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New York Pharmacy Program Changes Effective 04/01
UnitedHealthcare Wellness4Me
Medicaid
The Wellness4me Plan is offered through UnitedHealthcare Community Plan, a Health and Recovery Plan, or HARP, approved by New York State. HARPs are a new kind of plan that provide Medicaid members with their health care, plus care for behavioral health, including Serious Mental Illness and Substance Use Disorders.
This plan is for New York residents age 21 and who qualify for Medicaid coverage.
UnitedHealthcare Community Plan is a special health care plan with providers who have a lot of experience treating people who may need mental health and/or substance use care to stay healthy. We also provide care management services to help you and your health care team to work together to keep you as healthy as possible.
This plan is available in the following counties:
Albany, Bronx, Broome, Cayuga, Chautauqua, Chemung, Chenango, Clinton, Columbia, Dutchess, Erie, Essex, Franklin, Fulton, Genesee, Greene, Herkimer, Jefferson, Kings, Lewis, Livingston, Madison, Monroe, Nassau, New York, Niagara, Oneida, Onondaga, Ontario, Orange, Orleans, Oswego, Queens, Rensselaer, Richmond, Rockland, Schenectady, Seneca, St. Lawrence, Suffolk, Tioga, Ulster, Warren, Wayne, Westchester, Wyoming, and Yates.
- UnitedHealthcare Wellness4Me
Find providers and coverage for this plan.
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Benefits & features
Adult Day Care
Companionship is important. If your Primary Care Provider (PCP) recommends it, you may be able to participate in adult day health care. Adult day health care provides care and companionship for seniors who need extra help during the day.
Caregivers also benefit, knowing their loved one is safe when they can’t provide care.
Adult day care can provide:
- Social connections and friendship.
- Bathing and personal care.
- Meals.
Asthma and COPD Care
Do you need help trouble managing asthma, allergies or COPD symptoms? You’ll get a customized treatment plan and medicine to help:
- Manage flare-ups.
- Reduce symptoms.
- Live an active life.
Behavioral Health
Behavioral health is as important as physical health. Our behavioral health care includes mental health and substance use treatment services.
Required care is 100% covered with no copay. This includes:
- Intensive psychiatric rehab treatment (IPRT).
- Inpatient mental health treatment.
- Continuing day treatment.
- Personalized Recovery Oriented Services (PROS).
- Assertive Community Treatment Services (ACT).
- Individual and group counseling.
- Crisis intervention services.
You can also get help with alcohol or other substance use issues.
Care Management
A serious health problem requires extra care and support. We use Health Homes to coordinate services for our members.
Health Home Care 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 care manager will stay close by throughout the medical journey. He or she will:
- Think beyond immediate medical needs.
- Help manage ongoing medical issues like diabetes, asthma and high blood pressure
- Make sure you have support at home.
Choice of Birth Center
Where you have your baby is an important choice. That's why you can pick from 142 hospitals across New York.
We also encourage you to tour the hospital's birthing center. This way you will be familiar with it. And you'll be more relaxed when you have your baby.
Choice of Doctor
When you join UnitedHealthcare Community Plan, one of our providers will take care of you. Most of the time that person will be your Primary Care Provider (PCP). You may want to choose a PCP from your mental health or substance use clinic. If you need to have a test, see another specialist, or go into the hospital, your Primary Care Provider will arrange it.
Your PCP is your main doctor for:
- Preventive care.
- Treatment if you are sick or injured.
- Referrals to specialists for certain conditions.
Dental Care
Dental checkups and cleanings can help keep teeth and gums healthy. Covered services include:
- Regular checkups.
- Cleanings.
- X-rays.
- Treatments, including fillings and other services.
You do not need a referral from your PCP to see a dentist.
Diabetic Supplies
If you have diabetes, you may need insulin, needles, wipes and glucose strips. We cover all that and more.
Our plan also steps up with services to help you manage your diabetes, including:
- Diabetes counseling and self-management training.
Durable Medical Equipment
Our plan covers medical equipment ordered by your doctor or case manager. This can include supplies like:
- Hearing aids.
- Prosthetics.
- Orthotics.
Hearing Care
Trouble hearing can affect your everyday life in many ways. Our plan includes services and support to help protect your hearing.
Our plan covers:
- Exams and tests.
- Hearing aids and batteries.
Home Health Care
Sometimes our members are living with a long-term health condition or disability. Others are coming out of the hospital after surgery or a serious illness. These members can receive extra support from our plan.
With approval, our plan covers:
- An in-home medical visit.
- Medical equipment like hospital beds, walkers or wheelchairs.
- In-home medical visit
- Help with day-to-day tasks like cleaning, cooking or dressing.
- Disposable medical supplies.
Hospitalization
This plan pays for all expenses related to a hospital stay, so you can rest and heal.
Hospitalization coverage includes:
- Inpatient care.
- Outpatient care.
- Lab, X-ray, other tests.
Your Health Home Care Manager can:
- Help you safely return home after a hospital stay.
Medicines
Our plan covers prescription drugs and refills with a small copayment. Your copay is:
| Prescription Item | Wellness4me Plan | |
|---|---|---|
| Co-Payment Amount | Co-Payment Details | |
| Brand name prescription drugs | $3.00/$1.00 | 1 co-pay charge for each new prescription and each refill |
| Generic prescription drugs | $1.00 | Refer to the Preferred Drug List |
| Over-the-counter drugs, such as for smoking cessation and diabetes | $0.50 | Refer to the Preferred Drug List |
Over-the-counter medicines with a written order from your doctor are available for a copayment of $0.50 for each medicine.And we make getting your medicine easy. You can fill your prescriptions at:
- Local pharmacies.
- Services that deliver right to your door.
Member Services
You can call Member Services to get help any time you have a question.
You may call us to choose or change your Primary Care Provider (PCP for short), to ask about benefits and services, to get help with referrals, to replace a lost ID card, to report that you are pregnant, the birth of a new baby or ask about any change that might affect your benefits.
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 rehabilitation center where you can heal. Included are:
- Nursing home services.
- 24-hour nursing care.
- Help with activities of daily living.
- Physical, occupational and speech therapy.
If you are in need of long-term placement in a nursing home, your local department of social services must determine if you meet certain Medicaid income requirements.
Respite Care
Do you have family members or friends who care for you at home?
If so, we want to support their hard work too. That's why we provide respite care to give your caregivers a rest. Respite care offers caregivers time away from their loved one who is ill or has special care needs.
- Short-Term Respite — gives you a safe place to go when you need to leave a stressful situation.
- Intensive Respite — helps you stay out of the hospital when you are having a crisis by providing a safe place to stay that can offer you treatment.
Shots and Vaccines
Routine shots help protect you from illness.
So, our plan covers:
- Pneumonia, influenza and shingles shots.
- Other recommended shots and vaccines.
Vision Care
You'll get the care, eyeglasses and treatment that help you see better.
Coverage includes:
- Eye exams every two years, or as medically needed.
- Prescription lenses, including contact lenses.
- Glasses and frames.
- Specialist care when needed.
Well Visits
Well visits with your doctor can help you stay healthy. These visits can catch health problems early, so they can be treated. Preventive services include:
- Checkups for adults and children.
- Well-baby care.
- Care for women expecting a baby.
- Routine shots and tests.
- Mammograms.
There are no copayments for preventive care.
UnitedHealth Group is 100% owner of UnitedHealthcare of New York, Inc