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UnitedHealthcare Community Plan - Heritage Health Expansion

Medicaid

The UnitedHealthcare Community Plan Heritage Health Expansion plan is for Nebraska adults, ages 19-64, who are not eligible for or already in Medicare, and meet income requirements. You can enjoy many benefits and services that we have to offer. We will partner with your doctors to give you the quality of care you deserve.

Heritage Health Expansion Benefits includes:

A comprehensive benefits package that includes ambulatory services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive, wellness and chronic disease management and other services such as long-term care, non-emergent transportation, and durable medical equipment. Also Includes Basic Benefits, plus dental and vision services and select over-the-counter medications. 

Health Risk Screening

A tool that has a few questions about your health that will help UnitedHealthcare Community Plan’s clinical care team will work with you to identify areas where you may want to focus on to maintain or improve your health as well assist you with area of social service needs.

Benefits & Features

Well and Sick Care

Get the care you and your children need to stay healthy — or to be at your best. That includes:

  • Unlimited PCP Visits. See your primary care provider (PCP) as needed.
  • Shots and Vaccines. Routine shots help protect against illness.
  • Nurse Hotline. Speak with a registered nurse 24/7.
  • Lab and X-rays. Lab tests, x-rays and diagnostic imaging are covered.
  • Therapy Services. Physical or other therapy to help you be your best.
  • Foot Care. We provide special care to keep your feet healthy.
  • Hospitalization. You pay nothing for care in a hospital.
  • Chiropractor Care. Limited chiropractic visits are covered.
  • Lead Screening. Can be done in the doctor’s office or local health department.
  • Prescriptions. Many preferred Brand and Genetic Prescriptions are covered.. Note: Heritage Health Adult Expansion Prime Coverage includes Over-the-Counter (OTC) medication. * Coverage rules apply. Learn more. 

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

  • Choice of Birth Centers. Pick from our large network of hospitals or Birthing Center.
  • Choice of Doctors. Find a doctor you trust for your pregnancy care.
  • Healthy First Steps®. Get extra support and rewards to keep you and your baby healthy.
  • Prenatal Visits. Care for you before your baby is born.
  • Text4baby. Text messages with helpful tips and reminders for you and your baby.. 
  • Community Baby Showers. Education on prenatal and postpartum care.
  • Electric Breast Pumps covered.

If you or a family member has special health care needs, you can count on us. Our plan will provide the extra care and services you need. Benefits include: 

  • Asthma, Allergy, Heart Failure, CAD, Depression, Diabetes and COPD Care. Exams, testing and supplies are covered.
  • Care Management. Get personal help managing health conditions.
  • Mental Health and Substance Use Services. Get caring help to meet your recovery goals.

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. Benefits include:

  • Equipment and Supplies. In-home medical and safety equipment are covered.
  • Home Health Care. Medical care in your home, if needed.
  • Skilled Nursing Facility. Brief stay at a skilled nursing facility while you recover from sickness or injury.

Sometimes you might need a little extra help using your health plan. For those times, you can rely on: 

  • Nurse Hotline℠. Speak with a registered nurse 24/7.
  • Member Services. Your benefit questions are answered Monday - Friday, 7:00 a.m. - 7:00 p.m. CT or 6:00 a.m. – 6:00 p.m. MT
  • Language Help. Connect to an interpreter through Member Services at no cost to you.
  • Quitting Tobacco. Enroll with the Nebraska Tobacco - Free Quit Line and ask your doctor about support to help you quit.

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.

Care Management

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.. 

Chiropractic Care

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.

Choice of Birth Center

Where you have your baby is an important choice. 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.

Choice of Doctor

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

Your PCP is your main doctor for:

  • Preventive care.
  • Treatment if you are sick or injured.
  • 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.

Dental Care

This service is provided by Medicaid and Long-Term Care. MCNA Dental is the Medicaid dental plan for the State of Nebraska. MCNA administers the dental benefits for eligible children and adults. MCNA Member Hotline: 1-844-351-6262, TTY (Hearing Impaired) 1-800-833-7352, or visit www.mcnane.net.

Diabetic Support

If you have diabetes, we'll help make life a little easier for you. 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.

Disease Management

If you have chronic or high-risk illnesses, our disease management services may help you. We provide support for:

  • Congestive heart failure.
  • Asthma.
  • HIV.
  • Chronic obstructive pulmonary disease (COPD).
  • Coronary artery disease.

Equipment and Supplies

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

Our plan covers medical equipment ordered by the doctor or care manager. This can include supplies like:

  • Oxygen tanks.
  • Hospital beds.
  • Wheelchairs or walkers. 

Foot Care

We provide the exams you need to help keep your feet in great shape. And if you have diabetes, good foot care can help prevent much more serious problems.

Our podiatry coverage includes:

  • Routine foot exams.
  • Tips about foot care and choosing the right shoes.
  • Information about nerve damage warning signs.

Healthy First Steps®

Build a healthy future for you and your baby and earn great rewards with Healthy First Steps. Our program will help you take the right steps to keep you and your baby healthy. 

We will help you:

  • Choose a pregnancy provider and a pediatrician (child’s doctor).
  • Schedule visits and exams and arrange rides to your visits.
  • Earn rewards for going to visits throughout your pregnancy and baby’s first 15 months of life.
  • Get supplies, including breast pumps for nursing moms.
  • Connect with community resources such as Women, Infants and Children (WIC) services.

Hearing Care

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

We cover:

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

Home Care

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

With approval, our plan covers:

  • In-home medical visit(s).
  • Medical equipment like hospital beds, walkers or wheelchairs.
  • Disposable medical supplies.

Hospitalization

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

Hospitalization coverage includes:

  • Nursing care.
  • Room and board.
  • Supplies and equipment.
  • Treatment and therapies.
  • Diagnostic tests and exams.

And after leaving hospital, we can provide transitional care services. We make sure you get follow-up care to continue healing at home.

Hospice Services

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

Lab and X-rays

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

  • Labs and testing.
  • X-rays, scans and other imaging.

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

Language Help

We get member materials to you in a language or format that makes it easier for you to understand. Our provider network includes many doctors who speak different languages. Our provider directory shows which languages doctors speak. Additionally, many of our Member Service Advocates speak multiple languages. When you call, we will be able to connect with our interpreter service which offers support in more than 240 languages. We assist with interpreter services, including American Sign Language.

If you have trouble hearing over the phone you can use a text telephone. This free service allows persons with hearing or speech disabilities to place and receive telephone calls. Call 711. Give them the number 1-800-641-1902, and they will connect you to us.

You can also get information in large print, Braille, or audio files.

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

Member Services Advocates

Managing your health care alone can be hard, especially if you are dealing with many health problems at the same time. If you need extra support to get and stay healthy, we can help. 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 a.m.–7:00 p.m. CT (6:00 a.m.–6:00 p.m. MT), Monday–Friday

 

Mental Health and Substance Use Services

Behavioral health is about how you feel and act. It is also called 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.

We cover:

Behavioral/Mental Health Services 

  • Individual, group, and family therapy 
  • Outpatient behavioral health services 
  • Inpatient behavioral health services 
  • Specialized behavioral health services for children with autism.
  • Behavioral health rehabilitation services

Substance Use Disorder Services 

  • Outpatient opioid (pain medication) treatment 
  • Residential treatment

Additional health resources can be found at myuhc.com/CommunityPlan. Find the balance, support, and care you need to live the healthiest life possible.

Behavioral Health Crisis Services

What if I have a behavioral health crisis?

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.

Emergency services are covered anywhere in the United States. If you think you have a life-threatening emergency, call 911 or go to the nearest hospital location where emergency providers can help you.

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

Crisis Services:

If you think you have an emergency, no matter where you are, call 911 or go to the nearest hospital location where emergency providers can help you. As soon as it is possible, please call your doctor or behavioral health provider to arrange for follow-up care after the emergency is over.

If you need to talk to someone, we are here for you. If you do not feel like it is time to call 911 but need help right away, you can call our Behavioral Health Crisis Hotline 24/7 at 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.

This includes in network services:

  • Visits to doctors
  • Treatments at hospitals and clinics.
  • Home medical equipment and supplies to help you be at your best.

Nurse Hotline

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: 

  • Listen to symptoms.
  • Help with self-care.
  • Advise you about getting care at a doctor visit or an urgent care center.
  • Help you know when to go to the emergency room.

Over-the-Counter (OTC) Medicines

UnitedHealthcare Community Plan also covers many Over-the-Counter (OTC) Medications that are on the state’s approved list. 

A provider must write you a prescription for the OTC medication you need. Then all you have to do is take your prescription and member ID card into any network pharmacy to fill the prescription. 

OTCs include: • Pain relievers. • Cough or cold medicine. • First-aid cream. • Contraceptives. • Acne medicine. For a complete list of covered OTCs, go to https://member.uhc.com/communityplan

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. With a 90-day supply, you won’t need to get a refill every month. 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 a.m.–7:00 p.m. CT (6:00 a.m.–6:00 p.m. MT), Monday–Friday

Prenatal Visits

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

All recommended prenatal clinical visits and tests are covered by our plan.

At these visits, the clinic will:

  • Make sure both you and your baby are healthy.
  • Explain what to expect at each stage of your pregnancy.
  • Answer your questions.

Quitting Tobacco

Most people know the bad health effects of smoking. And they know they need to quit. 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. 

Included are:

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

Shots and Vaccines

Routine shots help protect members and their family from illness. Our plan covers:

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

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.

Transportation

If you need a ride, your benefits include transportation. We cover trips for Nebraska Medicaid coverable services within a 20-mile radius of your home. These include: medical, mental health, dental and vision appointments along with trips to the pharmacy.

Following these simple rules will help you get a ride: 

  • Call 3+ business days ahead of time 
  • 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. 
  • Be specific about where you need a ride to 
  • 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).   
  • If your doctor gives you a prescription you can stop at the pharmacy to get it 
  • 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.

This service is for rides planned in advance. If you have a life-threatening emergency, call 911. An ambulance will be provided if you need to be sent to the hospital.

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.

Vision Care

You’ll get the care, eyeglasses and treatment that let you see life more clearly. Coverage includes:

  • 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.

Well Visits

These visits can catch health problems early, so they can be treated.

Preventive services :

  • Checkups for adults and children.
  • Well-baby care.
  • Care for women expecting a baby.
  • Routine shots and tests.
  • Mammograms.

Member Resources

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