UnitedHealthcare Community Plan - Heritage Health

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.

Make sure your sight and hearing are at their best. Benefits include:

• Hearing. Tests, checkups and hearing aids, if needed.
• Vision. Routine eye exams, plus frames and prescription lenses are covered. 

Vision Provider Lookup

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.

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.

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.

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.. 

• Rewards program for well-child visits.
• Dr. Health E. Hound® provides nutritional education and promotes fitness and healthy habits.

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.

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.

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.

Getting a yearly dental check-up is important to your health. Your coverage includes: 

• Two exams and cleanings per year for children and adults.
• Bitewing X-ray once every 12 months and one complete set of X-rays every three years. 
• Minor restorations such as filling. 
• Major restorations such as crowns and root canals (one of each per 12 months). 
• Deep cleanings and surgical treatment for gum disease. 
• Partial or full dentures, and repairs to partials or full dentures. 
• Sedation and nitrous oxide (known as laughing gas) if medically necessary.

Sometimes people have a hard time going to the dentist. They may be sensitive to touch. They might need extra time or gentle care. Let us help you find the right dentist for you or your family. Call Member Services at 1-800-641-1902, TTY 711.

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.

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.

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. 

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.

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.

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.

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.

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 are covered when they are ordered by a physician.

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. 

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. 

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

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

You will not have a copayment for care and services covered by our plan.

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.

Select over-the-counter drugs and supplies are covered 100% with your doctor’s prescription.  

Your health care costs may include non-prescription medicines and supplies like aspirin, cough medicine or diabetic testing supplies. Covered 100% with your doctor’s prescription.

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

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.

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. 

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.

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.

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.

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.

Covered when ordered by a network physician.

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.

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.

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 with your doctor can help keep you healthy. These visits can catch health problems early, so they can be treated. Preventive services include:

• Checkups for adults and children.
• Routine shots and tests.
• Mammograms.

There are no copayments for preventive care.