If your doctor wants you to have a drug that is not on our list, your doctor can request it. Our pharmacy staff looks over the request within 24 hours and makes a decision.
• If you need drugs right away, the pharmacist can fill a one-time, five-day supply of the druga not on our Preferred Drug List.
• If you take the drug on an ongoing basis, the pharmacist can fill a 15-day supply. The pharmacist will have to call UnitedHealthcare Community Plan's pharmacy department for approval.
Healthchek is Ohio’s early and periodic screening, diagnostic, and treatment (EPSDT) benefit. Healthchek covers medical exams, immunizations (shots), health education, and laboratory tests for everyone eligible for Medicaid under the age of 21 years. These exams are important to make sure that young adults are healthy and are developing physically and mentally. Members under the age of 21 years should have at least one exam per year.
Healthchek also covers complete medical, vision, dental, hearing, nutritional, developmental, and mental health exams, in addition to other care to treat physical, mental, or other problems or conditions found by an exam. Healthchek covers tests and treatment services that may not be covered for people over age 20; some of the tests and treatment services may require prior authorization.
Healthchek services are available at no cost to members and include:
- Preventive check-ups for young adults under the age of 21.
- Healthchek screenings:
- Complete medical exams (with a review of physical and mental health development)
- Vision exams
- Dental exams
- Hearing exams
- Nutrition checks
- Developmental exams
- Laboratory tests for certain ages
- Medically necessary follow up care to treat physical, mental, or other health problems or issues found during a screening. This could include, but is not limited to, services such as:
- Visits with a primary care provider, specialist, dentist, optometrist and other UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan) providers to diagnose and treat problems or issues
- In-patient or outpatient hospital care
- Clinic visits
- Prescription drugs
- Laboratory tests
- Health education
Additionally, care management services are available to all members. Please see page 16 of the Member Handbook (Coming Soon) to learn more about the care management services offered by our plan.
In some cases, you may be able to get drugs that are not on our list if you are already taking the medication or if your doctor asks for prior authorization. Call our Member services or look at the View Drug List on this website to see if your drugs need approval. In some cases, you may be able to get drugs that are not on our list if your doctor asks for prior authorization.
There are a few reasons this could happen.
1. Some covered drugs need prior authorization.
2. Some drugs are called Step Therapy medications. That means you need to try other drugs before this one. These are covered only after other first-line drugs have been tried and failed.
3. Some drugs may be limited to the amount a person can be prescribed in one month.
4. Sometimes, a different strength or type of medicine is covered, such as tablets or liquid.
If you need other drugs, your doctor must get Prior Authorization from UnitedHealthcare Community Plan. Your doctor has to state how long you have been taking the drug and what other drugs you have tried.
When you apply for Medicaid, you must fill out an application form. You will also need to have various documents. You can get an application for Medicaid by calling the Ohio Medicaid Consumer Hotline at 1-800-324-8680 (TTY: 1-800-292-3572), your local County Department of Job and Family Services office, or click here.
- UnitedHealthcare Community Plan is a MCP that certain Ohio Medicaid consumers who are aged, blind or disabled (ABD) or meet certain financial requirements can choose to join. Joining a MCP will not cause you to lose your Medicaid, WIC (Women, Infants and Children) or other public assistance benefits. Joining UnitedHealthcare Community Plan is voluntary. It is your choice.
- You also must live in a county that has UnitedHealthcare Community Plan.
Exclusions – Individuals that are not permitted to join a MCP
Individuals are not permitted to join a MCP if they are:
- Children under twenty-one years of age;
- Dually eligible under both the Medicaid and Medicare programs;
- Eligible for Medicaid by spending down their income or resources to a level that meets the Medicaid program's financial eligibility requirements; or
- Receiving Medicaid Waiver services.
- Additionally, if anyone is a member of a federally recognized Indian tribe they have the option to not be a member of a managed care plan.
- If you believe that you meet any of the above criteria and should not be a member of a managed care plan, or are a member of a federally recognized Indian tribe and do not want to be a member, you must call the Ohio Department of Job and Family Services (ODJFS) Managed Care Enrollment Center at 1-800-605-3040 (TTY 1-800-292-3572).
If you have a medical emergency:
- Get medical help as quickly as possible. Go to the nearest hospital emergency room or other appropriate setting. Be sure to tell them you are a member of UnitedHealthcare Community Plan and show them your ID card if you are able.
- If you need emergency transportation, call 911 or your local emergency service.
- Make sure that your PCP knows about your emergency, because your PCP needs to be involved in following up on your emergency care. You or someone else should call to tell your PCP about your emergency care as soon as possible.
It is important to remember that you must receive services covered by UnitedHealthcare Community Plan from UnitedHealthcare Community Plan facilities and/or providers. The only time you can see providers that are not on UnitedHealthcare Community Plan's panel is for:
- Emergency services
- Federally Qualified Health Centers / Rural Health Clinics
- Qualified Family Planning Providers
- Community Mental Health Centers
- Ohio Department of Alcohol and Drug Addiction Services facilities that are Medicaid providers
- An out of panel provider that UnitedHealthcare Community Plan has approved you to see
- Pharmacies for prescription drugs and some prescription medical supplies that are covered by Ohio Medicaid