UnitedHealthcare Community Plan

Nothing is more important than the health and well-being of you and your baby. That’s why our TennCare Medicaid plan benefits include:

• Choice of Doctor. Find an OB/GYN you trust in our network.
• Prenatal Visits. Care for you before your baby is born.
• Healthy First Steps®. Get extra support and rewards to keep you and your baby healthy.
• Choice of Birth Centers. Pick from hospitals all across Tennessee.
• Wellhop for Mom & Baby. Connect with a community of moms. Get support and information as you welcome your baby.

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

• Mental Health. Counseling and other treatments are available.
• Care Management. Personal support from an experienced professional.
• Population Health Services. Help to manage your ongoing health or chronic condition.

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

Vision.

• For adults age 21 and older- vision services are limited to medical evaluation and management of abnormal conditions and disorders of the eye. The first pair of cataract glasses or contact lens/lenses after cataract surgery are covered.
• Children under 21 years old- can have their eyes checked and get eyeglass lenses and frames as medically necessary. If the eyeglass lenses or frames are broken or lost, we will replace them as medically necessary.
• TennCare will pay for other vision care if it is medically necessary. Contacts are covered only if they are medically necessary.
• Children do not have to see their PCP before seeing their eye doctor, the eye doctor must be in our Provider Directory.

Dental.  

• Dental care for adults age 21 and older is covered with limits. Dental care includes benefits like checkups, x-rays, oral treatments and more. See your Dental Benefits Manager (DBM) Handbook for limits. Your dental plan for your teeth is called DentaQuest.  They can help you if you have questions about dental care.  To find a DentaQuest dentist, go to http://www.dentaquest.com/state-plans/regions/tennessee/.  Then click Find a Dentist.  Or you can call them at 855-418-1622. It’s a free call.
• Dental Care for Children (for teeth) You also have a dental plan for your teeth called DentaQuest.  Their phone number is 1-855-418-1622.  You can call DentaQuest to find a dentist.  Or, if you have questions about caring for your child’s teeth, you can call them.  It’s a free call.
• Children’s teeth need special care.  Children under age 21 should have a checkup and cleaning every six months.  Children need to start seeing a dentist the time the first tooth comes in the mouth, or no later than the first birthday.
• TennCare will pay for some other dental care if it is medically necessary.  Braces are covered only if they are medically necessary and only for children.
• You do not need to see your PCP before you go to a dentist.  But, you will need to go to a DentaQuest dentist. 

Members who qualify can get the medically necessary equipment and help needed to live safety at home. Benefits include:

• Equipment and Supplies. In-home medical safety materials are covered.
• Nurse Visits. Short-term medical care while recovering at home.
• Care Coordinator. Someone to get you the services to live safely at home.

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.
  
• Language Help. Connect to a translator through Member Services.
• Member Services. Someone to help you understand how to use your benefits.
• Quitting Tobacco.  Coaches, supplies and medications to help you quit using tobacco.  
• Weight Control. Support and treatment to reach a healthy weight.
• Health Education. Free classes to help improve your health.

Do you or your child have a serious health problem? Then our care managers are in your corner. They will:

• Explain medical terms in plain language.
• Coordinate doctor appointments.
• Provide the care team with medical records.

Your care manager will stay with you or your child throughout the medical journey. He or she will:

• Think beyond immediate medical needs.
• Make sure there is support at home.

Where you have your baby is an important choice. That’s why you can pick from hospitals all across Tennessee.

We 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.

Your health and safety at home are important.

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

• Hospital beds.
• Oxygen tanks.
• Walkers or wheelchairs.

Free classes to help improve your health or 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 Healthy First Steps. 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.

This 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.

Do you know about the Affordable Connectivity Program? It’s a new program that helps pay for high-speed internet.  You can use the internet for work, school, healthcare, and more. What do you get with this program?  You may get up to $30 per month off your internet bills.  There is also a one-time $100 discount off a laptop, tablet, or computer. Who can get this program?  Any household that has at least one person enrolled in Medicaid.  How do you get this program?  You must enroll to get it.  Go online to getinternet.gov and enroll today.

Learn more

Your 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 appointments.

We also have people in member services who speak more than one language. Chances are, we have someone who speaks your language.

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 receive information in your preferred language. Just ask. We also have people at our member service centers who speak more than one language. Chances are, we have someone who speaks your language.

Understanding your health care options can be confusing. We can answer your questions simply and completely.

We help you find:

• Doctors.
• Pharmacies.
• Hospitals or other health facilities.
• Local resources.

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:

• Mental health therapy.
• Substance abuse treatment.
• Medications.

Members have no copayments for:

• Preventive care.
• Annual checkups.

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 for you.
• Answer your questions and concerns.
• Home health. Home nursing care limited to 125 visits per calendar year.

Medical questions and situations can sometimes come at inconvenient times. When you have questions about your health or your child’s health, you can call a trained nurse 24/7.

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.
• Help you know when to go to the emergency room.

All of your recommended prenatal clinical visits and tests are covered.

At these visits, the clinic will:

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

You can have one main person for your health care. He or she can be a doctor, a nurse practitioner, or a physician’s assistant. This person is called your Primary Care Provider (PCP). 

Your PCP is your main doctor for:

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

To change your PCP:

1. Find a new PCP in the UnitedHealthcare Community Plan network. To find a new PCP you can look in our Provider Directory, you can go online at
   myuhc.com/CommunityPlan, or call 1-800-690-1606.
2. Then call the new PCP to make sure that he or she is in the UnitedHealthcare Community Plan provider network. Be sure to ask if he or she is taking new patients.
3. If the new PCP is in our network and taking new patients, fill out the PCP Change Request in Part 8 of your Member Handbook and mail it back to us. Or you can call us at
   1-800-690-1606 to tell us the name of your new PCP.

You know the bad health effects of smoking.

You know you need to quit. We support you while you quit with the help of coaches and supplies. The only thing you won't get from us is a lecture.

Routine shots help keep you healthy. So, our plan covers:

• Recommended shots and vaccines.
• Influenza shots.

In case of emergency call 911

Important tips for setting up a ride- Please review Tennessee Carriers website- Rider Information Riders | Tennessee Carriers (tenncarriers.com)

• Call 1-866-405-0238, TTY 711 to set up your ride 
• Call at least seventy-two (72) hours in advance of your appointment whenever possible
• If the time for your return trip home was not already scheduled, you are responsible for calling to tell the transporter that you are ready to be picked up for your trip home
• If you cancel your appointment/visit, call 1-866-405-0238 to cancel your ride 
• Have your Medicaid ID card available 
• If you have more than one appointment on the same day, you can get a ride to all covered services. Please give Tennessee Carriers information for each appointment
• Know the address of your health care provider and the date and time of your appointment 
• Be specific about where you need a ride to 
• 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 
• Any minor requesting transportation without an accompanying adult will be handled on a case-by-case basis 
• If you wish to bring someone with you to your appointment, you can have someone ride with you. This is sometimes called an escort. An escort is someone over the age of 12. Please let Tennessee Carriers know you’ll have an escort riding with you
• If you’re going to an appointment and need to take your child with you, he or she won’t count as your escort

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.
• Health coaching.

Well visits with your doctor can help keep you healthy. These visits can help 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.

You will not have a copayment for preventive care.

Connect with other expectant moms. Get support and information during your pregnancy and after you deliver. This program is part of your health plan and there is no extra cost to you.
Here’s how it works:

• Join video conversations every other week with women who have similar due dates and a group leader.
• Chat and share experiences with moms from your group on the Wellhop app or website.
• Visit the Wellhop library. You’ll find articles, videos and more.