Asthma, Allergy and COPD Care

Do you or a family member have trouble managing asthma or COPD symptoms?
You will get a customized treatment plan and medicine to:

• Manage flare-ups.
• Reduce symptoms.
• Help you stay active.

Care Management

When a member has complex health care needs, a care manager can really help. He or she will:

• Work with you and family members and friends on a plan of care.
• Explain medical terms in plain language.
• Coordinate your doctor appointments.
• Provide your care team with your medical records. 
• Make a referral to community social service programs.
• Offer rewards like a gift card for chronic care checkups or well care visits.

Cell Phone Program

Eligible members can get health support with mobile phone service at NO COST to you from select Lifeline service providers. We want to help you stay connected!  Apply Now! Call Member Services at 1-800-641-1902, TTY 711 for assistance.. 

Children's Health Support

• Rewards program for well-child visits.
• 4-H program includes information on healthy eating and exercise.
• Dr. Health E. Hound® provides nutritional education and promotes fitness and healthy habits.

Chiropractor Services

Covered when order by a network provider.

Limited to certain spinal x-rays; manual manipulation of the spine; certain evaluation and management services; traction; electronic stimulation; ultrasound and certain therapeutic procedures, activities and techniques designed and implemented to improve, develop and maintain the function of the area treated.

• Ages 21 and older – Chiropractic treatment is limited to those treatments deemed medically necessary.
• Age 20 and younger – Chiropractic treatment is limited to those treatments deemed medically necessary and no more than one treatment per member per day is covered.

Prior authorization needed.

Choice of Birth Center

Where you have your baby is an important choice. That’s why you can pick from our large network of hospitals or Birthing Center.

We also encourage you to tour the hospital’s birthing center. This way you will be familiar with it and be better informed when you have your baby.

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.
• Care coordination with specialists.

For members who don’t have a doctor or whose doctor is not in our network, Member Services can help find a new one close by.

Dental Care

This service is provided by Medicaid and Long-Term Care. Contact ACCESSNebraska toll-free at 1-855-632-7633.

Diabetic Support

If you have diabetes, we'll help make life a little easier for you. You'll get medicine, supplies and education to help you reach and stay your best. Our diabetes program also includes self-care training and classes focused on:

• Managing stress.
• Living a healthy lifestyle.
• Wellness Rewards for getting needed exams.

Disease Management

If you have chronic or high-risk illnesses, our disease management services may help you. We provide support for:

• Congestive heart failure.
• Asthma.
• HIV.
• Chronic obstructive pulmonary disease (COPD).
• Coronary artery disease.

Equipment and Supplies

Our member’s health and safety at home are important.

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

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

Foot Care

We provide the exams you need to help keep your feet in great shape. And if you have diabetes, good foot care can help prevent much more serious problems.

Our podiatry coverage includes:

• Routine foot exams.
• Tips about foot care and choosing the right shoes.
• Information about nerve damage warning signs.

Healthy First Steps®

Our Healthy First Steps® program makes sure that both mom and baby get good medical attention.

We will help:

• Find a doctor for both mother and baby.
• Get good advice on nutrition, fitness and safety.
• Get supplies, including breast pumps for nursing moms.

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, aids and tests.
• Hearing aids and batteries.

Home Care

After surgery or a serious illness, you may need  in-home medical visit(s) to check on how well you are healing.

With approval, our plan covers:

• In-home medical visit(s).
• Medical equipment like hospital beds, walkers or wheelchairs.
• Disposable medical supplies.

Hospitalization

This plan pays for expenses related to a hospital stay, so our members can rest and heal.

Hospitalization coverage includes:

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

And after leaving hospital, we can provide transitional care services. We make sure you get follow-up care to continue healing at home.

Hospice Services

Hospice services are covered when they are ordered by a physician.

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

If you have trouble hearing, you can get help by phone. Call the TTY Service at TTY 711. Ask them to call Member Services at 1-800-641-1902. They will connect you to us. 

If you don't speak English, you can get help by phone. Call Member Services at 1-800-641-1902. They can let you speak to someone in your language.

Members can get information in their preferred language. You will get member materials in English and Spanish. We can give you member materials in a language or format that is easier for you to understand. Just ask.

Member Services

Sometimes you might need a little help understanding your health care options. Call us. We’ll answer your questions simply and completely.

We help you find:

• Doctors.
• Pharmacies.
• Hospitals or other health facilities.
• Local resources.

Mental Health and Substance Use Services

Inpatient, residential and outpatient services for mental health and substance use disorders are covered by UnitedHealthcare. The type, amount and length of services provided will be based on the level of your needs. Visit www.liveandworkwell.com.

No Copays

You will not have a copayment for care and services covered by our plan.

This includes in network services:

• Visits to doctors
• Treatments at hospitals and clinics.
• Home medical equipment and supplies to help you be at your best.

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 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.

Over-The-Counter Drugs/Supplies

Covered 100% with your doctor’s prescription.  

Your health care costs may include non-prescription medicines and supplies like aspirin, cough medicine or a cane. Covered 100% with your doctor’s prescription.

Pharmacy

Our plan includes prescription drugs and refills, and we make getting your medicine easy. Medicare and other insurance copays may apply. You can fill your prescriptions at:

• Local pharmacies.
• Services that deliver right to your door.

When you have a prescription filled, be sure to check that:

• It’s included on the Preferred Drug List (PDL). 
• It’s written by a network provider. 
• It’s filled at a network pharmacy. 
• You show your member ID card when you have it filled. 

Prescription Drug Copays

You can receive many available PREFERRED brand name and generic drugs with no copay. Brand NON-PREFERRED prescriptions drugs have a $3 copay.

If the Center of Medicare and Medicaid Services (CMS) shows you’re copay exempt, you will not have to pay the $3 copay. You may be copay exempt if you are:

• 18 years old or younger.
• Pregnant or gave birth within the last 60 days.
• Staying in an inpatient hospital, long-term care facility, residential facility, adult family home or center for the developmentally disabled.
• Staying in a medical facility and spending most of your income on medical costs.
• A Native American getting services from an Indian Health Center.
• Receiving waiver services under a 1915(c) waiver.
• Receiving assistance from the State Disability Program.

Prenatal Visits

Your pregnancy is a journey you’ll want to make with the help of friends, family and a pregnancy doctor.

All recommended prenatal clinical visits and tests are covered by our plan.

At these visits, the clinic will:

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

Quitting Tobacco

Most people know the bad health effects of smoking. And they know they need to quit. That’s why we encourage members to talk to their doctor about getting smoking cessation support. Counseling is covered when you enroll with the Nebraska Tobacco-Free Quit Line.  Medication for smoking cessation are available through Nebraska Medicaid. Call 1-800-784-8669. 

Residential Care

After a serious illness, surgery or injury, you may need extra nursing and therapy.  If needed, our plan covers short stays in a skilled facility where you can heal. 

Included are:

• Nursing home services.
• 24-hour nursing care.
• Help with activities of daily living.
• Physical, occupational and speech therapy.

Shots and Vaccines

Routine shots help protect members and their family from illness. Our plan covers:

• Pneumonia, influenza and shingles shots.
• Vaccines and Immunizations.  Routine shots to help keep your child healthy.
• Other recommended shots and vaccines.

Therapy 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.

Transportation

Your coverage for transportation includes rides with National MedTrans for medical visits and other health related appointments.

National MedTrans provides dependable rides and excellent personal service. Your health care appointments are important, and they work to meet your unique transportation needs with 24/7 support.

Schedule non-urgent rides at least tthree business days before your appointment.

Urgent care and same-day rides are accepted.

Call to schedule rides at 1-833-583-5683 (TTY 1- 833-587-6527)

You can also learn more, schedule rides at www.natmedtrans.com/ne

Transplant Services

Covered when ordered by a network physician.

Unlimited Primary Care Provider Visits

There may be times when a member’s health requires repeated doctor visits. Our plan does not limit the number the number of visits to a primary care provider (PCP).  This way the members get the care they need. And the doctor can see how their health is progressing.

Vision Care

You'll get the care, eyeglasses and treatment that let you see life more clearly. Coverage includes:

·  Annual eye exams.
·  Prescription lenses.

This benefit is offered by March Vision.

Wandering and Elopement

We will provide members and families with door and window alarms (up to six per household) to help reduce wandering without caregiver awareness.

Well Visits

Well visits with your doctor can help keep you healthy. These visits can catch health problems early, so they can be treated. Preventive services include:

• Checkups for adults and children.
• Routine shots and tests.
• Mammograms.

There are no copayments for preventive care.