UnitedHealthcare Community Plan QUEST Integration Program

Medicaid

UnitedHealthcare Community Plan QUEST Integration is a managed care plan offered through Hawai‘i’s Department of Human Service Med-QUEST. Ti UnitedHealthcare Community Plan ket maysa a plano ti salun-at para kadagiti kameng nga adda kababalinna para kadagiti benepisyo ti Medicaid nga naasistaran ti Estado. Iraman na dayta dagiti masikog nga babbai, ubbing, nataengan, nanakem, dagidiay addaan iti naisangsangayan nga kasapulan, ken pamilya. Babaen iti UnitedHealthcare Community Plan QUEST Integration, addaka ayan iti nasaysayaat nga dana iti panagtaripato ti salun-at mo.

Iti kangrunaan nga gandat ket tapno makatulong kenyam nga agtalinaed nga nasalun-at ken independente. Ti UnitedHealthcare Community Plan QUEST Integration a plano ket mangidaton kadagiti serbisyo iti medikal ken behavioral a salun-at mairaman iti, panagkita, agas, ken suplay. Awagan ti UnitedHealthcare Call UnitedHealthcare Community Plan QUEST Integration ita tapno duktalan panggep iti ad-adu pay nu kasatno ka a makaala iti nasaririt nga gida ken koordinasyon ti serbisyo. 

Makibinnadang dagiti lokal a kakaduami tapno mayurnos dagiti serbisio ken espesipiko a kasapulam. Tumulongkami a mangiturong kadakayo iti komplikado a sistema ti plano a para iti salun-at ken makisarita kadagiti doktoryo ken miembro ti pamiliayo tapno magun-odmo ti kalikagummo iti salun-at.   Ti UnitedHealthcare Community Plan ket sisasagana para kenyam, tunggal addaang iti dana.

Nabayagen nga ipapaay ti UnitedHealthcare Community Plan ti panangtaripato iti salun-at.  

Italek ti salun-at ti pamilya yo babaen ti UnitedHealthcare Community Plan.

 

Public Health Event – Pharmacy Response

IMPORTANT INFORMATION REGARDING

UnitedHealthcare Community & State, UnitedHealthcare Employee & Individual, and UnitedHealthcare Medicare & Retirement members covered under Medicaid, Medicare, and Part D prescription drug plans.

Due to Hurricane Flossie approaching Hawai‘i, UnitedHealthcare is authorizing a one-time override of the refill too soon (RTS) edit for members who reside in or may be visiting the following areas. These members may be in need of medication when traveling and mail delivery could be compromised. 

Hawai‘i

Entire State

This authorization should allow impacted UnitedHealthcare Community & State, UnitedHealthcare Employee & Individual, and UnitedHealthcare Medicare & Retirement members covered under Medicaid, Medicare, and Part D prescription drug plan to obtain early refills of their prescription medications if they have refills remaining on file at a participating retail or mail-order pharmacy. 

This policy will be reinforced through the dates listed below, unless conditions continue to warrant.

Line of Business Response Type Timeframe Membership Type

UHC C&S

 

Self-Identify

 

07/31/2019 – 08/14/2019

 

All Products

 

UHC E&I

 

Self-Identify

 

07/31/2019 – 08/14/2019

 

Fully Insured (including NIHPs) and ASO Business

 

UHC M&R Self-Identify 07/31/2019 – 08/14/2019 Fully Insured and ASO
Business

If you should receive a call from a member impacted by this emergency, please follow the standard process for administering refills during a disaster. The OptumRx Help Desk is available to assist in this process should it be needed.

 

UnitedHealthcare Community Plan provides free aids and services to people with disabilities to communicate effectively with us, such as: written information in other formats (large print, audio, accessible electronic formats, other formats). If you need these services, contact us toll-free at 1-888-980-8728 (TTY: 711).  We will provide you with the requested information, at no cost to you within five (5) business days.

Daytoy a plano ket sidadaan a mausar iti amin a county.

Dagiti Benepisyo ken Paset ti Plano

Ti Panagpili ti Doktor

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

Iti PCPim ket iti kangrunaam nga doktor para:

  • Managlapped a taripato.
  • Panagagas nu sika ket agsakit wenno nadunor.
  • Kadagiti reperal kadagiti espesyalista para ti maipadung nga kondisyon.

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.

Sometimes you might need a little help understanding your health care options. With us, you have someone you can call. We'll answer your questions simply and completely.

Mabalin mi pay sika a tulongan a mangsapul:

  • Home care providers.
  • Specialists.
  • Kadagiti doktor.
  • Dagiti parmasya.
  • Dagiti ospital wenno dadduma a pasilidad ti salun-at.
  • Dagiti lokal a materyales wenno paggapuan ti tulong.

There is no cost for covered prescriptions. We make getting your child's medicine easy. We'll provide a list of covered medicines if you have questions about what prescriptions are covered.

You can fill the prescriptions at local pharmacies in the UnitedHealthcare Community Plan network.

This plan pays for all expenses expenses related to a hospital stay, so you can rest and heal.

Hospitalization coverage includes:

  • Ti Nursing care.
  • Ti kwarto ken makan.
  • Dagiti suplay ken makinarya.
  • Panagagas ken dagiti therapy.
  • Dagiti eksamen a diagnostic.

Ken kalpasan a rumwar ka ti ospital, saan ka nga agmaymaysa. Siguradoen mi nga adda ti follow-up a taripato tapno agtultuloy ka nga agimbag iti pagtaengam.

Build a healthier 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.

Once you sign up, you can choose a $20 Old Navy gift card or a stylish diaper bag. The choice is yours.

Diabetic Support

If you have diabetes, we'll make life a little easier for you. You'll get medicine, supplies and education to help you reach and stay your best. 

Natibker ken manayon a ramit-medikal

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

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

  • Oxygen tanks.
  • Katre ti ospital.
  • Wheelchairs or walkers.

Healthy Rewards

An ounce of prevention can be worth a pound of cure. It can also be worth great rewards.

You can earn great gifts for you or your child by doing things like:

  • Completing well-child exams.

Taripato ti Panagdengngeg

Ti parikut ti panagdengngeg ket apektaran na ti inaldaw a biag mo iti nadum-duma a wagas. Ti plano mi ket kairamanan dagiti serbisyo ken suporta a makatulong a mangprotekta ti panagdengngeg.

Sakupen mi:

  • Exams, therapy and tests.
  • Hearing aids and batteries.

In-Home Care

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

  • An in-home medical visit.
  • Medical equipment like hospital beds, walkers or wheelchairs.
  • Disposable medical supplies.
  • Help with personal care or housekeeping.

Interpreters

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.

Kidney Disease Care

Kidney disease is a serious medical condition. After the kidneys stop working, regular treatments (called renal dialysis) or an organ transplant are necessary. Dialysis uses a machine to clean the blood, just like healthy kidneys do.

Ti planomi iramanna dagiti:

  • Dialysis.
  • Medications.
  • Health education and support.
  • Organ transplant if needed.

Lab ken X-rays

Ti panagammmo nu ania iti parikut ken panagduktal iti daytoy ti nasapa ket nalabit a makaaramid ti dakkel a pagdumaan. Ti plano mi ket sakupen na:

  • Dagiti Lab ken eksamen.
  • Dagiti X-rays, scans ken dadduma nga imaging.

Tulungandaka nga mangala iti impormasyon a kasapulam tapno maparang-ay ti salun-at wenno tapno addaka ti nasayaat a kasasaad.

Tulong ti Lenggwahe

You can get information in another language. Agdamag ka laeng. This is provided at no cost to you.

Member Advocates

Bantayandaka. Member advocates can help solve problems, provide training and education, and work on issues that concern members.

They can:

  • Provide information about your plan.
  • Teach you to get the care you need.
  • Help with doctor issues or complaints.

Salun-at ti Panagpampanunot

Mental health is as important as physical health. That's why we have coverage for both.

This includes:

  • Therapy ti Tig-tignay.
  • Panagagas iti panagabuso ti droga.
  • Medications.

NurseLine℠

Medical questions and situations can come at inconvenient times. When you have questions about your health, you can call a nurse 24 hours a day, 7 days a week.

Our nurses will:

  • Agdengngeg kadagiti sintomas.
  • Help with self-care.
  • Balakadan naka maipapan ti panangalam ti taripato iti panagbisitam iti doktor mo wenno iti urgent care center.
  • Tulongan naka a mang-ammo nu kaano ka a mapan ti emergency room.

Nurse Visits

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.
  • Answer any questions and concerns.

Nutrition Coaching

Healthy eating goes a long way to helping you stay at your best. A nutritionist can meet with you to review your eating habits and food choices.

You'll come away with new ideas for:

  • Making good choices for quick meals and snacks.
  • Preparing healthy meals on a budget.

Outpatient Services

Ti panagammmo nu ania iti parikut ken panagduktal iti daytoy ti nasapa ket nalabit a makaaramid ti dakkel a pagdumaan.

Ti plano mi ket sakupen na:

  • Dagiti Lab ken eksamen.
  • Dagiti X-rays, scans ken dadduma nga imaging.

We'll help you get the information needed to help improve your health or be your best.

Personal Care

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

  • Dressing.
  • Bathing.
  • Feeding.

Panagbisita Sakbay ti Panaganak.

A pregnancy is a journey that’s better 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.

Kadagitoy a panagbisita, ti klinika ket:

  • Make sure both mom and baby are healthy.
  • Ipalawag nu ania ti namnamaem kada lebel ti panagsikog mo.
  • Answer questions.

Quitting Tobacco

Most people know the bad health effects of smoking. And they know they need to quit. We support our members while they quit, with coaches and supplies. The only thing they won’t get from us is a lecture.

Rehabilitation Care

After a serious illness, surgery or injury you may need extra nursing and therapy. If needed, our plan covers short stays in a rehabilitation center where you can heal. Included are:

  • Nursing home services.
  • 24-hour nursing care.
  • Help with activities of daily living.
  • Physical, occupational and speech therapy.

Taripato iti Temporaryo nga Institusyon (Respite Care).

Adda kadi kameng ti pamilyam wenno gagayyem a mangaywan kenka nu addaka iti pagtaengan?

Nu adda, kayat mi a suportaran ti trabaho da met a tumulong kenka. That's why we provide respite care to give your caregivers a rest. Ti respite care ket mangidiaya kadagiti mangay-aywan ti waya a makabakasyon wenno makainana manipud kadagiti ay-ayaten da ti biag nga agsaksakit wenno addaan naisangsangayan a kasapulan a taripato.

Shots and Vaccines

Routine shots help protect you from illness.

So, our plan covers:

  • Recommended shots and vaccines.
  • Influenza shots.

Social Services

Many communities offer additional benefits for children in this plan. Social Services helps members connect to these local programs and services, such as:

  • WIC and financial support.
  • School services.
  • Taripato iti temporaryo nga institusyon (respite care).

Speech Therapy

Speech therapy visits and exercises can help those who have difficulty speaking.

Prior authorization needed except for  physical, occupational,  or speech therapy.

Text4baby

Text4baby can help new and expecting mothers keep themselves and their babies healthy.

You'll get text messages throughout your pregnancy and your baby's first year. Each text contains health and safety tips for topics like:

  • Prenatal care.
  • Labor and delivery.
  • Breastfeeding.
  • Safe sleep.
  • Nutrition.
  • Car seat safety.

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

Therapy Services

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

Our plan provides:

  • Okupasyonal a therapy.
  • Pisikal a therapy.
  • Therapy ti panagbalikas.

Unlimited Doctor Visits

There may be times when your or a family member’s health requires repeated visits to a primary care provider (PCP). Our plan does not limit the number the number of times you can see your PCP. This way you get care need when you need it. And your doctor can see how your health is progressing.

Urgent Care

You may have an injury or sudden illness that is not life-threatening but needs immediate attention. So our plan covers care at:

  • Dagiti sentro iti naganat a taripato.
  • Medical aid units.
  • Other walk-in clinics.

Dagiti Panagbisita ti Nakaradkad

Well visits with your doctor are important for good health. These visits can catch health problems early, so they can be treated. Dagiti serbisyo ti panagsakbay ket kairamanan ti:

  • Checkups for adults and children.
  • Well-baby care.
  • Care for women expecting a baby.
  • Routine shots and tests.
  • Dagiti Mammogram.

There are no copayments for preventive care.

Dagiti Pamuspusan ti Kameng

Kitaen dagiti Mabalin a Mausar a Pamuspusan

Ammoen ti Ad-adu pay

UnitedHealthcare Community Plan QUEST Integration Program

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