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The Wellness4me Plan is offered through UnitedHealthcare Community Plan, a Health and Recovery Plan, or HARP, approved by New York State. HARPs are a new kind of plan that provide Medicaid members with their health care, plus care for behavioral health, including Serious Mental Illness and Substance Use Disorders.
This plan is for New York residents age 21 and who qualify for Medicaid coverage.
UnitedHealthcare Community Plan is a special health care plan with providers who have a lot of experience treating people who may need mental health and/or substance use care to stay healthy. We also provide care management services to help you and your health care team to work together to keep you as healthy as possible.
Albany, Bronx, Broome, Cayuga, Chautauqua, Chemung, Chenango, Clinton, Columbia, Dutchess, Erie, Essex, Franklin, Fulton, Genesee, Greene, Herkimer, Jefferson, Kings, Lewis, Livingston, Madison, Monroe, Nassau, New York, Niagara, Oneida, Onondaga, Ontario, Orange, Orleans, Oswego, Queens, Rensselaer, Richmond, Rockland, Schenectady, Seneca, St. Lawrence, Suffolk, Tioga, Ulster, Warren, Wayne, Westchester, Wyoming, and Yates.
UnitedHealthcare continues to partner with state and local public health departments, following guidance and protocols appropriate to our members that are provided by the U.S. Centers for Disease Control and Prevention (CDC), and state and local public health departments that are appropriate for our members. Please review the UnitedHealthcare Coronavirus (COVID-19) Information. To learn more, go to CDC.gov.
COVID-19 NY State PPE Fee Guidance
The New York State Department of Financial Services (DFS) recently issued guidance stating that care providers should not charge members additional fees for items such as personal protective equipment (PPE). DFS expects New York care providers to refund any of these charges paid by the member that were more than the member’s financial responsibility on a claim. If you have questions, please contact your provider.
Companionship is important. If your Primary Care Provider (PCP) recommends it, you may be able to participate in adult day health care. Adult day health care provides care and companionship for seniors who need extra help during the day.
Caregivers also benefit, knowing their loved one is safe when they can’t provide care.
Adult day care can provide:
Do you need help trouble managing asthma, allergies or COPD symptoms? You’ll get a customized treatment plan and medicine to help:
Behavioral health is as important as physical health. Our behavioral health care includes mental health and substance use treatment services.
Required care is 100% covered with no copay. This includes:
You can also get help with alcohol or other substance use issues.
A serious health problem requires extra care and support. We use Health Homes to coordinate services for our members.
Health Home Care Managers are in your corner. They will:
Where you have your baby is an important choice. That's why you can pick from 142 hospitals across New York.
We also encourage you to tour the hospital's birthing center. This way you will be familiar with it. And you'll be more relaxed when you have your baby.
When you join UnitedHealthcare Community Plan, one of our providers will take care of you. Most of the time that person will be your Primary Care Provider (PCP). You may want to choose a PCP from your mental health or substance use clinic. If you need to have a test, see another specialist, or go into the hospital, your Primary Care Provider will arrange it.
Your PCP is your main doctor for:
Dental checkups and cleanings can help keep teeth and gums healthy. Covered services include:
You do not need a referral from your PCP to see a dentist.
If you have diabetes, you may need insulin, needles, wipes and glucose strips. We cover all that and more.
Our plan also steps up with services to help you manage your diabetes, including:
Our plan covers medical equipment ordered by your doctor or case manager. This can include supplies like:
Trouble hearing can affect your everyday life in many ways. Our plan includes services and support to help protect your hearing.
Our plan covers:
Sometimes our members are living with a long-term health condition or disability. Others are coming out of the hospital after surgery or a serious illness. These members can receive extra support from our plan.
With approval, our plan covers:
This plan pays for all expenses related to a hospital stay, so you can rest and heal.
Hospitalization coverage includes:
Your Health Home Care Manager can:
Our plan covers prescription drugs and refills with a small copayment. Your copay is:
|Prescription Item||Wellness4me Plan|
|Co-Payment Amount||Co-Payment Details|
|Brand name prescription drugs||$3.00/$1.00||1 co-pay charge for each new prescription and each refill|
|Generic prescription drugs||$1.00||Refer to the Preferred Drug List|
|Over-the-counter drugs, such as for smoking cessation and diabetes||$0.50||Refer to the Preferred Drug List|
Over-the-counter medicines with a written order from your doctor are available for a copayment of $0.50 for each medicine.And we make getting your medicine easy. You can fill your prescriptions at:
You can call Member Services to get help any time you have a question.
You may call us to choose or change your Primary Care Provider (PCP for short), to ask about benefits and services, to get help with referrals, to replace a lost ID card, to report that you are pregnant, the birth of a new baby or ask about any change that might affect your benefits.
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:
If you are in need of long-term placement in a nursing home, your local department of social services must determine if you meet certain Medicaid income requirements.
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.
Routine shots help protect you from illness.
So, our plan covers:
You'll get the care, eyeglasses and treatment that help you see better.
Well visits with your doctor can help you stay healthy. These visits can catch health problems early, so they can be treated. Preventive services include:
There are no copayments for preventive care.
UnitedHealth Group is 100% owner of UnitedHealthcare of New York, Inc
Medicaid Managed Care
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