at least 48 hours ahead of time..  

Rides are available to:

  • Dental and vision appointments.
  • Mga parmasya.
  • Women, infants and children (WIC) visits.
  • Job and Family Services offices for benefits redetermination.

UnitedHealthcare OMW™

UnitedHealthcare On My Way™ is an engaging, interactive program that informs Ohio youth and helps prepare them for many real-world situations that lie ahead. UnitedHealthcare OMW™ teaches the practical skills of managing bank accounts, securing housing, creating a resume, finding job training and applying for college. It is a reliable, go-to resource they can use throughout their journey toward independent living.

Agarang Pangangalaga

Posibleng mayroon kang injury o biglaang sakit na hindi nakamamatay pero kailangan ng agarang atensyon. Sakop ng aming plano ang pangangalaga sa:

  • Mga center ng agarang pangangalaga.
  • Federally qualified health centers.
  • Iba pang walk-in na klinika.

Pangangalaga sa Paningin

You'll get the care, eyeglasses and treatment that let you see life more clearly.

Kabilang sa mga benepisyo ang:

  • Annual eye exams.
  • Glasses and $150 toward contact lenses.

You also can chose from an expanded selection of frames.

This benefit is offered by March Vision.

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.

Walang copayment para sa pangangalagang pang-iwas sa sakit.

Wellhop for Mom & Baby

Connect with other expectant moms. Get support and information during your pregnancy and after you deliver. This program is part of your health plan and there is no extra cost to you.

Here’s how it works:

  • Join video conversations every other week with women who have similar due dates and a group leader.
  • Chat and share experiences with moms from your group on the Wellhop app or website.
  • Visit the Wellhop library. You’ll find articles, videos and more.

Mga Resource ng Miyembro

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