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UnitedHealthcare Connected® for MyCare Ohio

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UnitedHealthcare Connected® for MyCare Ohio a Medicare-Medicaid Product

OH Northeast English (PDF 18.24 MB)

OH Northeast Espanol (PDF 18.54 MB)

OH East Central English (PDF 7.67 MB)

OH East Central Espanol (PDF 7.73 MB)

OH Northeast Central English (PDF 3.28 MB)

OH Northeast Central Espanol (PDF 3.32 MB)


 

Ohio Community Mental Health Centers

Ohio Department of Mental Health and Addiction Services Centers

 

 

Prior Authorizations

Prior Authorization Request

Download the List of Services that Require Prior Authorization (PDF 185.79 KB)
Download the Prescription Prior Authorization List (Coming Soon)

 

Prior Authorization Process

Prior authorization is an okay for services that must be approved by UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan). Your doctor must call Utilization Management (UM) at 1-800-366-7304 before you obtain a service or procedure that is listed as requiring an okay on pages 19-22. Our UM team is available Monday through Friday, 8 a.m. to 5 p.m. On-call staff is available 24 hours a day, 7 days a week for emergency okays.

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) also reviews some of your services and care as they are happening. This is called concurrent review. Examples are when you are:

  • A patient in the hospital
  • Receiving home care by nurses
  • Certain outpatient services such as speech therapy and physical therapy

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) reviews your progress with your doctor to be sure you still need those services or if other services would be better for you.

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) has policies and procedures to follow when the UM team makes decisions regarding medical services. The UM doctors and nurses make their decision based on your coverage and what you need for your medical condition. The goal is to make sure that services are medically necessary, that they are provided in an appropriate setting, and that quality care is provided.

We want to help you stay well. If you are sick we want you to get better.

  • UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) does not pay employees extra for limiting your care.
  • Our network doctors do not receive extra money or rewards if they limit your care.

If you have questions about UM decisions or processes, call Member Services at 1-877-542-9236 (TTY 711).

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To file an Appeal or Grievance, please visit or FAQ section.

Find A Drug

Search for drugs covered by UnitedHealthcare Connected™ for MyCare Ohio

Click here (PDF 781.73 KB) to download the UnitedHealthcare Connected™ for MyCare Ohio Formulary. To view the UnitedHealthcare Connected™ for MyCare Ohio Formulary in Espanol, please click here (PDF 809.74 KB).

 

Prior Authorizations

Prior Authorization Request 
Download the List of Services that Require Prior Authorization (PDF 185.79 KB)
Download the Prescription Prior Authorization List (Coming Soon)

 

Pharmacy Direct Member Reimbursement Request

Download a MAPD Prescription Reimbursement Request Form (PDF 188.1 KB) from OptumRx. 

Prescription Drugs - Not Covered by Medicare Part D

While most of your prescription drugs will be covered by Medicare Part D, there are a few drugs that are not covered by Medicare Part D but are covered by UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan).  You can view our plan’s List of Covered Drugs on our website at www.myuhc.com/communityplan.  Drugs with an asterisk are not covered by Medicare Part D but are covered by UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan). You do not have any co-pays for non-Part D drugs covered by our plan.

Please note that our list of medications that require prior authorization can change so it is important for you and/or your provider to check this information when you need to fill/refill a medication.

Submit a Pharmacy Prior Authorization Request to OptumRx

Submit a Pharmacy Prior Authorization Request

Prescription Drug Transition Process

What to do if your current prescription drugs are not on the formulary or are limited on the formulary.

New members
As a new member of an UnitedHealthcare ConnectedUnitedHealthcare Connected™ for MyCare Ohio, insured through UnitedHealthcare, you may currently be taking drugs that are not on the UnitedHealthcare® formulary (drug list), or they are on the formulary but your ability to get them is limited.

In instances like these, start by talking with your doctor about appropriate alternative medications available on the formulary. If no appropriate alternatives can be found, you or your doctor can request a formulary exception. If the exception is approved, you will be able to obtain the drug for a specified period of time. While you and your doctor are determining your course of action, you may be eligible to receive an initial 31-day transition supply (unless your prescription is written for fewer days) of the drug anytime during the first 90 days you are a plan member.

For each of your drugs that is not on the formulary or if your ability to get your drugs is limited, UnitedHealthcare will cover a 31-day supply (unless your prescription is for fewer days) when you go to a network pharmacy. If the prescription is written for less than 31 days, multiple fills are allowed to provide up to a total of 31 days of drugs. After your first 31-day transition supply, these drugs may not continue to be covered. Talk with your doctor about appropriate alternative medications. If there are none on the formulary, you or your doctor can request a formulary exception.

If you live in a long-term care facility, UnitedHealthcare will cover a temporary 31-day transition supply (unless your prescription is for fewer days). UnitedHealthcare will cover more than one refill of these drugs for the first 90 days for plan members, up to a 93-day supply. If you need a drug that is not on the formulary or your ability to get your drugs is limited, but you are past the first 90 days of plan membership, the transition program will cover a 31-day emergency supply of that drug (unless your prescription is for fewer days) while you pursue a formulary exception.

You may face unplanned transitions after the first 90 days of plan enrollment, such as hospital discharges or level of care changes (i.e., in the week before a long-term care discharge), If you are prescribed a drug that is not on the formulary or your ability to get your drugs is limited, you are required to use the plan's exception process. You can request a one-time emergency supply of up to 31 days to allow you time to discuss alternative treatment with your doctor or to pursue a formulary exception.

Continuing members
As a continuing member in the plan, you receive an Annual Notice of Changes (ANOC). You may notice that a formulary medication you are currently taking is either not on the upcoming year's formulary or its cost sharing or coverage is limited in the upcoming year.

For coverage requests received each year by December 15, and approved, the plan will cover the drug as of January 1. For coverage requests initiated on or after December 16, normal time frames for resolution apply: you will receive an answer within 24 hours for urgent requests and within 72 hours for all other requests. If your request is still in process on January 1, you may receive a temporary supply of the drug for your current plan cost-sharing until your request is answered.

If you have any questions about this transition policy or need help asking for a formulary exception, a UnitedHealthcare representative can help.

Related Information
Medicare Part D Coverage Determination Request Form - (for use by members and providers)
The Coverage Determination Request Form may be found under Appeal a Coverage Decision section on this page.

Medication Therapy Management Program

UnitedHealthcare's Medication Therapy Management program was developed by a team of pharmacists and doctors to help eligible members make better use of their coverage and to improve their understanding and use of medications.  It also helps protect members from the possible risks of drug side effects and from potentially harmful drug combinations.

This program is available at no additional cost to you.  You will be automatically enrolled in the Medication Therapy Management Program if you:

  • take eight (8) or more chronic Part D medications, and
  • have three (3) or more long-term health conditions, and
  • might spend more than $3,507 a year on covered Part D medications

Below is a list of health conditions that may make you eligible for the Medication Therapy Management program. You need to have three or more of these conditions to qualify for this program.

  • Diabetes
  • Hypertension (High Blood Pressure)
  • Heart Failure
  • High Cholesterol
  • Rheumatoid Arthritis

UnitedHealthcare’s Medication Therapy Management program offers a Comprehensive Medication Review (CMR) for all eligible members over the phone. A pharmacist will review the member’s medication history, including prescription and over-the-counter medications, and identify any issues.  Upon completion of the medication review, the member is mailed a Medication Action Plan that summarizes any clinical concerns identified and a Personal Medication List of their medication history.  In addition, the member’s doctor is contacted and this information is provided to them. 

To help you track your medications, you can also download a blank Personal Medication List (PDF 308.21 KB) for your personal use.

Members may also receive helpful information in the mail. This can include additional information about their medications and suggestions from our pharmacists about how to make the most of your medications and benefits. This information can be helpful when meeting with your doctor or pharmacist.

For more information on UnitedHealthcare’s Medication Therapy Management program, please talk to a UnitedHealthcare representative (the phone number is on the back of your plan member ID card).

Please note that these programs may have limited eligibility criteria and are not considered a benefit.

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To file an Appeal or Grievance, please visit or FAQ section.

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Dental Provider Search

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Prior Authorization Request
Download the List of Services that Require Prior Authorization (PDF 185.79 KB)
Download the Prescription Prior Authorization List (Coming Soon)

 

Prior Authorization Process

Prior authorization is an okay for services that must be approved by UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan). Your doctor must call Utilization Management (UM) at 1-800-366-7304 before you obtain a service or procedure that is listed as requiring an okay on pages 19-22. Our UM team is available Monday through Friday, 8 a.m. to 5 p.m. On-call staff is available 24 hours a day, 7 days a week for emergency okays.

UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan) also reviews some of your services and care as they are happening. This is called concurrent review. Examples are when you are:

  • A patient in the hospital
  • Receiving home care by nurses
  • Certain outpatient services such as speech therapy and physical therapy

UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan) reviews your progress with your doctor to be sure you still need those services or if other services would be better for you.

UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan) has policies and procedures to follow when the UM team makes decisions regarding medical services. The UM doctors and nurses make their decision based on your coverage and what you need for your medical condition. The goal is to make sure that services are medically necessary, that they are provided in an appropriate setting, and that quality care is provided.

We want to help you stay well. If you are sick we want you to get better.

  • UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan) does not pay employees extra for limiting your care.
  • Our network doctors do not receive extra money or rewards if they limit your care.

If you have questions about UM decisions or processes, call Member Services at 1-877-542-9236 (TTY 711).

OH_MME_UHC_Logo

To file an Appeal or Grievance, please visit or FAQ section.

Find A Pharmacy

Search for a UnitedHealthcare network pharmacy below.

Prior Authorizations

Prior Authorization Request
Download the List of Services that Require Prior Authorization (PDF 185.79 KB)
Download the Prescription Prior Authorization List (Coming Soon)

 

Prior Authorization Process

Prior authorization is an okay for services that must be approved by UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan). Your doctor must call Utilization Management (UM) at 1-800-366-7304 before you obtain a service or procedure that is listed as requiring an okay on pages 19-22. Our UM team is available Monday through Friday, 8 a.m. to 5 p.m. On-call staff is available 24 hours a day, 7 days a week for emergency okays.

UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan) also reviews some of your services and care as they are happening. This is called concurrent review. Examples are when you are:

  • A patient in the hospital
  • Receiving home care by nurses
  • Certain outpatient services such as speech therapy and physical therapy

UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan) reviews your progress with your doctor to be sure you still need those services or if other services would be better for you.

UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan) has policies and procedures to follow when the UM team makes decisions regarding medical services. The UM doctors and nurses make their decision based on your coverage and what you need for your medical condition. The goal is to make sure that services are medically necessary, that they are provided in an appropriate setting, and that quality care is provided.

We want to help you stay well. If you are sick we want you to get better.

  • UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan) does not pay employees extra for limiting your care.
  • Our network doctors do not receive extra money or rewards if they limit your care.

If you have questions about UM decisions or processes, call Member Services at 1-877-542-9236 (TTY 711).

Questions?

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1-877-542-9236
TTY: 711

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7:00 a.m. to 8:00 p.m. local time
Voicemail available 24/7.

Member Information

Member Website

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Member Handbook

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Member Page

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Member Handbook

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UnitedHealthcare Connected®; for MyCare Ohio

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.