UnitedHealthcare Community Plan
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Member Information

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UnitedHealthcare Community Plan

Use the documents below to learn more about each important health topic.

Fraud, Waste, and Abuse

Healthcare fraud, waste and abuse affects everyone. Combating it begins with awareness. Fraud is committed when a dishonest provider or consumer intentionally submits, or causes someone else to submit, false or misleading information for use in determining the amount of health care benefits. Waste is the over-utilization of services not caused by criminally negligent actions and the misuse of resources. Abuse is provider practices that are inconsistent with professional standards of care: medical necessity, or sound fiscal, business, or medical practices and provider or beneficiary practices that result in unnecessary costs to the healthcare program.

What is provider fraud, waste and abuse?
  • Billing for services not rendered
  • Upcoding (billing for more expensive services or procedures than were actually provided or performed)
  • Soliciting, offering or receiving kickbacks
  • Improper or sloppy billing practices
  • Failure to maintain adequate records
  • Routine waiver of coinsurance and deductible

What is member fraud, waste and abuse?

  • Loaning or using another person's insurance card
  • Forging or selling prescription drugs
  • Providing false information when applying for program benefits

UnitedHealthcare Community Plan is committed to combating fraud, waste and abuse. If you suspect health care fraud, waste and abuse, you may report via the following methods:

  • Anonymous fraud, waste and abuse hotline: 1.877.766.3844

Clinical Health Guidelines

Perinatal Care

American Academy of Pediatrics and The American College of Obstetricians and Gynecologists, Sixth Edition, Guidelines for Perinatal Care
Click Here (PDF 394.85 KB)

Preventive Pediatric Health Care Screening

2009 Recommendations for Preventive Pediatric Health Care screening guidelines (periodicity schedule) from the American Academy of Pediatrics

American Academy of Pediatrics
http://brightfutures.aap.org/pdfs/AAP%20Bright%20Futures%20Periodicity%20Sched%20101107.pdf

Preventive Services Guideline

2010-2011 Guide to Clinical Preventive Services – US Preventive Services Task Force (USPSTF)

Agency for Healthcare Research and Quality
http://www.ahrq.gov/clinic/pocketgd.htm

Pregnancy

Healthy First Steps (PDF 1.7 MB)

Questions and Answers

2011 Flue Q&A (PDF 18.59 KB)
2011 Pneumonia Q&A (PDF 18.88 KB)

Other

Asthma Action Plan (PDF 172.95 KB)
Coronary Artery Disease Health Log (PDF 178.51 KB)
COPD Action Plan (PDF 164.76 KB)
Diabetes Health Log (PDF 242.77 KB)
Heart Failure Health Log (PDF 241 KB)
Lead Poisoning (PDF 142.79 KB)
Taking Charge of Your Ashthma (PDF 496.51 KB)
Taking Charge of Your COPD (PDF 455.12 KB)
Taking Charge of Your Depression (PDF 254.15 KB)
Taking Charge of Your Diabetes (PDF 1.93 MB)
Taking Charge of Your Heart Disease (PDF 432.1 KB)
Taking Charge of Your Heart Failure (PDF 517.98 KB)

Member Newsletters

Summer 2013 Issue (English) (PDF 1.28 MB)
Summer 2013 Issue (Español) (PDF 1.26 MB)
Spring 2013 Issue (English) (PDF 631.94 KB)
Spring 2013 Issue (Español) (PDF 619.89 KB)
Fall 2012 (PDF 780.75 KB)
Fall 2012 Español (PDF 680.29 KB)
Summer 2012 (PDF 575.27 KB)
Summer 2012 Español (PDF 621.07 KB)
Spring 2012 (PDF 731.48 KB)
Spring 2012 Español (PDF 669.95 KB)
Winter 2012 (PDF 726.2 KB)
Winter 2012 Español (PDF 689.48 KB)
Fall 2011 (PDF 1.24 MB)
Fall 2011 Español (PDF 765.57 KB)
Summer 2011 (PDF 561.42 KB)
Summer 2011 Español (PDF 523.8 KB)
Spring 2011 (PDF 522.36 KB)
Spring 2011 Español (PDF 437.31 KB)
Winter 2010-2011 (PDF 1.19 MB)

Disclaimer Information

Looking for the federal government’s Medicaid website? Look here at Medicaid.gov.

UnitedHealthcare Dual Complete Plans

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the state Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. You must continue to pay your Medicare Part B premium, if not otherwise paid for under Medicaid or by another third party. This information is not a complete description of benefits. Contact the plan for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.

Nurseline Disclaimer

This service should not be used for emergency or urgent care needs. In an emergency, call 911 or go to the nearest emergency room. The information provided through this service is for informational purposes only. The nurses cannot diagnose problems or recommend treatment and are not a substitute for your doctor's care. Your health information is kept confidential in accordance with the law. The service is not an insurance program and may be discontinued at any time.

UnitedHealthcare Connected™ for MyCare Ohio (Medicare-Medicaid Plan)

UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. If you have any problem reading or understanding this or any other UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan) information, please contact our Member Services at 1-877-542-9236 (TTY 711) from 7 a.m. to 8 p.m. Monday through Friday (voice mail available 24 hours a day/7 days a week) for help at no cost to you.

Si tiene problemas para leer o comprender esta o cualquier otra documentación de UnitedHealthcare® Connected™ de MyCare Ohio (plan Medicare-Medicaid), comuníquese con nuestro Departamento de Servicio al Cliente para obtener información adicional sin costo para usted al 1-877-542-9236 (TTY 711) de lunes a viernes de 7 a.m. a 8 p.m. (correo de voz disponible las 24 horas del día, los 7 días de la semana).

UnitedHealthcare Connected™ (Medicare-Medicaid Plan)

UnitedHealthcare Connected (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees.

UnitedHealthcare Connected Benefit Disclaimer

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected Member Services or read the UnitedHealthcare Connected Member Handbook. Benefits and/or copayments may change on January 1 of each year.

UnitedHealthcare Senior Care Options (HMO SNP) Plan

UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our SCO program.

Availability of Non-English Disclaimer

This information is available for free in other languages. Please call our customer service number at 1-800-905-8671, TTY 711, 8 a.m. - 8 p.m. local time, 7 days a week.

Esta información está disponible sin costo en otros idiomas. Comuníquese con nuestro Servicio al Cliente al número 1-800-905-8671, TTY 711, de 8 a.m. – 8 p.m. hora local, los 7 días de la semana.

Star Ratings Disclaimer

Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.

Formularies

The formulary, pharmacy network and provider network may change at any time. You will receive notice when necessary.

NCQA

UnitedHealthcare Connected has a Model of Care approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) through 2016 based on a review of UnitedHealthcare Connected’s Model of Care.