Hla mus rau cov ntsiab lus xub thawj
Cov Ntsiab Lus Xub Thawj

UnitedHealthcare Community Plan - MO HealthNet Managed Care Cov Lus Tshab Txhais

A

  • Kev Qhia Ua Ntej

    A decision about your health care that you make ahead of time in case you are ever unable to speak for yourself. This will let your family and your doctors know what decisions you would make if you were able to.

  • ASC/SPU

    Ambulatory surgical center/short procedure unit.

B

  • Cov Kev Pab

    Services, procedures and medications that UnitedHealthcare Community Plan will cover for you.

C

  • Clinical Care Management

    One-on-one help by a nurse providing education and coordination of UnitedHealthcare Community Plan benefits, tailored to your needs.

D

  • Disenrollment

    To stop your membership in UnitedHealthcare Community Plan.

E

  • Kev kub ntxhov

    A situation where your health, or the health of an unborn baby, could be threatened. Medical help is needed right away.

F

  • Federal Poverty Level (FPL)

    Poverty income thresholds by family size that are annually updated by the Census Bureau for inflation.

  • Kev dag

    An untruthful act – an example is someone other than you using your UnitedHealthcare Community Plan member ID card and pretending to be you.

H

  • Home Health Agency

    A company hired by UnitedHealthcare Community Plan to provide care for you in your home.

I

  • ID Card

    An identifcation card that says you are a UnitedHealthcare Community Plan member. You should have this card with you at all times.

  • Informed Consent

    That all medical treatments have been explained to you; you understand and agree to them.

  • Neeg Mob Pw Hauv Tsev Kho Mob

    When you are admitted into a hospital for a length of time.

M

  • Medical Necessity

    Your health care provider decides if a treatment, admission, procedure, medical supply, equipment, service or supply is medically necessary.

  • Tswv cuab

    A person who is eligible for UnitedHealthcare Community Plan.

P

  • Primary Care Physician (PCP)

    A doctor you choose to be your family physician. They have their own private practices.

  • Prior Authorization

    Your MO HealthNet Managed Care health plan’s method of pre-approving certain services.

  • Kws Pab Kho Mob

    Any medical professional that UnitedHealthcare Community Plan has contracted with to take care of you.

  • Daim Ntawv Teev Npe Cov Kws Muab Kev Kho Mob

    A list of providers who participate with UnitedHealthcare Community Plan to help take care of your healthcare needs.

S

  • Special Needs Unit (SNU)

    A voluntary service offered by UnitedHealthcare Community Plan that can give you extra help in understanding and using your benefits if you have a disability or other special need.

  • Kws Kho Mob Tshwj Xeeb

    Any doctor who has special training for a specific condition or illness.

U

  • Kev Kho Mob Sai

    Urgent care appointments for physical or behavioral illness injuries which require care immediately but are not emergencies such as high temperature, persistent vomiting or diarrhea, symptoms which are of sudden or severe onset but which do not require emergency room services, you must been seen within twenty-four (24) hours.

W

  • WIC

    Women, Infants and Children program, a supplemental nutrition program that provides nutritious food, education support and health care referrals for women, infants and children.

Rov qab mus rau sab saum toj ntawm nplooj ntawv

Kawm kom paub ntxiv


Individual & Family ACA Marketplace Plans Disclaimer
(swb txav hauv lub npov no txhawm rau saib)

Cov txiaj ntsig tau piav qhia tej zaum yuav siv tsis tau nyob hauv txhua txoj kev npaj los sis hauv txhua lub xeev. Qee qhov kev npaj tej zaum yuav tau thov kev sib koom them tus nqi kho mob, txiav tawm thiab / los sis nyiaj pab them tus nqi rau cov txiaj ntsig no. Txoj cai no muaj kev cais tawm, kev txwv, txo cov txiaj ntsig, thiab cov ntsiab lus raws li txoj cai yuav raug yuam ua txuas ntxiv mus los sis muab txiav tawm. For costs and complete details of the coverage, review your plan documents, call or write your insurance agent or the company, whichever is applicable. Kev npaj tshwj xeeb thiab cov txiaj ntsig sib txawv raws li cov cheeb tsam txog kev pab them nqi thiab raws li txoj kev npaj. Thov tshuaj xyuas cov ntsiab lus ntawm cov kev npaj kom muaj kev kawm paub ntau ntxiv.

UnitedHealthcare Individual & Family plans medical plan coverage offered by: UnitedHealthcare of Arizona, Inc.; Rocky Mountain Health Maintenance Organization Incorporated in CO; UnitedHealthcare of Florida, Inc.; UnitedHealthcare of Georgia, Inc; UnitedHealthcare of Illinois, Inc.; UnitedHealthcare Insurance Company in AL, KS, LA, MO, NJ, and TN; Optimum Choice, Inc. in MD and VA; UnitedHealthcare Community Plan, Inc. in MI; UnitedHealthcare of Mississippi, Inc.; UnitedHealthcare of New Mexico, Inc.; UnitedHealthcare of North Carolina, Inc.; UnitedHealthcare of Ohio, Inc.; UnitedHealthcare of Oklahoma, Inc.; UnitedHealthcare of South Carolina, Inc.; UnitedHealthcare of Texas, Inc.; UnitedHealthcare of Oregon, Inc. in WA; and UnitedHealthcare of Wisconsin, Inc.  Administrative services provided by United HealthCare Services, Inc. or its affiliates.

This policy has exclusions, limitations, reduction of benefits, and terms under which the policy may be continued in force or discontinued. Rau cov nqi them thiab cov ntsiab lus txog kev pab them nqi tag nrho, hu los sis sau ntawv xa mus rau lub qhov chaw sawv cev ntawm tuav pov hwm kev noj qab haus huv ntawm koj los sis lub tuam txhab, qhov twg yog qhov tsim nyog. By responding to this offer, you agree that a representative may contact you.

1 Unless otherwise required, benefits are available only when services are delivered through a Designated Virtual Network Provider. Virtual visits are not intended to address emergency or life-threatening medical conditions and should not be used in those circumstances. Services may not be available at all times, or in all locations, or for all members. Check your benefit plan to determine if these services are available. Cov kev ntaus nqi rau cov ntaub ntawv tej zaum yuav coj mus siv. Certain prescriptions may not be available and other restrictions may apply.

2 Tier 2 prescriptions for $5 or less not available on all medications. 3-month fills apply to select maintenance medications only. Applicable formulary requirements such as prior authorization and quantity limits may apply to your pharmacy benefits. Luv nqi ntawm Walgreens siv tau txog thaum 12/31/24. Discount valid only for in-store purchases of eligible Walgreens brand health and wellness products by current members eligible for the UnitedHealthcare discount program. Kev txo nqi tsis siv online. Txog rau daim ntawv teev npe txhij txhua ntawm cov khoom lag luam thiab cov kev cais tawm fab kev noj qab haus huv thiab kev noj qab nyab xeeb ntawm hom Walgreen, thov mus saib tau rau ntawm www.walgreens.com/smartsavings.

Tau Hloov Tshiab Zaum Kawg Nkaus: 04.18.2024 at 12:11 AM CDT

Cov ntaub ntawv qhia kev tsis lees txais kev thaj tsob
(swb txav hauv lub npov no txhawm rau saib)

Puas yog tab tom nrhiav lub vev xaib (website) Medicaid ntawm tsoom foov teb chaws? Saib tau nyob rau ntawm no Medicaid.gov.

UnitedHealthcare cov phiaj xwm Dual Complete

Cov phiaj xwm kho mob yog them los ntawm Lub Tuam Txhab Muab Is Saws Las Tuav Pov Hwm UnitedHealthcare los sis ib lub ntawm cov tuam txhab tau koom lag luam ua ke, ib lub koom txoos Medicare Advantage uas muaj Medicare daim ntawv cog lus ua hauj lwm ua ke thiab ib daim ntawv cog lus nrog lub Xeev Lub Khoos Kas Medicaid. Qhov yuav rau npe rau hauv qhov phiaj xwm kho mob yog nyob ntawm seb daim phiaj xwm kho mob daim ntawv sib cog lus tshiab nrog Medicare hais li cas. Daim phiaj xwm kho mob no muaj rau txhua tus neeg uas muaj ntawv pab kho mob Medical Assistance tuaj tim Xeev thiab tuaj tim Medicare tuaj tib si. Cov nyiaj pab, cov xim xoo zoo tshwj xeeb thiab/los sis cov cuab yeej koos pis tawj yuav sib txawv mus raws qhov phiaj xwm kev npaj tuav pov hwm kev kho mob/cheeb tsam. Tej zaum yuav tau siv cov ciaj ciam, cov kev cais tawm thiab/los sis cov kev txwv ntawm pab pawg kho mob koom tes ua ke. Cov kev pab, cov nqi them tus nqi tuav pov hwm thiab/los sis cov nqi feem nrog them/koom them kev tuav pov hwm tej zaum yuav muaj pauv thaum Lub Ib Hlis tim 1 txhua xyoo.

Daim ntawv tsis lees paub txog qhov nyiaj pov hwm kev kho mob

Cov phiaj xwm kev npaj tuav pov hwm kev kho mob uas Xav Tau Kev Pab Tshwj Xeeb Ob Yam Tib Si muab ib qho nyiaj pov hwm kev kho mob $0 rau cov tswv cuab uas xav tau Kev Pab Tshwj Xeeb (Nyiaj Pab Rau Cov Uas Khwv Tau Nyiaj Los Tsawg).

Daim ntawv tsis lees paub txog qhov nyiaj pab them nqi

Cov nyiaj pab them nqi, cov yeeb yam, thiab/los sis cov cuab yeej yuav sib txawv raws daim phiaj/cheeb tsam. Tej zaum yuav tau siv cov ciaj ciam, cov kev cais tawm thiab/los sis cov kev txwv ntawm pab pawg kho mob koom tes ua ke.

Kev tsis kam lees txoj kev thaj tsob Tus Xov Tooj Maj Rawm Ntawm Tus Kws Tu Neeg Mob

Qhov kev pab no yuav tsum tsis txhob muab siv rau cov kev xav tau ntawm kev mob xwm txheej ceev los sis maj rawm. Yog tias yog xwm txheej ceev, hu rau 911 los sis mus rau ntawm ib chav kho mob xwm txheej ceev nyob ze ntawm koj tshaj plaws. Cov ntaub ntawv tau muab los nyob rau qhov kev pab cuam no tsuas yog siv rau lub hom phiaj ua kev paub xwb. Cov kws tu neeg mob tsis muaj peev xwm kuaj pom cov teeb meem los sis xav kom yuav tsum mus kho mob thiab lawv tsis yog ib qho kev sib hloov pauv rau koj tus kws muab kev saib xyuas kho mob qhov kev saib xyuas kho mob. Koj cov ntaub ntawv kho mob yuav raug muab kaw cia tsis pub lwm tus paub raws nraim li txoj cai lij choj. Qhov kev pab cuam tsis yog ib qho txheej txheem pab cuam ntsig txog is saws laws tuav pov hwm thiab tej zaum yuav raug txiav tawm thaum twg los tau. Tus Xov Tooj Hu Maj Ceev Rau Tus Kws Tu Xyuas Neeg Mob (Nurse Hotline) tsis yog siv rau thaum muaj xwm txheej kub ceev, tsuas yog siv rau lub hom phiaj hu qhia cov ntaub ntawv kaus xwb.

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid plan)

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid plan) yog ib qhov phiaj xwm kho mob uas tau cog lus nrog Medicare thiab Ohio Medicaid tib sid kom muab cov kev pab ntawm ob qhov khoos kas pab cuam rau cov neeg rau npe txais kev pab. 

UnitedHealthcare Connected® (Medicare-Medicaid plan)

UnitedHealthcare Connected® (Medicare-Medicaid txoj phiaj xwm) yog ib qhov phiaj xwm kho mob uas tau cog lus nrog Medicare thiab Texas Medicaid ob yam tib si kom muab cov kev pab ntawm ob qhov khoos kas pab cuam rau cov neeg rau npe txais kev pab.

UnitedHealthcare Connected® for One Care (Medicare-Medicaid plan)

UnitedHealthcare Connected® for One Care (Medicare-Medicaid plan) yog ib qhov phiaj xwm kho mob uas tau cog lus nrog Medicare thiab MassHealth (Medicaid) tib sid kom muab cov kev pab ntawm ob qhov khoos kas pab cuam rau cov neeg rau npe txais kev pab. 

UnitedHealthcare Connected® cov lus hais txog kev pab

Qhov nod tsis yog daim ntawv teev npe uas muaj txhij txhua. Cov lus qhia txog cov kev pab yog ib qhov lus xaus tseem ntsiab luv luv xwb, nws tsis yog piav txhij txhua txog cov kev pab. Yog xav paub cov ntaub ntawv qhia paub ntau ntxiv ces tiv tauj mus rau qhov phiaj xwm kho mob los sis nyeem phau ntawv qhia tswv cuab. Tej zaum nws yuav muaj cov kev txwv, cov nyiaj sib koom them, thiab cov kev tsis pub ua tshaj. Yog xav paub ntxiv, hu rau UnitedHealthcare Connected® Lub Chaw Pab Cuam Tswv Cuab los sis nyeem UnitedHealthcare Connected® phau ntawv qhia tswv cuab. 

UnitedHealthcare Senior Care Options (HMO SNP) txoj phiaj xwm

UnitedHealthcare Senior Care Options (SCO) yog ib qho phiaj xwm kho mob uas Tau Koom Tes Ua Ke Saib Xyuas Kho Mob uas muaj daim ntawv cog lus nrog Medicare thiab daim ntawv cog lus nrog rau qhov txheej txheem pab cuam Commonwealth of Massachusetts Medicaid. Qhov yuav rau npe rau hauv qhov phiaj xwm kho mob yog nyob ntawm seb daim phiaj xwm kho mob daim ntawv sib cog lus tshiab nrog Medicare hais li cas. Qhov phiaj xwm kho mob no yog ib qho txheej txheem pab cuam pub dawb raws siab yeem uas muaj rau txhua leej uas muaj hnub nyoog 65 xyoo thiab cov neeg laus dua uas tsim nyog rau MassHealth Standard thiab Original Medicare thiab tsis muaj lwm yam Is Saws Las Tuav Pov Hwm Kho Mob uas muaj tag nrho txhua yam kev kho mob nyob rau hauv, tshwj kiag Medicare. Yog tias koj muaj MassHealth Standard, tab sis koj tsis tsim nyog rau Original Medicare, tej zaum koj tseem muaj cai tso npe rau hauv peb qhov phiaj xwm kho mob MassHealth Senior Care Option thiab tau txais tag nrho koj cov kev pab MassHealth los ntawm peb qhov txheej txheem pab cuam Senior Care Options (SCO).

Kev tsi kam lees kev muab qhab nias hnub qub

Txhua-Txhua Xyoo, Medicare ntsuam xyuas cov phiaj xwm kho mob raws kev muab qhab nias 5-Lub Hnub Qub. Qhov kev ntaus nqi muab 5-Lub Hnub Qub siv tau rau daim phiaj kho mob hauv lub xyoo 2024.

Cov ntaub ntawv tseem ceeb hais txog tus kws kho mob

Txoj kev xaiv yog koj li

Peb yuav muab cov ntaub ntawv qhia rau koj txhawm rau pab koj txiav txim siab los xaiv, xws li cov ntaub ntawv pov thawj txheeb txog cov kws kho mob thiab cov kws kho mob txawj tshaj lij. Txawm li cas los xij, cov ntaub ntawv qhia no, tsis yog kev pom zoo los ntawm ib tus kws kho mob los sis kws kho mob txawj tshaj lij qhov kev tsim nyog rau koj cov kev xav tau.

Cov kws muab kev pab kho mob uas muaj los ntawm daim ntawv thov no yuav tsis tas cuam tshuam txog tag nrho ntawm UnitedHealthcare lub network ntawm cov kws muab kev pab kho mob uas tau cog lus. Tej zaum yuav muaj cov kws muab kev pab kho mob los sis qee yam kev txawj tshwj xeeb uas tsis suav nrog hauv daim ntawv thov no uas yog ib feem ntawm peb lub network. Yog hais tias koj tsis pom tus kws muab kev pab kho mob uas koj tab tom nrhiav, koj tuaj yeem tiv tauj ncaj nqa mus rau tus kws muab kev pab kho mob txhawm rau txheeb xyuas qhov kev koom tes nrog UnitedHealthcare lub network, los sis tiv tauj rau Feem Saib Xyuas Cov Neeg Qhua ntawm tus naj npawb xov tooj hu dawb uas muaj nyob hauv koj daim npav ID UnitedHealthcare. Dua li nod lawm peb kuj tseem qhia tias, ua ntej yuav mus ntsib ib tus kws kho mob twg, suav nrog cov kws kho mob txawj tshwj xeeb, koj hu rau tus kws kho mob lub chaw ua hauj lwm txhawm rau txheeb xyuas lawv qhov kev koom tes thiab kev npaj muaj.

Qee cov neeg muab kev pab kho mob hauv lub network yuav raug ntxiv los sis tshem tawm ntawm peb lub network tom qab cov npe no tau hloov kho. Peb tsis lav tau tias txhua tus kws muab kev pab kho mob tseem yuav txais cov tswv cuab tshiab ntxiv.

Cov kws muab kev pab kho mob uas tsis nyob hauv pab pawg kho mob koom tes ua ke/tsis muaj-ntawv cog lus yog tsis muaj kev sib cuam tshuam txog qhov kho cov tswv cuab nyob ntawm lub phiaj xwm UnitedHealthcare, tsis xam nrog thaum muaj xwm txheej ceev. Thov hu rau tus nab npawb pab cuam tub lag luam los sis mus saib koj li Pov Thawj ntawm Kev Pab Them Rau rau kev paub ntxiv, xam nrog rau tus nqi- sib faib them uas yuav siv rau cov kev pab cuam nyob sab nraud-ntawm nev vawj.

Daim ntawv ceeb toom Ntawm Tsab Cai Hais Txog Cov Neeg Meskas Uas Muaj Mob Xiam Oob Khab

Raws li cov kev cai ntawm tsoom fwv teb chaws tsab cai Americans with Disabilities Act ntawm 1990 thiab Tshooj lus 504 ntawm tsab cai Rehabilitation Act ntawm 1973 ("ADA"), UnitedHealthcare Lib Tuam Txhab Muab Is Saws Las Tuav Pov Hwm muab cov kev nkag cuag tau cov kev pab them nqi kho mob tag nrho thiab sib npaug thiab tsis pub muaj kev ntxub ntxaug rau cov tib neeg uas muaj qhov kev tsis taus raws li lub hauv paus ntawm kev tsis taus nyob rau hauv nws cov kev pab cuam, cov khoos kas pab, los yog tej kev ua dej num.

Cov ntawv xa mus rau lwm qhov

Cov kws muab kev kho mob koom hauj lwm ua ke yuav pab tau koj thiab cov neeg hauv koj tsev uas muaj npe kom tau txais qhov kev pab kho tus mob uas xav tau. Kev nkag mus cuag tau rau cov kws kho mob txawj tshwj xeeb tej zaum yuav tau txais kev koom tes los ntawm koj tus kws kho mob xub thawj.

Daim ntawv thov daim ntawv teev cov npe

Cov ntawv theej ntawm cov npe kws muab kev pab kho mob hauv network muaj rau cov tswv cuab yam tsis tau them nqi los ntawm kev hu rau tus xov tooj feem pab cuam cov neeg qhua uas nyob nraum qab ntawm koj daim npav ID. Cov neeg uas tsis yog cov tswv cuab tuaj yeem rub tawm thiab luam tawm cov txiaj ntsig tshawb fawb los ntawm cov npe hauv online.

Cov ntaub ntawv uas tsis raug

Yog xav tshaj tawm qhia cov ntaub ntawv uas tsis raug, xa email provider_directory_invalid_issues@uhc.com. Lub npov (box) sau email no yog muab rau cov tswv cuab qhia paub txog cov ntaub ntawv uas sau tsis yog lawm (xws li qhov chaw nyob, tus xov tooj, thiab lwm yam) cov ntaub ntawv qhia nyob hauv online los yog nyob hauv cov ntawv teev npe. Kev qhia cov teeb meem siv lub npov sau ntawv li no yuav ua rau xa mus txog tus kws kho mob qhov chaw ua hauj lwm kom xyuas cov ntaub ntawv uas muab tso rau hauv daim ntawv teev npe, uas tuaj yeem siv sij hawm kwv yees li 30 hnub. Sawv daws kuj tseem siv tau lub xov tooj hu qhia paub txog tej yam sau tsis yog li no thiab. UnitedHealthcare Cov Tswv Cuab yuav tsum hu rau tus xov tooj uas muaj nyob sab nraum qab ntawm lawv daim npav ID, thiab cov uas tsis yog UnitedHealthcare cov tswv cuab tuaj yeem hu rau 1-888-638-6613 / TTY 711, los sis siv qhov kev pab hu rau cov neeg tsis hnov lus zoo uas koj nyiam.

Tshaj tawm txog kev puas tsuaj los sis xwm txheej kub ceev

Yog tias koj raug cuam tshuam los ntawm kev puas tsuaj los sis kev tshaj tawm xwm txheej ceev los ntawm Thawj Tswj Hwm los sis tus thawj kav teb chaws, los sis tshaj tawm txog kev kub ntxhov rau pej xeem kev noj qab haus huv los ntawm Tus Thawj Saib Xyuas Kev Noj Qab Haus Huv thiab Cov Kev Pab Cuam Tib Neeg, muaj qee yam kev txhawb nqa ntxiv rau koj.

  • Tshooj A, Tshooj B, thiab cov nyiaj pab ntxiv ntawm txoj phiaj xwm rau Tshooj C yuav tsum tau muab rau ntawm cov chaw kho mob tsis muaj-ntawv cog lus (nco ntsoov tias Tshooj A thiab Tshooj B cov txiaj ntsig pab yuav tsum tau txais cov txiaj ntsig ntawm Medicare cov chaw kho mob muaj ntawv ua pov thawj);
  • Yog tias tsim nyog, cov cai hais txog ntawm tus neeg saib xyuas qhov rooj muaj ntaub ntawv ua pov thawj ces raug zam tag nrho;
  • Kev sib koom them nqi kho mob uas tsis nyob hauv pab pawg koom tes ua ke uas tau txais kev pom zoo raws li qhov phiaj xwm kev npaj mus rau cov nqi sib koom them hauv pab pawg koom tes ua ke yuav raug txo qis mus ib ntus; thiab
  • Yog tias txhua yam hloov pauv tag nrho (xws li txo tus nqi sib faib them thiab kev tso cai zam) muaj txiaj ntsig rau cov tswv cuab, yog li ntawd qhov kev ceeb toom 30-hnub yuav tsum tau zam rau cov tswv cuab.

Cov phiaj xwm yuav rov ua hauj lwm li qub 30 hnub tom qab tau tshaj tawm thawj zaug, yog tias CMS tsis tau muab hnub kawg rau kev puas tsuaj los sis xwm txheej ceev.

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