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UnitedHealthcare Wellness4Me

메디케이드

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.

혜택 및 특징

Special Services

With the Wellness4me program, UnitedHealthcare Community Plan offers new services, called Behavioral Health Home and Community Based Services (BHHCBS), to members who qualify.

BHHCBS may help you:

  • Find housing or live independently.
  • Return to school or find a job.
  • Manage stress and prevent crises.

As a member of UnitedHealthcare Community Plan, you will also have the opportunity to enroll in a Health Home and meet with a Care Manager who will work with all your physical and behavioral health providers to pay special attention to your whole health care needs.

Get the care you need to stay healthy — or to get better if you are injured or sick. 다음이 포함됩니다.

  • Choice of Doctor. Use "Doctor Lookup" to see if your doctor is in our network or to find a new one.
  • 사례 관리 Get personal help managing health conditions.
  • Well Visits. Annual checkups to help keep you healthy.
  • Medicines. Fill your prescriptions at local pharmacies with a small copay.
  • Referrals. Care from a specialist when recommended by your PCP.
  • Pregnancy Care. Extra care and support for both you and your baby.
  • Shots and Vaccines. Routine shots to help protect against illness.

If you have asthma, diabetes or another long-term condition such as substance abuse disorder, you can depend on us. 당사 플랜에서는 가입자에게 필요한 치료, 지원 및 서비스를 받을 수 있도록 보장합니다. 혜택에는 다음이 포함됩니다.

  • Asthma and COPD Care. Exams, testing and supplies are covered.
  • 사례 관리 Get personal help managing health conditions.
  • 당뇨병 지원. Medicine, needles and wipes for managing diabetes.
  • 정신 건강. 상담 및 기타 치료가 보장됩니다.
  • Residential Care. Brief stay at a care facility while you recover from sickness or injury.

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. 혜택에는 다음이 포함됩니다.

  • Adult Day Care. Friendship and social activities in a safe setting.
  • Emergency Response System. Sends an urgent request for someone to help you.
  • Durable Medical Equipment. We cover wheelchairs, hospital beds and more.
  • Home Health Care. Medical and personal care at home, if needed.

Make sure your sight, smile and hearing are at their best. 혜택에는 다음이 포함됩니다.

  • Dental. We cover cleanings, checkups and dental work.
  • Hearing. Tests, checkups and hearing aids, if needed, are provided.
  • Vision. Covers eye exams and glasses or contact lenses.

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. 혜택에는 다음이 포함됩니다.

  • Adult Day Care. Friendship and social activities in a safe setting.
  • Emergency Response System. Sends an urgent request for someone to help you.
  • Durable Medical Equipment. We cover wheelchairs, hospital beds and more.
  • Home Health Care. Medical and personal care at home, if needed.

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.

정신 건강

정신 건강도 육체 건강 못지 않게 중요합니다. Our behavioral health care includes mental health and substance use treatment services.

필요한 진료가 본인 부담금 없이 100% 보장됩니다. 다음이 포함됩니다.

  • 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.

의료 관리

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. 다음을 수행합니다.

  • 의학 용어를 쉬운 말로 설명합니다.
  • Coordinate your doctor appointments.
  • Provide your care team with your medical records.
  • Your care manager will stay close by throughout the medical journey. 다음을 수행합니다.
  • 즉각적인 의학적 요구를 넘어 생각합니다.
  • Help manage ongoing medical issues like diabetes, asthma and high blood pressure
  • Make sure you have support at home.

출산 센터의 선택

어디에서 아이를 출산할 것인가는 중요한 선택입니다. That's why you can pick from 142 hospitals across New York.

We also encourage you to tour the hospital's birthing center. 이런 방식으로 출산 센터에 익숙해질 수 있습니다. And you'll be more relaxed when you have your baby.

의사 선택

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.

귀하의 PCP는 다음을 주로 담당하는 주치의입니다.

  • 예방적 건강 관리
  • 질병 또는 상해에 대한 치료
  • 특정 상태에 대한 전문가 소개

치아 관리

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. 당사는 이 모든 항목과 기타 항목을 보장해 줍니다.

또한 당사 플랜에서는 다음을 비롯하여 당뇨병을 관리하는 데 유용한 서비스로 가입자 혜택을 한층 강화합니다.

  • Diabetes counseling and self-management training.

내구성 의료 장비

당사의 플랜은 담당 의사 또는 사례 관리자가 주문하는 의료 장비를 보장해 드립니다. 다음과 같은 소모품이 필요할 수 있습니다.

  • 보청기
  • Prosthetics.
  • Orthotics.

청력 관리

청각에 문제가 있는 경우 여러 방식으로 일상생활에 영향을 줄 수 있습니다. 당사 플랜에는 청력을 보호하는 데 도움이 되는 서비스 및 지원이 포함되어 있습니다.

당사 플랜은 다음을 보장합니다.

  • Exams and tests.
  • 보청기 및 배터리

가정간호

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. 

당사 플랜에서는 승인을 전제로 다음을 보장합니다.

  • 가정 방문 진료
  • 병원 침대, 보행 보조기, 휠체어 등의 의료 장비
  • In-home medical visit
  • Help with day-to-day tasks like cleaning, cooking or dressing.
  • 일회용 의료 소모품

입원

이 플랜은 입원과 관련된 모든 비용을 지급하므로, 비용 걱정 없이 휴식과 치료에 전념하실 수 있습니다.

입원 보상 범위는 다음과 같습니다.

  • Inpatient care.
  • Outpatient care.
  • Lab, X-ray, other tests.

Your Health Home Care Manager can:

  • Help you safely return home after a hospital stay.

의약품

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:

  • 현지 약국
  • 집까지 배달하는 서비스

가입자 서비스

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.

당사 플랜에서는 필요한 경우 재활 센터 단기 입원을 보장합니다. 포함되는 항목:

  • 요양원 서비스
  • 24시간 간호 케어
  • 일상 생활 활동 보조
  • 물리, 작업 및 언어 치료

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.

간병 휴식

자택에서 가입자를 간호해 주는 가족이나 친구가 있습니까?

그렇다면 당사에서 가족이나 친구의 고생을 덜어 드리겠습니다. 이것이 바로 간병인의 휴가를 위해 간병 휴식을 제공하는 이유입니다. 간병 휴식은 질병을 앓고 있거나 특별한 요구가 있는 가족을 돌보는 간병인에게 휴가를 제공해 줍니다.

  • 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.

예방주사 및 백신

정기 예방주사는 질환을 예방하는 데 도움이 됩니다.

따라서 당사 플랜은 다음을 보장합니다.

  • Pneumonia, influenza and shingles shots.
  • Other recommended shots and vaccines.

시력 관리

You'll get the care, eyeglasses and treatment that help you see better.

보험 적용 범위:

  • Eye exams every two years, or as medically needed.
  • Prescription lenses, including contact lenses.
  • Glasses and frames.
  • Specialist care when needed.

건강 진료

담당 의사에게 꾸준히 건강 진료를 받으면 건강을 유지하실 수 있습니다. 이러한 방문으로 건강 문제를 조기에 발견하여 치료를 받을 수 있습니다. 예방 서비스에는 연간 건강검진이

  • 성인 및 어린이를 위한 검진
  • 건강한 육아 진료
  • 출산 예정 여성을 위한 케어
  • 정기 예방 주사 및 검사
  • 유방 X선 사진

예방 치료에는 본인 부담금이 없습니다.

가입자 자료

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