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Don't lose benefits
Your health plan renewal date may be coming soon. If you haven’t already, you may need to recertify to keep getting UnitedHealthcare coverage.
Need help finding a provider or setting up a visit?
MCO’s have received communication from HHSC that as of January 2023 some types of assessments will require a face-to-face visit. This means a United Healthcare staff member will need to visit with you in your place of residency.
Please be advised that missing your assessment could impact your services or eligibility. If you have questions, please contact your Service Coordinator or Member Services.
At UnitedHealthcare Community Plan, we understand that the health care system can be complex and confusing. We know it can be especially stressful when your health care plan changes. UnitedHealthcare Community Plan will be with you every step of the way.
We want to make sure our members have access to the quality care they need and deserve. Our large network includes the doctors you already know and trust. That’s what you can count on with UnitedHealthcare Community Plan. View the list below to see what STAR Kids includes.
Language and Interpreter Services
UnitedHealthcare Community Plan has staff that speaks English and Spanish. If you speak another language or are hearing impaired and need help, call Member Services at 1-877-597-7799 or TTY 711 for hearing impaired.
If you need materials in audio, Braille, larger print and in other languages at your request. Please call 1-877-597-7799 for help.
This plan is available in the following counties:
Anderson, Angelina, Austin, Bell, Blanco, Bosque, Bowie, Brazoria, Brazos, Burleson, Cameron, Camp, Cass, Chambers, Cherokee, Colorado, Comanche, Cooke, Coryell, DeWitt, Delta, Duval, Erath, Falls, Fannin, Fort Bend, Franklin, Freestone, Galveston, Gillespie, Gonzales, Grayson, Gregg, Grimes, Hamilton, Hardin, Harris, Harrison, Henderson, Hidalgo, Hill, Hopkins, Houston, Jackson, Jasper, Jefferson, Jim Hogg, Lamar, Lampasas, Lavaca, Leon, Liberty, Limestone, Llano, Madison, Marion, Matagorda, Maverick, McLennan, McMullen, Milam, Mills, Montague, Montgomery, Morris, Nacogdoches, Newton, Orange, Panola, Polk, Rains, Red River, Robertson, Rusk, Sabine, San Augustine, San Jacinto, San Saba, Shelby, Smith, Somervell, Starr, Titus, Trinity, Tyler, Upshur, Van Zandt, Walker, Waller, Washington, Webb, Wharton, Willacy, Wood, and Zapata.
The State of Texas determines eligibility for this plan. In general terms, eligibility is limited to those who are unable to pay for medically necessary services and who meet certain eligibility requirements.
If you lose your Medicaid eligibility you cannot receive care or services under STAR. If you lose Medicaid eligibility but become eligible again within 6 months, you will automatically be re-enrolled with STAR and have the same PCP you had before, unless he or she is no longer a part of STAR.
More information on Eligibility and Enrollment can be found on Texas Health and Human Services Commission website.
Find providers and coverage for this plan.
Search for doctors, hospitals and specialists.
Find medications covered by this plan.
Find a pharmacy near you.
Benefits & Features
Asthma and COPD Care
One hypoallergenic mattress cover and one hypoallergenic pillowcase for qualifying members with a diagnosis of severe asthma.
Does your child 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.
Your case manager will stay with you on your child's medical journey. He or she will:
- Think beyond your medical needs.
- Make sure you have support at home.
So you can focus on helping your child get 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 their 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 your child is sick or injured.
- Referrals to specialists for certain conditions.
Checkups, routine and emergency care are covered.
Exams and cleanings every six months help keep teeth and gums strong and healthy. If there is a dental problem that needs to be fixed, that's covered as well.
Equipment and Supplies
Our plan covers medical equipment ordered by your doctor or case manager. This includes:
- Hospital bed.
- Oxygen tank.
- Walker or wheelchair.
Sports and school physicals at no cost to you.
Our plan covers up to two free physicals each year so your child can:
- Go to camp.
- Join a team.
- Play a school sport.
This plan pays for all expenses related to a hospital stay, so your child can rest and heal.
- Nursing care.
- Room and board.
- Supplies and equipment.
- Treatment and therapies.
- Diagnostic tests and exams.
After your child leaves the hospital, you are not alone. We make sure your child gets follow-up care to continue healing at home.
Your child's 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 child's appointment.
We have people at our phone centers that speak more than one language. A service lets us connects with others that speak hundreds of languages.
You can ask to receive information in another language. Then anything we write to you will only be in that language. This is provided at no cost to you.
We make getting your child's medicine easy.
There are no copays for covered drugs. You can fill your child's prescriptions at:
- Local pharmacies.
- Services that deliver routinely right to your door.
We also cover over-the-counter medicines with a written order from your child's doctor.
Sometimes you might need a little help understanding your child's health care options. With us, you have someone you can call 24/7. We'll answer your questions simply and completely.
We can also help you find:
- Home care providers.
- Dentists and vision providers.
Mental health is as important as physical health. That's why we have the same coverage for both.
Required care is 100% covered with no copay. This includes:
- Behavioral therapy.
You pay nothing for covered services.
While your health care is low-cost or free, the care quality is high. You get:
- Care from highly skilled and compassionate doctors.
- Treatments at respected hospitals and clinics.
- Home medical equipment and supplies to help your child be at his or her best.
Medical questions and situations come at inconvenient times. When you have questions about your health or your child's health, you can call a trained nurse 24 hours a day, 7 days a week.
Our Nurse Hotline nurses will:
- Listen to the symptoms.
- Guide you on self-care.
- Advise you about getting care at a doctor visit or an urgent care center.
- Suggest you go right to the emergency department.
If needed, we provide someone to help with:
We provide respite care to give caregivers a rest. Respite care offers caregivers time away from their loved one who has special care needs to run errands or just relax.
Every STAR Kids member gets a service coordinator. Your child’s service coordinator will visit with your family in person to go over your child’s health care needs. At these visits you will talk about the services your child is getting and other services your child may need.
Together you will create a care plan that works best for your family. Your care plan may include:
- Acute medical services.
- Behavioral health services.
- Primary care services.
- Special care services.
- Value-added services.
Your service coordinator can also help you.
- Arrange care with your primary care provider and with specialists.
- Connect your family with community programs and additional services.
- Answer questions about benefits.
- Help coordinate benefits with other providers.
What is a Transition Specialist? What will a Transition Specialist do for me?
For children with special health care needs, the transition to adulthood often brings many changes. A Transition Specialist can help you understand and plan for these changes. All STAR Kids members have access to a Transition Specialist.
How can I talk to a Transition Specialist?
If you want to speak with a Transition Specialist or have a Transition Specialist as part of your Care Team, let your Service Coordinator know and he or she can help you.
Whether you live in the city or in the country, rides are available. Our plan provides up to round trips to and from plan locations. This includes trips to and from the pharmacy to fill your prescriptions.
Vaccines and Immunizations
All of the immunizations your child needs are covered.
Your child can get the care, eyeglasses and treatment that lets him or her see life more clearly. Coverage includes $105 each year toward frames or contact lenses.
This benefit is offered by certain stores and retailers.
Toll Free Numbers
Information and Interpreters are available in many languages from 8 a.m. to 8 p.m. Monday through Friday. . . . .1-800-256-6533
After hours and weekends, please contact Nurse Hotline. Se habla Español.
TDD/TTY (for hearing impaired). . . . . . . . . . . . . .711
Nurse Hotline (Available 24 hours a day, 7 days a week) . . . .1-844-222-7323
Call 9-1-1 or go to the nearest hospital or emergency facility if you think you need emergency care. We have free interpreter services for people who do not speak English.
This call is free.
8 a.m. to 8 p.m. Central Time, Monday – Friday.
After hours, please call our Nurse Hotline at 1-844-222-7323.
UnitedHealthcare Community Plan
14141 Southwest Freeway, Suite 800
Sugar Land, TX 77478
What to Do in an Emergency
Call 911 or go to the nearest hospital/emergency facility if you think you need emergency care. You can call 911 for help in getting to the hospital emergency room. If you receive emergency services, call your doctor to schedule a follow up visit as soon as possible. Please call us and let us know of the emergency care you received. An emergency is a condition in which you think you have a serious medical condition, or not getting medical care right away will be a threat to your life, limb or sight.
Behavioral Health and Substance Abouse Services
You should call 911 if you are having a life-threatening behavioral health or substance abuse emergency. You can also go to a crisis center or the nearest emergency room.
Optum Behavioral Health
- Available 24 hours, 7 days a week.
- Interpreter services available.
- Se Habla Español.
External Medical Review
Fill out the ‘State Fair Hearing and External Medical Review Request Form’ that came with the Member Notice of MCO Internal Appeal Decision letter and mail or fax it to
UnitedHealthcare Community Plan
Attn: Fair Hearings Coordinator
14141 Southwest Freeway, Suite 500
Sugar Land, TX 77478
- Call UnitedHealthcare at 1-800-288-2160
- Email UnitedHealthcare at firstname.lastname@example.org
State Fair Hearing Contact Information
To ask for a State Fair Hearing, you or your representative should call UnitedHealthcare Community Plan at 1-888-887-9003 or send a letter to the health plan at:
UnitedHealthcare Community Plan Attn: State Fair Hearings Coordinator 14141 Southwest Freeway, Suite 800 Sugar Land, TX 77478
Disaster Prep Pharmacy Guide
STAR Kids Member SK-SAI Assessment Refusal or Reschedule Guidance
The STAR Kids Screening and Assessment Instrument (called an assessment, or SAI) is used to determine eligibility for Personal Care Services, Community First Choice, and Medically Dependent Children Program services for your child.
Please see our STAR Kids Member SK-SAI Assessment Refusal or Reschedule Guidance memo for additional information.
National Flu Campaign Questions and Answers
National Flu Campaign Questions & Answers
Just for Teens
Just for Teens
Continuation of Benefits
Coordination of Benefits
- With respect to a member who is hospitalized at the time of the request UHC will issue a coverage determination within 1 business day. For members who are not hospitalized at the time of a routine prior authorization request, within 3 business days or up to 72 hours for expedited authorization requests.
- UHC will send a request for additional information if a decision cannot be made based on the information submitted within the initial request. The request will include a list of documents that are needed. For members under the age of 21, UMCM 3.22 is followed and the authorization decision can be pended for up to 7 days from the request date before a coverage determination will be issued to allow additional time for the necessary information to be submitted.
- Our current prior authorization lists are broken out by when they went into effect and are located here.
- UHC’s telephone, fax and provider portal link are listed at the top of each of our Prior Authorization documents so we can be easily contacted with any questions.
- Eligibility and benefits information on UHC’s website can be found here.
- Medicaid MCOs are responsible for providing all services and benefits available to clients of the Medicaid Fee-for-Service (FFS) Program to the MCO’s Medicaid Members, in the same amount, duration, and scope as is available through FFS as reflected in the state plan under Title XIX of the Social Security Act Medical Assistance Program and detailed in the Texas Medicaid Provider Procedures Manual (TMPPM).
Member Newsletters 2016 - Current
Member Newsletters Prior to 2016
File a Complaint, Report Suspected Fraud, Waste or Abuse
If you get benefits through Medicaid’s STAR, STAR+PLUS, STAR Kids or STAR Health program, call your medical or dental plan first. If you don’t get the help you need there, you should do one of the following:
a. Call Medicaid Managed Care Helpline at 1-866-566-8989 (toll free)
b. Online: Send your complaint in an email to HPM_Complaints@hhsc.state.tx.us
c. Mail: Texas Health and Human Services Commission
Office of the Ombudsman, MC H-700
P.O. Box 13247
Austin, TX 78711-3247
d. Fax: 1-888-780-8099 (Toll-Free)
To report suspected fraud, waste, or abuse by a member and/or provider: https://www.tdi.texas.gov/fraud/index.html
How to Submit a Complaint
Member Advisory Committee Meetings
Member Advisory Council Flyer
Member Advocate Flyer
Member News and Bulletins
UHC Network Update 9.19.2016
Form 1718 Electronic Visit Verification Rights and Responsibilities
How to Submit a Complaint
National Prescription Drug Take Back Day
The Drug Enforcement Administration’s National Prescription Drug Take Back Day is Saturday, October 27. This a safe, convenient, and responsible way to dispose of unused or expired prescription drugs. A list of drug collection sites is available here.
Download the DEA National Take Back Brochure.
Time to See Your Doctor?
It’s important to get medical care when you need it. Call your doctor’s office to make an appointment. Tell them the reason for the visit. This will help them make the appointment within the right time frame.
Download our Access to Care document.
Learn more about Housing Support.
Housing Resource List by County.
Annual Care Checklist
Annual Care Checklist for kids
Annual Care Checklist for Women
Annual Care Checklist for Men
At UnitedHealthcare we want to make sure you can access all the benefits your plan provides.
If you’ve had a change in your health status and your doctor determines you need a wheelchair, your plan is here for you.
To make sure you get the equipment you need with the coverage you have, follow these simple steps.
You may need a wheelchair evaluation referral from a healthcare provider in your plan’s network for wheelchairs with special features.
Next a Durable Medical Equipment or DME vendor in your health plan network is located.
In many cases, your healthcare provider can help locate an in-network provider and send the referral.
If the health care provider does not complete this step we can help you find an in-network provider and schedule an appointment.
It is important to understand what your insurance does and does not cover, so that you don’t have unexpected expenses.
And we can help you with that.
Once the referral has been sent to the identified provider the evaluation will be performed by a physical therapist, an occupational therapist or a physiatrist who specializes in determining proper seating and positioning.
This evaluation may take place in your home or in the DME provider’s office.
If the assessment takes place at the provider office, be sure to bring your wheelchair with you if you have one.
During the visit you may be asked to provide additional information including your health status and risk factors, transportation needs, and information on your home environment (if the assessment does not take place in your home).
Wheelchairs may take anywhere from 60 to 90 calendar days to be delivered.
Factors such as supply chain issues and availability of parts may cause additional delay.
Your DME provider can assist you with a loaner chair during the waiting period if needed.
When your new wheelchair is delivered be sure to sit in it to ensure proper fit and adjustments.
And even if you have experience with wheelchairs do take the time for the vendor to provide instructions on the use of the chair and its features, care and maintenance.
If any equipment you are requesting is not a covered benefit you may be asked to pay out of pocket for the equipment.
The vendor should provide you with a clear explanation of why it is not part of your benefits.
Generally, a wheelchair should last at least five years, although growing children may need a new chair more often.
If you already use a wheelchair and it’s damaged and unable to be repaired you may also be eligible for a new wheelchair.
Over time your insurance and DME providers may change.
So, be sure and keep all the information about the chair, the DME provider, the coverage and any documentation on any repairs or changes made.
Remember, if you have any questions or need more information visit https://member.uhc.com/communityplan or call member services at the number on the back of your member ID card.