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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. UnitedHealthcare Community Plan is a health plan for members who are eligible for State-assisted Medicaid benefits. That includes pregnant women, children, adults, seniors, those who have special needs, and families. With UnitedHealthcare Community Plan QUEST Integration, you are on a better path to your health care.

Our primary goal is to help you stay healthy and independent. The UnitedHealthcare Community Plan QUEST Integration plan offers medical and behavioral health services including, vision, drug, and supplies. Call UnitedHealthcare Community Plan QUEST Integration today to find out more about how you can get skilled guidance and service coordination. 

Our local staff will work with you to coordinate your services and specific needs. We will help guide you through the complex health care system and work with your doctors and family members to help you meet your health-related goals.  UnitedHealthcare Community Plan is here for you, every step of the way.

UnitedHealthcare Community Plan has been doing care management for a long time.  

Trust your family’s health with UnitedHealthcare Community Plan.

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.

This plan is available in all counties.

Please review the UnitedHealthcare Coronavirus (COVID-19) facts. Additional information can be found on the Coronavirus (COVID-19) FAQ. 

Information on Temporary Public Assistance During COVID-19 Pandemic:

 Kauai | Maui County | Honolulu | Hawaii Island

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Benefits & Features

With UnitedHealthcare Community Plan QUEST Integration you can get:

Access to care

  • A Primary Care Provider (PCP) that you can choose from in our large list of providers. Here is the link to help you find one in your area
  • Referral specialty care from a Specialist Provider
  • Scheduled rides to health-related appointments
  • 24-hour/7 day NurseLineSM and on-line Nurse Chat to talk to a nurse any time you have a question
  • Language interpreter services (including Sign language)

Benefits to help you stay healthy

No cost for any services provided under your benefit plan

  • Prescription drug coverage
  • Vision and eyewear coverage
  • Help with behavioral health issues such as mental, alcohol, or substance abuse
  • Preventive health care
  • Vaccines (such as for flu and other illnesses)
  • Child immunizations
  • Health education classes
  • Quarterly newsletters

Rural Exceptions

In areas in which there is only one QUEST Integration health plan, members have the freedom to:

  • Choose from at least two (2) PCPs
  • Obtain services from any other provider under any of the following circumstances:
    • The service or type of provider (in terms of training, experience, and specialty) is not available within the health plan’s provider network;
    • The provider is not part of the health plan’s provider network but is the main source of a service to the member. We will work with the provider to participate in our provider network. If the provider chooses not to join our provider network, or does not meet the necessary qualifications to be part of the provider network, we will transition the member to an in-network provider within sixty (60) days. If the provider is not appropriately licensed or is sanctioned, we will transition the member to another provider immediately;
    • The only provider in-network and available to the member does not, because of moral or religious objections, provide the services the member seeks, or all related services are not available;
    • The member’s PCP determines that the member needs related services that would be subject the member to unnecessary risk if received separately and not all of the related services are available within the health plan’s provider network; and
    • The State determines that other circumstances warrant out-of-network treatment.
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Choice of Doctor

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

Your PCP is your main doctor for:

  • Preventive care.
  • Treatment if you are sick or injured.
  • Referrals to specialists for certain conditions.

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.

We can also help you find:

  • Home care providers.
  • Specialists.
  • Doctors.
  • Pharmacies.
  • Hospitals or other health facilities.
  • Local resources.

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 related to a hospital stay, so you can rest and heal.

Hospitalization coverage includes:

  • Nursing care.
  • Room and board.
  • Supplies and equipment.
  • Treatment and therapies.
  • Diagnostic tests and exams.

And after you leave the hospital, you are not alone. We make sure you get follow-up care to continue healing at home.

Healthy First Steps is a free online wellness program for pregnant women and moms who have given birth within the last 15 months. This program offers rewards for obtaining your prenatal, postpartum and child’s well-baby care (up to 15 months of age). This program can help keep track of your appointments. You can also earn as many as 8 rewards of your choosing.  Rewards include a diaper bag or Old Navy gift card, a nursing cover or teething rattle, a first aid kit or tabletop toy, a childproofing kit or puzzles and books among other rewards to support your well-being and your child/children’s development. Sign up for Healthy First Steps at UHCHealthyFirstSteps.com and start earning rewards.

Please note: rewards options may be subject to change and we will notify you in the future through various methods (i.e., Member Handbook, website, HealthTalk (Member Newsletter) or written communication by mail or post card).

Incentive Completed Action Option 1 Option 2 Value
1 Baby Blocks enrollment Diaper Bag Old navy gift card $10
2 24-week prenatal visit Nursing cover Teething rattle with mirror $10
3 32-week prenatal visit First-aid kit Tabletop toy $10
4 Birth Digital thermometer Rubber duck bath thermometer $10
5 Postpartum visit Car seat cover Old navy gift card $10
6 6-month-well-child visit Dental care kit Baby feeding kit $10
7 Lead screening Childproofing kit Children's book $10
8 15-month well-child visit Puzzle Bath accessories for mother $10

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. 

Durable Medical Equipment

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

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

  • Oxygen tanks.
  • Hospital beds.
  • Wheelchairs or walkers.

Member Rewards

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

You may be able to earn a gift for you or your child by doing things like:

  • Completing a well-child exam or a postpartum visit

Hearing Care

Trouble hearing can affect your everyday life in many ways. Our plan includes services and support to help protect your hearing.

We cover:

  • 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. Interpreter Services also includes sign language interpretation or help.

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.

Our plan includes:

  • Dialysis.
  • Medications.
  • Health education and support.
  • Organ Transplant if needed (We will coordinate benefits with Medicare and the State of Hawai’i Tissue and Transplant program (SHOTT))

Lab and X-rays

Knowing what's wrong and finding it early can make all the difference. Our plan covers:

  • Labs and testing.
  • X-rays, scans and other imaging.

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

Language Help

We can give you member materials in a language and/or in a written format that is easier for you to understand. We make all written information for Members available in languages that comply with Section 1557 of the Patient Protection and Affordable Care Act. If you need information in a language other than English (i.e., Ilocano, Vietnamese, Chinese (traditional), Korean, etc.), call Member Services. You can also get information in large print, braille or audio tapes. We can send you the information in another language within seven (7) days of the request. If the request is received after normal business hours, we will send you the information within seven (7) days of the next business day following the request. These services and help are available to current and potential members at no cost.

Examples of written materials include but are not limited to:

  • Provider Directory
  • Member Handbook
  • Appeals and Grievance Notices
  • Adverse Benefit Determination Notices
  • Network Provider Termination Notices to Members

Member Advocates

We're looking out for you. 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.

Mental Health

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

This includes:

  • Behavioral therapy.
  • Substance abuse treatment.
  • 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:

  • Listen to the symptoms.
  • Help with self-care.
  • Advise you about getting care at a doctor visit or an urgent care center.
  • Help you know when to go to the 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

Knowing what's wrong and finding it early can make all the difference.

Our plan covers:

  • Labs and testing.
  • X-rays, scans and other 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.
  • Cooking.
  • Shopping.
  • Running errands.

Prenatal Visits

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.

At these visits, the clinic will:

  • Make sure both mom and baby are healthy.
  • Explain what to expect at each stage of your pregnancy.
  • 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.

Respite Care

Do you have family members or friends who care for you at home?

If so, we want to support their hard work too. That's why we provide respite care to give your caregivers a rest. Respite care offers caregivers time away from their loved one who is ill or has special care needs.

Shots and Vaccines

Routine shots help protect you from illness.

So, our plan covers:

  • Recommended shots and vaccines.
  • Influenza, Pneumococcal, Diphtheria and Tetanus 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.
  • Respite care.

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.

To sign up, visit UHCHealthyFirstSteps.com

Therapy Services (Habilitation 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:

  • Occupational therapy.
  • Physical therapy.
  • Speech therapy.

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 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:

  • Urgent care centers.
  • Medical aid units.
  • Other walk-in clinics.

Well Visits

These visits can catch health problems early, so they can be treated.

Preventive services :

  • Checkups for adults and children.
  • Well-baby care.
  • Care for women expecting a baby.
  • Routine shots and tests.
  • Mammograms.
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UnitedHealthcare Community Plan QUEST Integration Program