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Child Health Plus
The New York State Child Health Plus program offered through UnitedHealthcare is simply great health care coverage. It's for children and young adults up to age 19 who are residents of the State of New York and are not eligible for Medicaid or enrollment in or access to NYSHIP. View the list of benefits below to see all that our plan covers.
This plan is available in the following counties:
Albany, Bronx, Broome, Cayuga, Chautauqua, Chemung, Chenango, Clinton, Columbia, Dutchess, Erie, Essex, Fulton, Genesee, Herkimer, Jefferson, Kings, Lewis, Madison, Monroe, Nassau, New York, Niagara, Oneida, Onondaga, Ontario, Orange, Oswego, Queens, Rensselaer, Richmond, Rockland, Seneca, St. Lawrence, Suffolk, Tioga, Ulster, Warren, Wayne, and Westchester.
Child Health Plus
After December 31, 2013, you can no longer apply for Family Health Plus. Throughout 2014, existing Family Health Plus members will be asked to complete a renewal form that includes information on your household income, your age and residency, and status of other insurance. This is called the renewal or recertification process. New York State has to collect this information to determine if you are still eligible for New York State sponsored health insurance. Prior to your renewal date, you will receive a letter from New York State Department of Health with instructions of what you need to do.
It is very important that you complete your renewal and return it promptly to keep your coverage active. UnitedHealthcare Community Plan will send you a reminder when it’s time to renew. In some counties, you can renew by telephone by calling the New York State of Health Enrollment Center. Keeping your healthcare coverage active is an important part of staying healthy.
Find providers and coverage for this plan.
Search for doctors, hospitals and specialists.
Find medications covered by this plan.
Find a pharmacy near you.
Find a dentist near you.
Benefits & Features
Asthma and COPD Care
Does your child have asthma or respiratory allergies? If so, you are on watch for a breathing emergency.
Your child can be assigned a nurse with special knowledge of childhood breathing problems. Your child's nurse will:
- Get to know your child.
- Learn his or her triggers and activities.
- Develop a customized treatment plan.
So your child may have:
- Reduced symptoms.
- Less need for emergency care.
Does your child have a serious health problem? If so, and your child qualifies, we offer case managers that can:
- Explain medical terms in plain language.
- Coordinate your child's doctor appointments.
- Provide your care team with your child's medical records.
Your case manager will stay with your child throughout the medical journey. He or she will:
- Think beyond your child's medical needs.
- Make sure you have support at home.
So your child can focus on getting better.
Choice of Doctor
Your child gets a primary care physician (PCP), who is his or her main doctor. Use the Doctor Lookup tool to see if your child's doctor is in our network.
If your child doesn't have a doctor or if this doctor is not in our network, we can help you find a new one close to you.
Your PCP is your main doctor for:
- Preventive care.
- Treatment if you are sick or injured.
- Referrals to specialists for certain conditions.
Your child can see a specialist without a referral.
Checkups and emergency care are covered.
Exams and cleanings every six months help your child develop strong and healthy teeth and gums. If there is a dental problem that needs to be fixed, that's covered as well.
If your child has diabetes, you may need insulin, needles, wipes and glucose strips.
Our plan also steps up with services to help you manage your child's diabetes, including:
- Classes on keeping diabetes in control.
- Coordinating doctor care.
- Nutrition and diet.
Durable Medical Equipment
Your child's health and safety at home are important.
Our plan covers medical equipment ordered by your doctor or case manager for your child. This can include supplies like:
- Diabetic supplies.
- Hospital beds.
- Wheelchairs or walkers.
A loss can take many different forms. And you may get lots of suggestions on how to help your child. Grieving is part of the healing process.
If a recent loss has made your child sad or unhappy, help is available. Our plan offers counseling and support to your child during the grieving process. Our team will work with you to find a counselor or program to help your child adjust to the loss.
Trouble hearing can affect your child's everyday life in many ways. Our plan includes services and support to help protect your child's hearing.
Our plan covers:
- Exams, therapy and tests.
- Hearing aids.
This plan pays for all your child's expenses related to a hospital stay.
Hospitalization coverage includes:
- Nursing care.
- Room and board.
- Supplies and equipment.
- Treatment and therapies.
- Diagnostic tests and exams.
And after your child leaves the hospital, we watch over his or her care. We make sure your child gets follow-up care to continue healing at home.
In Home Care
After surgery or a serious illness your child may need extra care and services to recover. This may include an in-home medical visit to check on how well your child is healing.
With approval, our plan covers:
- Medical equipment like hospital beds, walkers or wheelchairs.
- Disposable medical supplies.
- In-home medical visit
There are no copays for covered drugs.
We also cover over-the-counter medicines with a written order from your child's doctor.
And we make getting your child's medicine easy. You can fill his or her prescriptions at:
- Local pharmacies.
- Services that deliver right to your door.
Sometimes you might need a little help understanding your health care options. With us, you have someone you can call Monday – Friday 8 a.m. – 6 p.m. EST. We’ll answer your questions simply and completely.
We can also help you find:
- Home care providers.
- Dentists and vision providers.
- Adult day health centers.
Mental health is as important as physical health. That's why we have coverage for both.
Required care is 100% covered with no copay. This includes:
- Behavioral therapy.
- Substance abuse treatment.
You will not have a copayment for your child's care and services covered by our plan.
That means you will pay nothing for covered services, including:
- Preventive care.
- Annual checkups.
- Prescription drugs covered by the plan.
- Routine dental or vision care.
Your child may need continued care after leaving the hospital or urgent care.
If your child's health is at risk after a serious illness, surgery or injury, a nurse will visit your child to:
- Provide medical care for your child.
- Answer your questions and concerns.
Healthy eating goes a long way to helping your child grow and stay at his or her best. A nutritionist can meet with you to review your child's eating habits and food choices.
You'll come away with new ideas to:
- Making good choices for quick meals and snacks.
- Preparing healthy meals on a budget.
Knowing what's wrong and finding it early can make all the difference for your child.
Our plan covers:
- Labs and testing.
- X-rays, scans and other imaging.
We'll help you get the information needed to help improve your child be his or her best.
Caring for a child with special health needs is an act of love.
It can also be physically and emotionally exhausting. We can provide respite care to give you a rest.
Shots and Immunizations
Routine shots help keep your child healthy.
So, our plan covers:
- Recommended shots and vaccines.
- Diagnostic tests and exams.
See life more clearly with routine eye exams and glasses, if needed.
We also include:
- Prescription lenses.
- Medicaid approved frames.
- New eyeglasses every two years.
This benefit is offered by March Vision Care.
Well Child Visits
Well visits with your doctor can help your child stay healthy. These visits can catch health problems early, so they can be treated.
Preventive services include:
- Annual checkups for children.
- Well-baby care.
- Routine shots and tests.
There are no copayments for preventive care.
When you join as a new member, UnitedHealthcare wants you to become familiar with all the benefits and resources available to you as a member. This welcome letter provides a brief overview of the plan and what to expect as a UnitedHealthcare member.
Getting Started Guide
As a member, we want to provide you with all the resources and information you need. This useful guide provides a quick resource for getting started, finding help, your benefits, how to connect, getting care and so much more.
Child Health Plus Member Handbook
Child Health Plus Member Subscriber
Renewing Your Coverage
Every year, members enrolled in a New York State sponsored health insurance programs must renew their health care coverage. This process is called annual recertification or renewal of health care coverage.
Make sure to maintain your UnitedHealthcare Community Plan Coverage.
UnitedHealthcare cares about you. Our mission is to help people live healthier lives. To stay a UnitedHealthcare member, you have to renew your Medicaid coverage. Call us at 1-800-493-4647, TTY 711, or visit one of our office locations, and we will be happy to help you with questions about renewing your coverage
Assignment of Benefits Form
Find a Provider
There are many ways to choose a health care provider. It is important to find providers who are a good fit for you. Ideas include:
- Talk to a friend or family member about who they see.
- Call the provider office and ask questions.
- Choose based on where the office is located.
- View a list of providers that accept your health plan
Wewant you to feel good about the quality of the providers you choose. Health care providers include:
- Primary Medical Providers (PMPs)
- Behavioral health providers
- Eye doctors
- Urgent care clinics
- Medical equipment companies
Of course, you can also call your Member Services Advocate at 1-800-493-4647. We will help you make the choice that’s right for you.
NY Medicaid Member Notification PCP Referral Letter
Specialty Referral Requirements
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: 1-877-597-7801, TTY 711.
Our nurses will:
- Listen to your symptoms
- Help with self-care
- Advise if you can get care at your next doctor visit or need an urgent care center
- Help you know when it is time to go to the emergency room
UnitedHealthcare Mobile App
It’s designed for people on the go and includes many of the same features as the member website. Find it at the App Store or Google Play.
Preventative Care, Wellness and Health Conditions Guides
Getting to the doctor when you are healthy is important. We have guides to help you know what to expect at each well visit. You can also talk to your Member Services Advocate for support and information.
We also have helpful guides for most health problems and conditions. You can also talk to your Member Services Advocate for support and information.
Our educational materials can be found on https://member.uhc.com/communityplan.
You will find condition-specific and general health topics, including:
- Physical Health
- Children's Health
- Chronic Pain
Information about Enterovirus D68
Health Tips Flyer
National Flu Campaign Questions and Answers
Flu Shot Reminder
UnitedHealthcare Community Plan members are not responsible for payment for any covered services. Some services may have small co-payments, which can be waived if you cannot afford them.
You should not pay out-of-pocket upfront for any services. There are no out-of-network benefits except in a few cases. A surprise medical bill certification form may be required at those times. See your member handbook for times when you can go to an out-of-network provider. Reimbursement is not guaranteed.
If you have received a bill for covered services or need help fining a participating provider, please call us at 1-800-493-4647, TTY 711 for assistance.
Emergency Services and "Surprise" Bills
Information on Emergency Services and "Surprise" Bills
Notices and Bulletins
Specialty Referral Requirements
New York Independent Assessor MMC Guidance and Member Notice
Clinical Practice Guidelines
UnitedHealthcare Community Plan has practice guidelines that help providers make healthcare decisions. These guidelines come from nationally recognized sources. UnitedHealthcare Community Plan has practice guidelines for preventive health and other health conditions.
Call our Member Services at 1-800-493-4647 (TTY: 711) to request a printed copy.
Member Newsletters 2016 - Current
Member Newsletters Prior to 2016
Behavioral health is about how you feel and act. It is also called mental health. Your mental health is very important. The UnitedHealthcare Community Plan of New York includes mental health and substance use disorder services. You or your provider can call Optum Behavioral Health anytime for help at 1-844-206-1399.
Covered services include:
- All inpatient mental health and substance use disorder services (including alcohol and substance use disorder).
- Most outpatient mental health services (contact plan for specifics).
- Medicaid recipients who receive SSI or who are certified blind or disabled get mental health and substance use disorder services from any Medicaid provider by using their Medicaid Benefit Card.
- Detoxification services are covered by UnitedHealthcare Community Plan as a benefit.
Social Needs & Community Services
Being healthy is not always about your urgent medical needs. Sometimes you may need help connecting to resources out in the community. We call these social needs. These are things like housing, getting food every day or feeling safe. We can also help you with finishing your education. You can call your Member Services Advocate for more information. Or you can visit findhelp.org
We also offer special programs that include:
- Low-cost internet service at home
- Free phone service through SafeLink/TracFone Wireless
- Money back if you use alternative medicine, such as home herbal remedies, vitamins, acupuncture or therapeutic massage
- On My Way online program that guides and supports teens as they start their journey to independence and adulthood
Advance directives are instructions you give about your future medical care in case there is a time you can’t speak or make decisions for yourself. They help your family and physician understand your wishes.
With advance directives, you can:
- Let your doctor know if you would or would not like to use life-support machines
- Let your doctor know if you would like to be an organ donor
- Give someone else permission to say “yes” or “no” to your medical treatments
Advance directives are only used if you can’t speak for yourself. It does not take away your right to make a different choice if you later become able to speak for yourself.
You can make an advance directive by:
- Talking to your doctor and family
- Choosing someone to speak or decide for you, known as a health care representative
- Creating a Power of Attorney and/or Living Will
You can look at advance directive and health care proxy forms here:
UnitedHealthcare Community Plan provides member materials to you in a language or format that makes it easier for you to understand. Our provider network includes many doctors who are multilingual.
Our provider directory shows which languages doctors speak. Additionally, many of our Member Services Advocates speak multiple languages, so when you call they will be able to help you or connect you with our interpreter service which covers more than 170 languages.
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 Member Services number, 1-800-493-4647, and they will connect you to us.
You can also get information in large print, Braille or audio files on a CD. We can also assist with interpreter services, including American Sign Language. To ask for help, please call us Monday through Friday, 8 am to 6 pm EST.
Our toll-free Member Services number is 1-800-493-4647, TTY: 711.
Your Rights and Responsibilities
We want to hear from our members about any questions, complaints or concerns you may have. If you have a grievance, please call Member Services toll-free, at 1-800-493-4647, TTY 711.
If you are not happy with the response from your Member Services Advocate, Care Manager or Member Services, you may file a grievance. You may file a complaint or grievance against us (the health plan) or a provider with us at any time.
Members may file a grievance verbally with their Member Services Advocate from 8 am to 6 pm EST, Monday through Friday, at 1-800-493-4647, TTY 711. All members can file a grievance through this process.
You have other rights that include appeals and a State Fair Hearing. For detailed information about complaints and appeals, contact Member Services or view the Appeals and Grievances section of the Member Handbook.
Fraud, Waste and Abuse
Fraud, waste and abuse are serious problems. There can be penalties under law. To make a report, call the UHC Fraud Hotline at 1-844-359-7736. You can also call Member Services at 1-800-493-4647. We will not use your name in your report. You will not get in trouble for reporting this. We will look into the matter for you.
More information about fraud, waste or abuse, or to make a report online.
Medicaid Managed Care