UnitedHealthcare Community Plan of California Medi-Cal

Medicaid

UnitedHealthcare Community Plan of California includes a range of benefits. Children, pregnant women, families, adults and seniors and people with disabilities may qualify based on income. View the benefits below to see what our plan covers.

Avantaj & Karakteristik

Swen pou moun ki ansante ak Moun ki malad

Get the assistance you need to be at your best — or to get better if you are injured or sick. Li gen ladann:

  • Vizit pou moun ansante. Annual checkups to help keep you healthy. 
  • Chwazi Doktè w vle. Jwenn yon doktè ou fè konfyans, nan rezo nou an. 
  • Piki ak Vaksen. Routine shots to help protect against illness. 
  • Swen Ijan. Convenient care for a sudden illness or injury. 
  • NurseLine℠. Pale avèk yon enfimyè otorize 24/7.  
  • Laboratwa ak Radyografi. Tès laboratwa, radyografi, ak imajri dyagnostik kouvri. 
  • Medikaman. Fill prescriptions at local pharmacies.

Nothing is more important than the health and well-being of a mother and your baby. Se poutèt sa plan avantaj nou yo gen ladan:

  • Choice of Doctor. Find a doctor or OB/GYN you trust in our network. 
  • Prenatal Visits. Care for you before your baby is born.
  • Baby Blocks™. Earn rewards for completing checkups on time during and after your pregnancy.
  • Text4Baby. Receive text messages with helpful tips and reminders.

Si ou gen opresyon, dyabèt oswa yon lòt pwoblèm alontèm, ou ka konte sou nou. Plan nou an asire ou jwenn swen ak sèvis ou bezwen yo. Avantaj yo gen ladan yo:

  • Care Manager. If you qualify, get personal help managing health conditions. 
  • Disease Management. Focused care for those with chronic health needs, like asthma and diabetes. 
  • Sante mantal. Nou garanti konsèy ak lòt tretman. 
  • Swen Rezidansyèl. Sejou kout nan yon etablisman swen pandan w ap refè nan maladi oswa chòk.

Asire ke kapasite pou ou wè ak pou ou tande nan meyè eta yo kapab ye. Avantaj yo gen ladan yo:

  • Vision Care. Routine eye exams every two years. 
  • Eyeglasses. For members under 21 and pregnant women, if needed.

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. Some benefits include:

  • Ekipman ak Founiti. In-home medical and safety equipment. 
  • Home Health Care. Medical and personal care in your home, if medically needed.

Sometimes members need a little extra help using their health plan. Lè sa yo, ou ka konte sou:

  • Transportation. Get rides to and from doctor appointments and more. 
  • Èd nan domèn Lang. Translated materials and interpreters who are ready to help you 24/7. 
  • Sèvis pou Manm. Available 7 a.m. to 7 p.m. PT, Monday – Friday. 
  • Member Advocate. Local advocates to get you information, services and care. 
  • NurseLine℠. Pale avèk yon enfimyè otorize 24/7.

UnitedHealthcare Community Plan of California, Inc. has health education programs, services and materials to help you improve your health and manage illness. 

These are available to you for free. Many of the materials are offered in different languages and/or in formats for the hard of hearing and visually impaired. 

Baby Blocks™

Build a healthy future for you and your baby — and earn great rewards — through Baby Blocks. This program helps keep you and your baby healthy during your pregnancy and your baby's first 15 months of life.

Baby Blocks includes:

  • Email appointment reminders.
  • Fun program to keep track of appointments.
  • Reward cards for clothing and more.

Care Manager

Do you have a serious health problem? If so, our case managers are in your corner. Yo pral:

  • Esplike tèm medikal yo nan yon langaj ki senp.
  • Coordinate your doctor appointments.
  • Provide your care team with your medical records.

  • The care manager will stay with you throughout your medical journey. Li pral:
  • Think beyond your medical needs.
  • Make sure you have support at home.
  • Chwazi Doktè

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

    PCP w la se doktè prensipal ou pou:

    • Swen prevantif.
    • Tretman si w malad oswa blese.
    • Rekòmandasyon kay espesyalis pou sèten pwoblèm medikal.

    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.  

    Diabetes Prevention Program

    Diabetes Prevention Program is a covered benefit offered to our eligible members designed to assist in preventing or delaying the onset of Type 2 Diabetes by making lifestyle changes.

    UnitedHealthcare Community Plan is pleased to offer a healthy lifestyle program at no cost to qualified members. The program can help you make small changes to live a healthy life, lose weight and lower your chance of developing type 2 diabetes.

    To see if you qualify:

    • Take a 1-minute quiz at solera4me.com/UHC.
    • Or call 1-888-305-6015, TTY 711, Monday - Friday, 6 a.m. - 6 p.m. PT. 

    Disease Management

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

    We have special programs for:

  • Chronic obstructive pulmonary disease (COPD)
  • Coronary artery disease (CAD)
  • Congestive heart failure (CHF)
  • Dyabèt
  • High Risk Pregnancy and Neonatal Intensive Care Unit
  • Sickle Cell Disease
  • Ekipman ak Founiti

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

    Our plan covers medical equipment ordered by a member's doctor or care manager. Sa ka gen ladan founiti tankou:

    • Tank oksijèn.
    • Wòkè oswa chèz woulant.

    Foot Care

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

    Our podiatry coverage includes:

  • Routine foot exams.
  • Tips about foot care and choosing the right shoes.
  • Information about nerve damage warning signs.
  • Health Homes Program (HHP)

    UnitedHealthcare Community Plan of California covers Health Homes Program (HHP) services for Members with certain chronic health conditions. These services are to help coordinate physical health services, behavioral health services, and community-based long term services and supports (LTSS) for Members with chronic conditions.

    You may be contacted if you qualify for the program. You can also call UnitedHealthcare Community Plan of California, or talk to your doctor or clinic staff, to find out if you can receive HHP services.

    You may qualify for HHP if:

    • You have certain chronic health conditions. You can call UnitedHealthcare Community Plan of California, to find out the conditions that qualify; and
    • You meet one of the following:
      • You have three or more of the HHP eligible chronic conditions;
      • You stayed in the hospital in the last year;
      • You visited the emergency department three or more times in the last year; or
      • You do not have a place to live.

    You do not qualify to receive HHP services if:

    • You receive hospice services; or
    • You have been residing in a skilled nursing facility for longer than the month of admission and the following month.

    Covered HHP Services:

    HHP will give you a care coordinator and care team that will work with you and your health care providers, such as your doctors, specialists, pharmacists, case managers, and others, to coordinate your care. UnitedHealthcare Community Plan of California provides HHP services, which include:

    • Comprehensive Care Management
    • Care Coordination
    • Health Promotion
    • Comprehensive Transitional Care
    • Individual and Family Support Services
    • Referral to Community and Social Supports

    Cost to Member:

    There is no cost to the Member for HHP services.

    Home Health Care

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

    • In-home medical visits.
    • Medical equipment like hospital beds, walkers or wheelchairs.
    • Disposable medical supplies.
    • Help with personal care.

    Ospitalizasyon

    This plan pays for all expenses related to a hospital stay - the member will never be changed. Plan nou an kouvri:

    • Chanm ak manje.
    • Materyèl ak ekipman.
    • Tretman ak terapi.  
    • Tès dyagnostik ak egzamen.

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

    Entèprèt

    UnitedHealthcare offers services to help you talk with your doctor or other health care workers. You can get this service if you do not speak English or have hearing and speech barriers. You do not need a referral from your doctor to get these services.

    Interpreter services are offered free of charge.

    Laboratwa ak Radyografi

    Lè w konnen kisa pwoblèm lan ye e lè w detekte l bonè, sa ka fè tout yon diferans. Plan nou an kouvri:

  • Laboratwa ak tès.
  • Radyografi, eskanografi, ak lòt tès imajri.

  • N ap ede w jwenn enfòmasyon ki nesesè pou amelyore sante w oswa pou w nan pi bon fòm ou.

    Èd nan domèn lang

    You may be able to receive information in your preferred language or format, including Braille. Mande tousenpleman. We also have people at our member service centers who speak more than one language. Gen anpil chans ke nou gen youn moun ki pale menm lang avèk ou. All languages required by the State of California are covered, plus more.

    Medikaman

    Prescriptions and certain over-the-counter items are covered by our plan.

    You may receive a prescription from a UnitedHealthcare doctor or specialist. You can fill your prescription at any UnitedHealthcare contracted pharmacy. Just show your State Benefit Identification Card (BIC) and your UnitedHealthcare Identification card to the pharmacy when you get your prescriptions filled. 

    Member Advocates

    We’re looking out for you. Our local member advocates can help solve problems, provide training and education, and work on issues that concern you.

    They can:

    • Answer your questions about your benefits.
    • Help with doctor issues or complaints.
    • Help you clarify your health care benefits.

    Sèvis pou Manm

    Gen dèfwa ou ka bezwen èd pou konprann opsyon swen sante w yo. Lè w avèk nou, ou gen yon moun ou ka rele. N ap reponn kesyon w yo konplètman e avèk yon langaj ki senp.

    Nou ka ede w tou pou jwenn:

  • Find a doctor.
  • Change your primary care physician.
  • Questions on benefits.

  • Just call 1-866-270-5785, TTY: 711 Monday - Friday, 7:00 am – 7:00 pm PT.

    Kopeman

    You pay nothing for covered services.

    While your health care is low-cost or free, the care quality is high. You get: 

    • Care from highly skilled and compassionate doctors.
    • Treatments at respected hospitals and clinics.
    • Prescription drugs and over-the-counter medicines.

    NurseLine℠

    Pafwa, kesyon ak sitiyasyon medikal prezante a dè moman ki pa apwopriye. When you have questions about your health, you can call a nurse 24 hours a day, 7 days a week: 1-877-543-3409 (TTY 711).

    Our NurseLineSM will:

    • Tande ki sentòm ou di l ki prezante.
    • Help with self-care.
    • Ba w konsèy sou kijan pou jwenn swen kay yon doktè oswa nan yon sant swen dijans.
    • Ede w konnen kilè pou w ale nan sal dijans.

    If you have a life threatening emergency, go immediately to the emergency room or call 911.

    Outpatient Mental Health

    Sante mantal toutosi enpòtan ke sante fizik. Se poutèt sa nou gen pwoteksyon asirans pou toude.

    Mental Health Screening:

    • A mental health screening will be completed to determine if you are in mild or moderate distress or have acute impairment of mental, emotional or behavioral functioning.
    • This screening can be completed by a PCP, UnitedHealthcare Community Plan of California, Inc. or county mental health plan.

    Outpatient Mental Health Services- Covered by UnitedHealthcare Community Plan of California:

    • If your mental health screening results determine you are in mild to moderate distress, UnitedHealthcare Community Plan of California covers the following outpatient mental health services:
      • Outpatient mental health services
      • Individual and group mental health evaluation and treatment (psychotherapy)
      • Psychological testing when clinically indicated to evaluate a mental health condition
        Psychiatric consultation for medical management
      • Screening and Brief Intervention (SBI)
      • Outpatient laboratory, supplies and supplements
      • Drugs (excluding anti-psychotic drugs which are covered by Medi-Cal fee-for-service)
      • Family Counseling
      • Neuro behavioral testing
      • Neuro psychological testing
    • Outpatient mental health services do not require a referral from your PCP.
    • For help finding more information on mental health services provided by UnitedHealthcare Community Plan of California, Inc., call 1-866-270-5785, TTY 711.

    Specialty Mental Health Services- Covered by County Mental Health Plan

    • If your mental health screening results determine you have acute impairment of mental, emotional or behavioral functioning, you may be eligible for specialty mental health services.
    • Your PCP or UnitedHealthcare Community Plan of California, Inc. can refer you to the county mental health plan to receive an assessment.
    • County mental health plans cover specialty mental health services for Medi-Cal beneficiaries who meet criteria.
    • Specialty mental health services may include the following inpatient and outpatient services:
      • Outpatient specialty mental health services:
        • Mental health services (assessments, plan development, therapy, rehabilitation, and collateral)
        • Medication support services
        • Day treatment intensive services
        • Day rehabilitation services
        • Sèvis entèvansyon pou kriz
        • Crisis stabilization services
        • Targeted case management services
        • Therapeutic behavioral services
        • Intensive care coordination (ICC)
        • Intensive home-based services (IHBS)
        • Therapeutic foster care (TFC)
      • Residential services:
        • Adult residental treatment services
        • Crisis residental treatment services
      • Inpatient services:
        • Acute psychiatric inpatient hospital services.
        • Psychiatric inpatient hospital professional services.
        • Psychiatric health facility services.

     

    • For help finding more information on specialty mental health services provided by the county mental health plan, call the county at 1-888-724-7240.
       

    Personal Care

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

    • Dressing.
    • Bathing.
    • Feeding.

    Prenatal Visits

    Your pregnancy is a journey you'll want to make 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.

    Nan vizit sa yo, klinik la ap:

    • Make sure both you and your baby are healthy.
    • Eksplike kisa pou w atann nan chak etap gwosès ou.
    • Reponn kesyon w yo.

    Sispann itilize tabak

    Most people know the bad health effects of smoking. And they know they need to quit. We support our members to help them quit. The only thing they won’t get from us is a lecture.

    Text4baby

    Text4baby ka ede nouvo manman ak fiti manman yo kenbe tèt pa yo ak tibebe yo ansante.

    You’ll get text messages each week throughout your pregnancy and your baby’s first year. Chak tèks gen ladan konsèy sou sante ak sekirite pou sijè tankou:

  • Swen prenatal.
  • Tranche ak akouchman.
  • Alètman matènèl.
  • Dòmi san danje.
  • Nitrisyon.
  • Sekirite chèz machin.

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

    Sèvis Terapi

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

    Our plan covers limited visits for:

     

  • Terapi okipasyonèl.
  • Terapi fizik.
  • Terapi lapawòl.
  • In-home therapy.
  •  

    Sèvis Transpò

    Rides can be scheduled at least 30 days in advance, and no later than 2 business days before your appointment. Scheduling your ride at least 2 business days in advance will help you to have the best experience. Urgent care and other urgent types of trips, like dialysis or chemotherapy, can be scheduled on the same day.

    Members can get round trip transportation to and from health care locations as needed, including rides to:  

    • Doctor or therapy visits
    • Pickup prescription drugs that cannot be mailed directly to the member
    • Pickup medical supplies, prosthetics, orthotics and other equipment
    • Specialty mental health services
    • Substance use disorder services
    • Dental and any other benefits covered through Medi-Cal  

     

    Swen pou vizyon

    Members can get the care, eyeglasses and treatment that let them see life more clearly.
    Avantaj yo gen ladan yo:

  • Eye exams.
  • Prescription lenses and frames for member under 21 years of age or pregnant.
  • Vizit pou moun ansante

    Well visits with your doctor can help keep you and your family healthy. Vizit konsiltasyon sa yo ka ede detekte pwoblèm sante bonè, pou yo sa trete yo. Sèvis prevantif gen ladan yo:

  • Tchekòp pou granmoun ak timoun.
  • Swen pou tibebe ki ansante.
  • Swen pou fanm ki pral fè yon tibebe.
  • Piki ak tès woutin.
  • Mamogram.
  • To File a Complaint or Grievance, Download the GRIEVANCE FORM.

    Resous pou Manm

    Gade Resous ki Disponib yo

    Konnen Plis

    UnitedHealthcare Community Plan of California Medi-Cal

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