UnitedHealthcare Community Plan Medicaid

Get the care you need to stay healthy — or to get better if you are injured or sick. Member benefits include:

• Care Coordinator. Someone to coordinate the services and care you need for your health.
• Choice of Doctor. Find a doctor you trust in our network.
• Hospitalization. You pay nothing for care in a hospital.
• Lab and X-rays. Lab tests, x-rays and diagnostic imaging are covered.
• Medicines. Fill prescriptions at local pharmacies.
• Nurse Hotline . Speak with a registered nurse 24/7.
• Pregnancy Care. Extra care and support for both you and your baby.
• Shots and Vaccines. Routine shots to help protect against illness.
• Therapy Services. Physical or other therapy to help you be your best.
• Well Visits. Annual physical exams, checkups, shots and lab tests.
• Unlimited Doctor Visits. See your doctor as often as needed.
• Urgent Care. Convenient care for a sudden illness or injury.  

Nothing is more important than the health and well-being of a mother and her baby. That’s why member benefits include:

• Breastfeeding Support. Receive up to six virtual breastfeeding visits. For more information or to book an appointment, text UHCNC4MILK to 888-458-1364, visit www.simplifed.com/united-nc, or call 844-799-0538. 
• Choice of Doctors. Find a doctor or OB/GYN you trust in our network.
• BabyScripts. Get extra support and rewards to keep you and your baby healthy.  
• Prenatal Visits. Care for you before your baby is born.
• Text4baby. Receive text messages with helpful tips and reminders.
• Wellhop. Participate in virtual pregnancy support groups.  Visit momandbaby.wellhop.com to learn more.

If you have asthma, diabetes or another long-term condition, you can depend on us. Our plan makes sure you get the care and services you need. Benefits include:

• Asthma and Allergies Care. Exams, testing and supplies are covered.
• Care Management. If you qualify, get personal help managing health conditions.
• Diabetic Support. Medicine, needles, wipes and other supplies for managing diabetes.
• Kidney Disease Care. Dialysis, medicine and treatments are covered.
• Behavioral Health Disorders. Counseling and other treatments are covered.
• Obesity Care. We cover screenings and counseling for obesity
• Special Needs Unit. Services for members with special health care needs.  

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

• Hearing. Tests, checkups and hearing aids, if needed, are provided.
• Vision. Covers eye exams and glasses if needed.

Transportation Services

Emergency: If you need emergency transportation (an ambulance), call 911.

Non-emergency: UnitedHealthcare Community Plan of North Carolina can arrange and pay for your transportation to help you get to and from your appointments for Medicaid-covered care. This service is free to you. If you need an attendant to go with you to your doctors appointment, or if your child (18 years old or younger) is a member of the plan, transportation is also covered for the attendant, parent or guardian. Non-emergency transportation includes personal vehicles, taxis, vans, mini-buses, mountain area transports and public transportation.

How to get non-emergency transportation. Call 1-800-349-1855, TTY 711 up to 2 days before your appointment to arrange transportation to and from your appointment. Non-emergency transportation services via personal vehicles, taxis, vans, mini-buses, mountain area transports and public transportation are provided through our contracted transportation company ModivCare. You can contact ModivCare to request or cancel a trip by calling Member Services at 1-800-349-1855, TTY 711 and choosing the option for Transportation. Rides for routine appointments should be scheduled at least 2 business days in advance by calling between 7:00 a.m. and 6:00 p.m., Monday through Saturday. Rides for urgent appointments can also be made after hours by calling Member Services.

Responsibilities of the member:

1. To use those transportation resources which are available and appropriate to their needs in the most efficient and effective manner.
2. To utilize transportation services, such as gas vouchers, appropriately.
3. To travel to the requested location and receive a Medicaid covered service.
4. To make timely requests for transportation assistance.
5. To be ready and at the designated place for transportation pick-up or cancel the transportation request timely.
6. To follow the instructions of the driver.
7. To respect and not violate the rights of other passengers and the driver, such as not creating a disturbance or engaging in threatening language or behavior.

Member no-shows:
A no-show is when the member does not go to the medical appointment.

1. The member must be ready and at the designated place for pick-up at the time required by the transportation vendor.
2. The member must complete their trip and show evidence in order to be issued reimbursement for their mileage.
3. The member must call the number provided for trip requests to cancel scheduled transportation at least 24 hours in advance.
4. Members who miss three or more trips in a three-month period, or who risk the safety of other passengers or the driver may be suspended from transportation services for up to 30 days.

You can get additional information on our Non-Emergency Medical Transportation policy by calling Member Services at 1-800-349-1855, TTY 711.

To view the UnitedHealthcare Community Plan of North Carolina NEMT Policy click here.

Sometimes you might need a little extra help using your health plan. For those times, you can rely on:

• BabyScripts. Earn rewards for keeping you and your baby healthy.
• Language Help. Connect to a translator through Member Services.
• Member Advocate. Someone to get you information, services and care.
• Nurse Hotline℠. Speak with a registered nurse 24/7.
• Quitting Tobacco. Coaches and supplies to help you quit using tobacco.
• Social Services. We’ll help you find community services.
• Transportation. We pay for rides to and from medical visits or qualified trips to the Pharmacy.
• Weight Control. Support and treatment to reach a healthy weight.

Behavioral 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:

• Counseling
• Substance use treatment.
• Medications.

Call the Behavioral Health Crisis Line at 1-877-334-1141, at any time, 24 hours a day, 7 days a week. If you are in danger or need immediate medical attention call 911.

SimpliFed provides free virtual breastfeeding and baby feeding support to UnitedHealthcare Community Plan of North Carolina members, starting in pregnancy. Members have access to up to six visits with baby feeding experts who provide judgment-free care, no matter how you feed your baby.

For more information or to book an appointment, text UHCNC4MILK to 888-458-1364, visit www.simplifed.com/united-nc, or call 844-799-0538. 

Each member can choose a primary care provider (PCP). Use the Doctor Lookup tool to see if your doctor is in our network.

The PCP is the main doctor for:

• Preventive care.
• Treatment if you are sick or injured.
• Referrals to specialists for certain conditions.

For members who don’t have a doctor or whose doctor is not in our network, we can help find a new one close by.  

Copays If You Have Medicaid

There are No Medicaid copays for the following people or services:

• Members under age 21
• Members who are pregnant
• Members receiving hospice care
• Federally recognized tribal members
• North Carolina Breast and Cervical Cancer Control Program (NC BCCCP) beneficiaries
• People living in an institution who get coverage for cost of care
• Children in foster care
• People living in an institution who are receiving coverage for cost of care
  
• Behavioral health services
• Intellectual/developmental disability (I/DD) services
• Traumatic brain injury (TBI) services

A provider cannot refuse to provide services if you cannot pay your copay at the time of service. If you have any questions about Medicaid copays, call Member Services at 1-800-349-1855, 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:

• Planning healthy meals.
• Managing stress.
• Living a healthy lifestyle. 

If you have chronic or high-risk illnesses, our disease management services are designed to support you.

We have special programs for:

• Congestive heart failure.
• Asthma.
• HIV.
• Chronic obstructive pulmonary disease (COPD).
• Coronary artery disease.

Some members may need extra support to live safely at home.

Our plan covers medical equipment ordered by your doctor or case manager. This can include supplies like:

• Oxygen tanks.
• Hospital beds.
• Wheelchairs or walkers.

Take free classes to help improve your health or to address a condition.

Our plan includes classes on diabetes, nutrition and more. You can even get a ride, if needed, to and from the class at no cost to you. 

Build a healthy future for you and your baby and earn great rewards with BabyScripts. Our program will help you take the right steps to keep you and your baby healthy. Plus you can earn $20 just for signing up. 

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.

An ounce of prevention can be worth a pound of cure. It can also be worth great rewards.

You can earn great gifts for your child by doing things like:

• Completing well-child exams.
• Getting lab tests.
• Recording your family’s health activities. 

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, therapy and tests.
• Hearing aids and batteries.

This plan pays for all expenses related to a hospital stay, so you can rest and heal. 

Hospitalization coverage includes:

• Nursing care.
• Room and board.
• Supplies and equipment.
• Treatment and therapies.
• Diagnostic tests and exams.

And after you leave the hospital, you are not alone. We make sure you get follow-up care to continue healing at home.

After surgery or a serious illness, you may need extra help with day-to-day tasks like cleaning, cooking or dressing. You may even need an in-home medical visit to check on how well you are healing. With approval, our plan covers:

• An in-home medical visit.
• Medical equipment like hospital beds, walkers or wheelchairs.
• Disposable medical supplies.
• Help with personal care or housekeeping.

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. 

You can get information in another language. Just ask. Then anything we write to you will only be in that language. This is provided at no cost to you.  

And we make getting your child's medicine easy. We'll provide a list of covered drugs if you have questions about what prescriptions are covered.

You can fill the prescriptions at local pharmacies in the UnitedHealthcare Community Plan network.

Sometimes you might need a little help understanding your health care options. We’ll answer your questions simply and completely.

We can also help you find:

• Home care providers.
• Specialists.
• Doctors.
• Pharmacies.
• Hospitals or other health facilities.
• Local resources.

Sometimes continued care is needed after leaving the hospital or urgent care. For example, after a serious illness, surgery or injury. In these cases, a nurse will make home visits to:

• Provide medical care.
• Answer any questions and concerns.

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.

Healthy eating goes a long way to helping you stay at your best. A nutritionist can meet with you to review your eating habits and food choices. 

You’ll come away with new ideas for:

• Making good choices for quick meals and snacks.
• Preparing healthy meals on a budget.

Obesity is common and serious.  It can also lead to other health problems. To help our members be their best, our plan includes:

• Screening for obesity.
• Counseling for obesity.

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. 

Sometimes the basics are hard to do yourself after an illness or injury. If needed, we provide someone to help with:

• Dressing.
• Bathing.
• Feeding. 

A pregnancy is a journey that’s better with the help of friends, family and a pregnancy doctor, or OB/GYN.

All recommended prenatal clinical visits and tests are covered by our plan.

At these visits, the clinic will:

• Make sure both mom and baby are healthy.
• Explain what to expect at each stage of pregnancy.
• Answer questions.

Most people know the bad health effects of smoking. And they know they need to quit. We support our members while they quit, with coaches and supplies. The only thing they won’t get from us is a lecture.

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.

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.  

Routine shots help protect you from illness. So, our plan covers:

• Recommended shots and vaccines.
• Influenza shots. 

Many communities offer additional benefits for children in this plan. Social Services helps members connect to these local programs and services, such as:

• WIC and financial support.
• School services.
• Respite care.
• Training and family phone line.

Speech therapy visits and exercises can help those who have difficulty speaking. At your doctor’s requests, we will cover up to 60 combined physical, occupational, speech and other therapy visits each year

Text4baby can help new and expecting mothers keep themselves and their babies healthy.

You’ll get text messages throughout your pregnancy and your baby’s first year. Each text contains health and safety tips for topics like:

• Prenatal care.
• Labor and delivery.
• Breastfeeding.
• Safe sleep.
• Nutrition.
• Car seat safety.

So you and your baby can make a great start on life.

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.

There may be times when your or a family member’s health requires repeated visits to a primary care provider (PCP). Our plan does not limit the number the number of times you can see your PCP.  This way you get care need when you need it. And your doctor can see how your health is progressing.   

You may have an injury or sudden illness that is not life-threatening but needs immediate attention. So our plan covers care at:

• Urgent care centers.
• Medical aid units.
• Other walk-in clinics.

Our plan encourages a healthy approach to eating and living. To help our members be their best, we cover:

• Screening for obesity.
• Support for healthy diet and exercise choices.

An online meeting and resource community for pregnant members. Wellhop brings pregnant women together and matches them with clinically trained facilitators in group video conversations for education and support. 

Well visits with your doctor are important for good health. 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.