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UnitedHealthcare Community Plan
UnitedHealthcare Community Plan

Essential Plan


The Essential Plan is offered through UnitedHealthcare Community Plan. It’s for lower income individuals in New York who meet the income or citizenship status requirements.

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Call us to learn more:
Enrollment: 1-888-617-8979 or Benefits: 1-866-265-1893 / TTY: 711

Call us to learn more:
Enrollment: 1-888-617-8979 or Benefits: 1-866-265-1893
TTY: 711

Enrollment:
Monday - Friday 8 a.m.-8 p.m. EST.
Benefits:
Monday - Friday 8 a.m.-6 p.m. EST.

Enrollment:
Monday - Friday 8 a.m.-8 p.m. EST.
Benefits:
Monday - Friday 8 a.m.-6 p.m. EST.

Have Questions? Call Us at:
1-888-617-8979 / TTY: 711

Have Questions? Call Us at:
1-888-617-8979
TTY: 711

Monday - Friday.
8am - 6pm EST.

Monday - Friday.
8am - 6pm EST.

See if your doctor or hospital is in our network. Or use this tool to find a new doctor, hospital or specialist.

This plan is available in the following counties:

Albany, Bronx, Broome, Cayuga, Chautauqua, Chemung, Chenango, Clinton, Columbia, Delaware, Dutchess, Erie, Essex, Fulton, Genesee, Greene, Jefferson, Kings, Lewis, Livingston, Madison, Monroe, Nassau, New York, Niagara, Oneida, Onondaga, Ontario, Orange, Oswego, Queens, Rensselaer, Richmond, Rockland, Seneca, St. Lawrence, Suffolk, Tioga, Ulster, Warren, Wayne, Westchester and Wyoming.

To find out if UnitedHealthcare Community Plan is offered in your county, please call 1-888-617-8979. A representative will contact you to schedule an appointment to help you apply.

More information on eligibility and enrollment can be found on the NY State of Health, The Official Health Plan Marketplace, visit www.nystateofhealth.ny.gov or call 1-855-355-5777.

 

Benefits & Features

Coverage Types


Essential Plan 1 Standard
: Coverage for those ages 19-64 who earn 151-200% of the Federal Poverty Level.

Essential Plan 1 Native American/Alaskan: Coverage for those ages 19-64 who earn 151-200% of the Federal Poverty Level.  Designed for Native American or Alaskan Native Individuals.

Essential Plan 1 Plus: Coverage for those ages 19-64 who earn 151-200% of the Federal Poverty Level. Includes Dental and Vision benefits.

Essential Plan 1 Native American/Alaskan Plus: Coverage for those ages 19-64 who earn 151-200% of the Federal Poverty Level. Includes Dental and Vision benefits.  Designed for Native American or Alaskan Native Individuals.

Essential Plan 2 Standard: Coverage for those ages 19-64 who earn 139-150% of the Federal Poverty Level.

Essential Plan 2 Native American/Alaskan: Coverage for those ages 19-64 who earn 139-150% of the Federal Poverty Level.  Designed for Native American or Alaskan Native Individuals.

Essential Plan 2 Plus: Coverage for those ages 19-64 who earn 139-150% of the Federal Poverty Level. Includes Dental and Vision benefits.

Essential Plan 2 Native American/Alaskan Plus: Coverage for those ages 19-64 who earn 139-150% of the Federal Poverty Level. Includes Dental and Vision benefits.  Designed for Native American or Alaskan Native Individuals.

Essential Plan 3: Coverage for those ages 21-64 who are “Legally Present” but not eligible for Medicaid, earning 100-138% of the Federal Poverty Level.

Essential Plan 4: Coverage for those ages 21-64 who are “Legally Present” but not eligible for Medicaid, earning less than 100% of the Federal Poverty Level.

Premium


Monthly plan premium will apply for all Essential Plan 1 Standard and Essential Plan Plus plans. 

Copays*


Medical Services:
Copays will apply for all Essential Plan 1 plan types.

Inpatient Hospital Services: Copays will apply for all Essential Plan plans.

Emergency Medical Services: Copays will apply for all Essential Health Plan plans.

Outpatient Hospital/Facility Services: Copays will apply for all Essential Plan plans.

Preventive and Primary Care Services:  PCP/Specialist copay per visit (based on type of physician performing the service) will apply for all Essential Plan plans.

Physician /Professional Services: Copays will apply for all Essential Plan plans.

Prescription Drugs: Copays will apply for all Essential Plan plans.

* Copays may vary.  Alaskan Natives and American Indian members are exempt from co-pays and co-insurance.  Refer to Subscriber Contract in Member Information section for more details regarding copays and coinsurance.

Well and Sick Care


Get the care you need to stay healthy — or to get better if you are injured or sick. That includes: 

 

  • Choice of Doctor. Use “Doctor Lookup” to see if your doctor is in our network or to find a new one.
  • Medicines. Prescription drugs are covered with a small copay.
  • Dental*. We cover cleanings, checkups and dental work.
  • Well Visits. Annual checkups can help keep you healthy.
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    * Dental benefits are available through purchase of Essential Plus plans or as a standard benefit in Essential Plan 3 and 4 plans; these benefits are not available for Essential Plan 1 and 2 Standard Plans.   

    Care for Conditions


    If you have special health care needs, you can count on us. Our plan will provide the extra care and services needed. Benefits include:

    • Mental Health. Counseling and other treatments are covered.
    • Case Management. If you qualify, get personal help managing health conditions.
    • Asthma and COPD Care. Exams, testing and supplies are covered.

    Vision, Dental and Hearing Care


    Make sure your sight, teeth, speech and hearing are at their best. Benefits include:

  • Vision. Covers eye exams and glasses.** 
  • Dental. We cover cleanings, checkups and dental work.**
  • Hearing. Screenings and therapies, if needed, are provided.
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    ** Vision and dental benefits are available through purchase of Essential Plus plans or as a standard benefit in Essential Plan 3 and 4 plans; these benefits are not available for Essential Plan 1 and 2 Standard Plans.   Cost sharing will apply for those in Essential Plan Plus plans.  

    Gym Membership Reimbursement


    Partial reimbursement ($200/$100 every 6 months) for facility fees if member attains at least 48 visits.

    Gym Reimbursement Forms: English | Espanol

    Home Care and Supplies


    Get the medical care and equipment you need to recover safely at home. Benefits include:

     

  • Care Coordinator. Someone to get you the services you need to recover safely.
  • Personal Care. Services to help you heal after illness or injury.
  • Equipment and Supplies. In-home medical and safety equipment are covered.
  • Nurse Visits. Care after surgery or illness to recover at home.
  •  

    Extra Support


    Sometimes you might need a little extra help using your health plan. For those times, you can rely on: 

     

  • Member Services M-F 8:00am to 6:00pm EST. When you call Member Services you will be connected with a specially trained Advocate. They will help you get the most from your health plan.  For example, your Advocate is equipped to answer your questions, resolve issues, help set up doctor appointments and directly connect you with services available to you.
     
  • Nutrition Coaching. Helpful advice to improve your diet.
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    Questions?

    Ready to get started? Call us at Enrollment: 1-888-617-8979 or Benefits: 1-866-265-1893 TTY: 711 Enrollment:
    Monday - Friday
    8am - 8pm EST.
    Benefits:
    Monday - Friday
    8am - 6pm EST.

    Questions?

    Ready to get started?

    Call Us:
    Enrollment: 1-888-617-8979 or Benefits: 1-866-265-1893
    TTY: 711

    Enrollment:
    Monday - Friday 8 a.m.-8 p.m. EST.
    Benefits:
    Monday - Friday 8 a.m.-6 p.m. EST.

    Lookup Tools

    Doctor Lookup

    Search for doctors, hospitals and specialists.

    Download Directories
    Pharmacy Search

    Find a pharmacy near you.

    View Drug List

    Find medications covered by this plan.

    Find a Dentist

    Find a dentist near you.