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UnitedHealthcare Community Plan

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UnitedHealthcare Community Plan of Ohio

Our Ohio Medicaid plan covers eligible families, pregnant women of any age, infants, children and young adults. The plan also offers extra support and care to adults and children with a disability, long-term illness or special health care needs. Members can choose a primary care doctor from our network. Plus get access to a 24/7 nurse advice hotline, health education materials and extras that other plans don't offer. View the benefits below to see all that it offers.

More information on eligibility and enrollment can be found on the Ohio Medicaid website, or by calling the Medicaid Hotline at 1-800-324-8680, TTY users should call Ohio Relay at 7-1-1.

OhioRISE

Ohio Resilience through Integrated Systems and Excellence (OhioRISE) program is a managed care program for youth with behavioral health needs. OhioRISE increases access to in-home and community-based services to ensure OhioRISE members and families have help with systems such as juvenile justice, child protection, developmental disabilities, mental health and addiction, education, and others.

An individual who is enrolled in the OhioRISE program will also keep their managed care enrollment for the physical health benefit. To be eligible for OhioRise, you must be: enrolled in Ohio Medicaid, under the age of 21 and meet a functional needs threshold for behavioral health care, as identified by the Child and Adolescent Needs and Strengths (CANS) assessment. 

  • UnitedHealthcare Community Plan Steps to Enroll
  • 자격 확인(모달 창 열림)

Beginning November 1, Ohio Medicaid managed care members will be able to select their plan by calling the Ohio Medicaid Consumer Hotline at 1-866-693-0898 or utilizing the Ohio Medicaid Consumer Hotline Member Portal at https://members.ohiomh.com/Login.aspx. You do not have to do anything if you want to keep your current Medicaid Managed Care Plan.

Visit the Ohio Medicaid Consumer Hotline website at www.ohiomh.com for information.

After you receive your renewal form from the Ohio Department of Medicaid (ODM) you will need to take a few steps to keep UnitedHealthcare as your health insurance company.

Click here to learn how to renew your Medicaid coverage.

혜택 및 특징

For OhioRISE, please refer to the OhioRISE handbook

건강 및 질병 관리

Get the care you need to get better if you are injured or sick — or to reach your full potential. 혜택에는 다음이 포함됩니다.

  • NurseLine. Speak with a registered nurse 24/7.
  • No Copays. You pay nothing for your care or services.
  • Medicines. Fill your prescriptions, including over the counter drugs at local pharmacies.
  • Therapy Services. Physical or other therapy to recover and heal.
  • Chiropractor Services. We provide up to 15 chiropractic visit per year.
  • Well Visits. Annual checkups can help keep you healthy.
  • 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 child. 그게 바로 당사의 플랜이 다음과 같은 혜택을 제공하는 이유입니다:

  • Choice of Doctors and Birthing Center. Find a doctor and hospital 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.
  • Text4baby. Get helpful tips and links to free health and wellness items for you and your baby.
  • 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 chronic condition, you can depend on us. 당사 플랜에서는 가입자에게 필요한 치료, 지원 및 서비스를 받을 수 있도록 보장합니다. 혜택에는 다음이 포함됩니다.

  • Mental Health and Substance Abuse Services. With prior approval counseling and other treatments are covered.
  • Care Management. Personal support from an experienced professional.
  • Asthma Care. Exams, testing and supplies are covered for asthma and other lung diseases.
  • Kidney Disease Care. Dialysis, medicine and treatments are covered.
  • Obesity Care. We cover screenings and counseling for obesity.

We help members keep their vision, smile and hearing at their best. 혜택에는 다음이 포함됩니다.

  • Vision. Covers exams, glasses or $150 toward contact lenses.
  • Dental. We pay for cleanings, checkups and some dental work.
  • Hearing. Tests, checkups and with prior approval hearing aids are provided.

Earning a reward for taking care of yourself or your child is easy. The following programs offer incentives:

  • Healthy First Steps®  -  Earn $20 for signing up. Our program will help keep you and your baby healthy. 
  • Healthy Rewards -  Earn gifts for you or your child with preventive care.  

You get the medical care and equipment needed to live safely at home. 혜택에는 다음이 포함됩니다.

  • Equipment and Supplies. With prior approval, in-home medical and safety equipment are covered.
  • Nurse Visits. Medical care to help with a safe recovery at home.
  • Respite Care. In-home help to give caregivers taking care of children under age 21 a rest.
  • Care Coordinator. Someone to get you the services you need after surgery or illness.
  • Home Health Care. With prior approval, medical and personal care in your home, if needed.

Sometimes members need a little extra help using their health plan. For those times, they can rely on:

  • Transportation. We pay for up to 30 one way or 15 round trip rides to medical visits or the pharmacy.
  • Language Help. Connect to a translator through Member Services.
  • Member Services. Someone to help you get the most from your plan.
  • Quitting Tobacco. Coaches and supplies to help quit using tobacco.
  • My Advocate. We help members connect to community services.
  • Healthy Rewards. Earn up to $100 in credits for completing healthy activities.
  • Mileage Reimbursement. Mileage reimbursement is now available for those members or their representative that would prefer to use their own vehicle for trips to medical appointments. Members must call for trips in 5 days in advance.

Asthma and COPD Care

Individual care to help control asthma or COPD symptoms.

Some members may have trouble managing asthma or COPD symptoms. For them, a nurse who specializes in breathing issues can really help. They get a customized treatment plan and medicine to:

  • Manage flare-ups.
  • Reduce symptoms.
  • Help you stay active.

의료 관리

Members who need extra help get a Personal Care Manager. The care manager is there for you throughout your medical journey. 다음을 수행합니다.

  • Work with you to develop a plan of care that meets your individual needs.
  • Coordinate with family members, caregivers and health care providers.
  • Help get additional services or support you may need.

카이로프랙틱 서비스

Our plan includes visits for chiropractic care.

  • Members of all ages can get up to 15 visits per year.
  • Members under 21 may get additional visits with prior authorization.

의사 선택

From regular checkups to preventive health screenings, we want to make sure you get access to the right care at the right time.

You get a primary care physician (PCP), who is your main doctor. If you don't have a doctor or if your doctor is not in our network, we can help you find a new one close to you.

귀하의 PCP는 다음을 주로 담당하는 주치의입니다.

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

출산 센터의 선택

Where a mother has her baby is an important choice. That's why pregnant moms can pick from hundreds of hospitals across Ohio.

We encourage mothers-to-be to tour the hospital's birthing center. This way they will be familiar with it. And be more relaxed when they have their baby.

치아 관리

Checkups and cleanings are covered.

Exams and cleanings every six months help keep teeth and gums strong and healthy. If you obtain prior approval for a dental problem that needs to be fixed, that's covered as well.

Employment Physicals

Some employers or training programs require a physical before a person can start work. Our plan covers pre-employment physical exams.

장비 및 소모품

The health and safety of our members at home are important.

Our plan covers medical equipment ordered by a member's doctor or care manager. 다음과 같은 소모품이 필요할 수 있습니다.

  • 병상
  • 산소 탱크
  • 휠체어 또는 보행보조기구

For some of these services prior approval is required. Please check your member handbook for these details.

발 관리

We provide the exams and treatments needed to help keep your feet in great shape. And for those with diabetes, good foot care can help prevent much more serious problems.

발치료 보험 적용 범위는 다음과 같습니다.

  • Routine foot exams.
  • 발 관리 및 알맞은 신발 선택에 대한 팁
  • 신경 손상의 위험 신호에 대한 정보

청력 관리

Trouble hearing can affect a person's everyday life in many ways. 당사 플랜에는 청력을 보호하는 데 도움이 되는 서비스 및 지원이 포함되어 있습니다.

보장 내용은 다음과 같습니다.

  • 검사, 치료 및 테스트
  • With prior approval, hearing aids and batteries.

Healthchek

Healthchek covers medical exams, immunizations (shots), health education, and laboratory tests for Medicaid eligible individuals under the age of 21. Healthchek also covers medical, vision, dental, hearing, nutritional, developmental, and behavioral health exams, in addition to other care to treat physical, behavioral or other problems or conditions found by an exam. Learn more information about Healthchek. 

Healthy First Steps®

Healthy First Steps를 통해 귀하와 아기의 건강한 미래를 준비하고 많은 리워드까지 받으세요. 저희 프로그램은 귀하와 아기를 건강하게 유지하기 위한 올바른 조치를 취할 것입니다. 게다가 가입만 해도 20달러를 받을 수 있습니다. 

당사는 다음과 같은 경우에 가입자에게 도움을 드립니다.

  • 임신 진료 제공자 및 소아과 의사(소아 의사)를 선택하는 경우.
  • 진료 및 검진을 예약하고 병원 방문을 위한 교통편을 준비하는 경우.
  • 전체 임신 기간과 출산 후 첫 15개월 동안 방문할 때마다 리워드를 받는 경우.
  • 수유모를 위한 유축기 등 소모품을 받는 경우.
  • 여성, 영유아 및 어린이(WIC) 서비스와 같은 커뮤니티 리소스에 연결하는 경우.

건강 리워드

간단한 예방 조치가 대대적인 치료를 방지해 줄 수 있습니다. 그리고 리워드 혜택을 받을 기회도 제공합니다.

Earn great gifts for you or your child by doing things like:

  • 자녀 건강 검진 완료
  • Getting lab tests.
  • Recording the family's health activities.

가정간호

If you are living with a long-term health condition, disability or leaving the hospital after surgery or a serious illness, you may need extra support. This can include help with day-to-day tasks like cleaning, cooking or dressing. 회복 상태를 확인하기 위한 가정 방문 진료가 필요할 수도 있습니다.

당사 플랜에서는 승인을 전제로 다음을 보장합니다.

  • 가정 방문 진료
  • 병원 침대, 보행 보조기, 휠체어 등의 의료 장비
  • 일회용 의료 소모품
  • 개인 위생 또는 가사 보조

입원

This plan pays for all medically necessary expenses related to a hospital stay. 따라서 마음 편히 휴식을 취하고 치료를 받을 수 있습니다.

당사 플랜은 다음을 보장합니다.

  • 간호
  • 숙식
  • 소모품 및 장비
  • 치료 및 요법
  • 진단 검사 및 검진

And after leaving the hospital, you are not alone. 자택에서 후속 치료를 통해 계속 치료를 받을 수 있도록 보장해 줍니다.

신장 질환 치료

신장 질환은 중증 질환입니다. After the kidneys stop working regular treatments, called renal dialysis, or an organ transplant are needed to live. 투석 시에는 건강한 신장의 기능과 동일한 기능을 가진 기계를 사용하여 혈액을 정화합니다.

플랜의 혜택으로는 다음이 있습니다.

  • 투석
  • 의약품
  • 건강 교육 및 지원
  • 장기 이식(필요한 경우)

검사실 및 X-레이

문제가 무엇인지 알고 또 이를 일찍 발견할 수 있다면 그 차이는 큽니다. With prior approval, our plan covers:

  • 검사실 및 검사
  • X-레이, 스캔 및 기타 영상 처리

건강을 개선하거나 최상의 상태를 유지하는 데 필요한 정보를 얻을 수 있도록 지원해 드립니다.

언어 지원

원하는 언어로 정보를 받을 수 있습니다. 요청하기만 하면 됩니다. We also have people at our service centers who speak more than one language. 당사는 여러 언어의 통역자를 보유하고 있습니다.

의약품

Our plan includes prescription drugs and refills for prescriptions written by your doctor or specialist. Thousands of drugs are covered.

You pay a co-pay amount, if needed, and you can get your prescription drugs at any in-network pharmacy.

Member Services Representative

Meet your personal health plan assistant. Our job is to help you get the most of your benefits. 당사는 다음과 같은 서비스를 도와드릴 수 있습니다.

  • Schedule doctor, dental and vision appointments.
  • Arrange for extra support services.
  • Complete a health risk assessment.
  • Stay in touch with you.

Mental Health and Substance Abuse Services

Get help with personal problems that may affect your mental or physical health. These may include stress, depression, anxiety or drugs and alcohol abuse. Our services also include:

  • Therapy
  • Counseling
  • 의약품

For some of these services prior approval is required. 자세한 내용을 알아보려면 가입자 서비스에 문의하십시오.

No Copays

With our plan there are no copayments for covered services.

Members get:

  • Care from highly skilled and compassionate doctors.
  • Treatments at respected hospitals and clinics.
  • Home medical equipment and supplies to help them be their best.

NurseLine

곤란한 경우에 의학적 문제 및 상황이 발생하기도 합니다. For questions about health, call a nurse 24/7. Call:  1-866-801-4407, TTY 711.

NurseLine 간호사는 다음을 수행합니다.

  • 증상을 경청합니다.
  • Provide guidance on self-care.
  • Advise the member about getting care at a doctor visit or an urgent care center.
  • Help know when to go to the emergency room.

Obesity Care

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.

태아기 진료

임신은 어려운 과정입니다. It's a journey the new mother wants to make with the help of friends, family and a pregnancy doctor, or OB-GYN.

당사 플랜에서는 권장되는 모든 태아기 임상 진료 및 검사가 보장됩니다.

이러한 진료 시 클리닉에서는 다음을 수행합니다.

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

Residential Care

After a serious illness, surgery or injury, you may need extra nursing and therapy.

With prior approval, our plan covers short stays in a rehabilitation center where you can heal. 포함되는 항목:

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

Call Member Services for information on available providers.

간병 휴식

Caring for a child recovering from an illness, surgery or with special health needs is an act of love. It can also be physically and emotionally exhausting. This service is for SSI members under 21 years of age.

금연

대부분의 사람들은 흡연이 건강에 미치는 악영향을 알고 있습니다. 금연해야 한다는 사실도 압니다. We support our members with coaching while they quit. 당사는 지도와 소모품을 통해 금연하는 동안 가입자를 지원합니다. 강의만 제공하는 것은 아닙니다.

치료 서비스

Physical, occupational and speech therapy can help members recover from a serious injury or illness, or simply reach their full potential.

With prior approvals, our plan covers visits for:

  • 작업 치료
  • 물리 치료
  • 언어 치료
  • 재가 치료

교통편

Our plan provides up to 30 one way or 15 round trip rides to medical appointments and other needed services. Call 1-800-895-2017 (TTY 711) to schedule a ride. You must call at least 48 hours ahead of time..  

Rides are available to:

  • Dental and vision appointments.
  • 약국
  • Women, infants and children (WIC) visits.
  • Job and Family Services offices for benefits redetermination.

UnitedHealthcare OMW™

UnitedHealthcare On My Way™ is an engaging, interactive program that informs Ohio youth and helps prepare them for many real-world situations that lie ahead. UnitedHealthcare OMW™ teaches the practical skills of managing bank accounts, securing housing, creating a resume, finding job training and applying for college. It is a reliable, go-to resource they can use throughout their journey toward independent living.

긴급 치료

생명을 위협하지는 않지만 즉각적인 치료를 요하는 부상 또는 급성 질환도 있습니다. 따라서 당사 플랜은 다음과 같은 케어를 보장합니다.

  • 응급 치료 센터
  • Federally qualified health centers.
  • 기타 예약이 필요 없는 클리닉

시력 관리

You'll get the care, eyeglasses and treatment that let you see life more clearly.

혜택에는 다음이 포함됩니다.

  • Annual eye exams.
  • Glasses and $150 toward contact lenses.

You also can chose from an expanded selection of frames.

This benefit is offered by March Vision.

건강 진료

Well visits with your doctor can help keep you and your family healthy. 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.

Wellhop for Mom & Baby

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.

가입자 자료

이용 가능한 자료 보기(모달 창 열림)

자세히 알아보기

UnitedHealthcare Community Plan

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