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Child Health Plus Frequently Asked Questions

Child Health Plus is a New York State health insurance plan for kids. Your child may be eligible for Child Health Plus or Children's Medicaid depending upon your family income and household size.

You can apply for Child Health Plus by the visiting the New York State of Health website, or by calling 1-855-355-5777. UnitedHealthcare wants to help you and has Certified Application Counselors who will assist you with applying. Just call 1-888-617-8979 to have a Certified Application Counselor help you.

When you enroll in CHPlus and select UnitedHealthcare you must be pay your premium prior to the month that coverage will begin. If your coverage is effective January 1, your payment must be received before that date. We'll provide a grace period for your initial payment up to the 10th of the month. If we do not receive your premium payment by January 10th, your child's coverage for January will be cancelled. You'll have to re-apply on the New York State of Health website. After your initial payment, we will send you a bill each month. Please call our Premium Billing department at 1-877-229-3439 with any questions or to pay by telephone.

If you have questions or problems, call Member Services at 1-800-493-4647, TTY 711. We can help with:

  • Any concerns you may have about your child's health care benefits or services
  • Answers to questions about how to get services
  • Health education information
  • Errors on the UnitedHealthcare ID card

If you have questions about premium payment, please call toll-free 1-877-229-3439.  Please have the UnitedHealthcare ID card available when you call so we can help you sooner.

You will receive an ID card for your child after you enroll that shows that your child is a member of the UnitedHealthcare Community Plan for Kids program. Carry the ID card with you at all times and show the ID card each time your child receives medical care. Showing your card makes sure that medical bills for covered services are not sent to you.

If you have questions about premium payment, please call toll-free 1-877-229-3439. Please have the UnitedHealthcare ID card available when you call so we can help you sooner.

We can help you if you do not speak or understand English. If you need an interpreter, please call Member Services at 1-800-493-4647, TTY 711, and notify our representatives what languages you speak.

 

Some people have to pay a premium for their children enrolled in UnitedHealthcare Community Plan for Kids. If you have to pay a premium, it is important that you pay the premium for each child enrolled with UnitedHealthcare by the first of each month. If you do not pay the premium by the end of the grace period, your child will be disenrolled from UnitedHealthcare Community Plan for Kids. If you have questions regarding whether or not UnitedHealthcare has received your premium payment, call toll-free 1-877-229-3439.

 

As an enrollee of UnitedHealthcare, you must choose a primary care doctor for your child. You may choose a different doctor for each child in your family. To help you decide what is best for you and your family, here are some definitions:

  • Family practice doctors see patients of all ages from infants to adults for general health care.
  • Internal medicine doctors (internist) treat diseases in adults. They do not do surgery or treat young children, but may treat children over the age of 16.
  • Pediatricians are doctors who care for children from birth to age 16, sometimes 18.

Your child's primary care doctor can help you with all of your child's health care needs and should always be a part of your child's medical care team. To help you with your child's medical needs, your primary care doctor and staff are available to you by telephone for advice or an appointment. He or she should:

  • Refer your child to a specialist when necessary
  • Give you advice or appointments
  • Admit your child to a hospital if medically necessary
  • Be called whenever possible if an emergency happens (unless it is life threatening. If your child is suffering from a life threatening injury or illness and you cannot call your child's primary care doctor, call 911 or go to your nearest emergency room).

If you choose a primary care doctor that your child has never been to before, it is important for you to have your child's medical records transferred as soon as possible. This will help your child's doctor provide your child with the best care possible. To transfer your child's records, call or write your former doctor and ask him or her to send those records to your child's new doctor.

 

You can obtain prescriptions for your child(ren) through any pharmacy that participates with Optum Rx. A list of participating pharmacies is included in the Provider Directory. Simply present your prescription and your UnitedHealthcare Community Plan Member ID card to your pharmacist. There are no copayments required for prescriptions. Certain medications may require prior authorization, check the Preferred Drug List on this website to see which items require prior authorization.

 

You can use any pharmacy that participates with OptumRx. You will also find the names of these pharmacies in the Provider Directory enclosed within your welcome packet. Just ask your pharmacist if they participate in the Medicaid Prescription drug program.

As a new member you should expect to receive your UnitedHealthcare Community Plan ID card within 14 days of joining the plan. You should also receive your new member welcome kit which includes your Member Handbook, the Provider Directory and other important information.

Additionally, we will contact you by phone to welcome you to the plan and conduct a new member orientation and a health risk assessment (HRA). The new Member Orientation is a great way to learn about the benefits available to you under the plan. UnitedHealthcare Community Plan reviews all HRAs and identifies members with chronic and long term medical conditions that we can help you manage. In some cases, you may be assigned a Case Manager who will work with you and your physician to manage your healthcare needs.

As a member of the UnitedHealthcare Community Plan you do not have to pay for any covered services you receive.

If you receive a bill from a provider, do not send them payment. Instead return the bill to your provider along with your UnitedHealthcare Community Plan ID number and ask your provider to bill us directly.

Your child's primary care doctor is important to his health care. If you are unhappy with your child's doctor, please talk with him or her so that they know why you are unhappy. Your doctor can only correct a problem that he/she knows about.

If you feel it will be better to change to another primary care doctor, call Member Services at 1-800-493-4647, TTY 711. If you need help in finding a new doctor, Member Services will help you. After you change your child's primary care doctors, be sure to have your child’s medical records transferred to your new doctor.

Whenever possible, schedule your child's appointments in advance. This will save you time. If you think your child has a medical problem that needs the primary care doctor's attention quickly, make sure you tell the person who is scheduling your appointment. If you cannot keep a scheduled appointment with your child'’s doctor, please call and cancel the appointment as soon as possible.

Depending on the care you need, the doctor must be able to see your child within these time limits:

  • Urgent medical or behavioral problems within 24 hours;
  • Non-urgent "sick visits" within 48-72 hours;
  • Routine, non-urgent or preventive care visits within 4 weeks; and
  • In-plan, non urgent mental health or substance abuse visits within 2 weeks.

Just call our Premium Billing team at 1-877-229-3439 and our Billing Representatives will assist you with questions about your account, processing your payment and general billing questions.


New York State sponsored health insurance programs.
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To learn more about applying for health insurance, including Medicaid, Child Health Plus, Essential Plan, and Qualified Health Plans through NY State of Health, The Official Health Plan Marketplace, visit nystateofhealth.ny.gov or call 1-855-355-5777. To find out if you qualify for Medicaid Managed Care or Child Health Plus offered by UnitedHealthcare Community Plan, please call 1-888-617-8979. UnitedHealthcare does not discriminate on the basis of race, color, national origin, sex, age or disability in health programs and activities. We provide free services to help you communicate with us. Such as, letters in other languages or large print. Or, you can ask for an interpreter. To ask for help, please call Member Services at 1-800-493-4647, TTY 711, 8 a.m. – 6 p.m., Monday – Friday ATTENTION: Language assistance services, free of charge, are available to you. Call 1-800-493-4647, TTY 711. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-493-4647, TTY 711. 注意：您可以免費獲得語言援助服務。請致電 1-800-493-4647, TTY 711 ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-800-493-4647 (телетайп: TTY 711).

Last Updated: 12.11.2024 at 07:52 AM CST

Disclaimer information
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Looking for the federal government’s Medicaid website? Look here at Medicaid.gov.

UnitedHealthcare Dual Complete plans

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. Benefits, features and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

Premium disclaimer

Dual Special Needs plans have a $0 premium for members with Extra Help (Low Income Subsidy).

Benefit disclaimer

Benefits, features, and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply.

Nurse Hotline disclaimer

This service should not be used for emergency or urgent care needs. In an emergency, call 911 or go to the nearest emergency room. The information provided through this service is for informational purposes only. The nurses cannot diagnose problems or recommend treatment and are not a substitute for your provider's care. Your health information is kept confidential in accordance with the law. The service is not an insurance program and may be discontinued at any time. Nurse Hotline not for use in emergencies, for informational purposes only.

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid plan)

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. 

UnitedHealthcare Connected® (Medicare-Medicaid plan)

UnitedHealthcare Connected® (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees.

UnitedHealthcare Connected® for One Care (Medicare-Medicaid plan)

UnitedHealthcare Connected® for One Care (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and MassHealth (Medicaid) to provide benefits of both programs to enrollees. 

UnitedHealthcare Connected® general benefit disclaimer

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the member handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® member handbook. 

UnitedHealthcare Senior Care Options (HMO SNP) plan

UnitedHealthcare Senior Care Options (SCO) is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare and does not have any other comprehensive health Insurance, except Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our Senior Care Options (SCO) program.

Star ratings disclaimer

Every year, Medicare evaluates plans based on a 5-Star rating system. The 5-Star rating applies to plan year 2024.

Important provider information

The choice is yours

We will provide you with information to help you make informed choices, such as physicians' and health care professionals' credentials. This information, however, is not an endorsement of a particular physician or health care professional's suitability for your needs.

The providers available through this application may not necessarily reflect the full extent of UnitedHealthcare's network of contracted providers. There may be providers or certain specialties that are not included in this application that are part of our network. If you don't find the provider you are searching for, you may contact the provider directly to verify participation status with UnitedHealthcare's network, or contact Customer Care at the toll-free number shown on your UnitedHealthcare ID card. We also recommend that, prior to seeing any physician, including any specialists, you call the physician's office to verify their participation status and availability.

Some network providers may have been added or removed from our network after this directory was updated. We do not guarantee that each provider is still accepting new members.

Out-of-network/non-contracted providers are under no obligation to treat UnitedHealthcare plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost- sharing that applies to out-of-network services.

American Disabilities Act notice

In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 ("ADA"), UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

Referrals

Network providers help you and your covered family members get the care needed. Access to specialists may be coordinated by your primary care physician.

Paper directory requests

Paper copies of the network provider directory are available at no cost to members by calling the customer service number on the back of your ID card. Non-members may download and print search results from the online directory.

Inaccurate information

To report incorrect information, email provider_directory_invalid_issues@uhc.com. This email box is for members to report potential inaccuracies for demographic (address, phone, etc.) information in the online or paper directories. Reporting issues via this mail box will result in an outreach to the provider’s office to verify all directory demographic data, which can take approximately 30 days. Individuals can also report potential inaccuracies via phone. UnitedHealthcare Members should call the number on the back of their ID card, and non-UnitedHealthcare members can call 1-888-638-6613 / TTY 711, or use your preferred relay service.

Declaration of disaster or emergency

If you’re affected by a disaster or emergency declaration by the President or a governor, or an announcement of a public health emergency by the Secretary of Health and Human Services, there is certain additional support available to you.

  • Part A, Part B, and supplemental Part C plan benefits are to be provided at specified non-contracted facilities (note that Part A and Part B benefits must be obtained at Medicare certified facilities);
  • Where applicable, requirements for gatekeeper referrals are waived in full;
  • Plan-approved out-of-network cost-sharing to network cost-sharing amounts are temporarily reduced; and
  • The 30-day notification requirement to members is waived, as long as all the changes (such as reduction of cost-sharing and waiving authorization) benefit the member.

If CMS hasn’t provided an end date for the disaster or emergency, plans will resume normal operation 30 days after the initial declaration.