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Starting September 1, 2022, UnitedHealthcare will no longer be a Medical Assistance plan option in the Southwest and Lehigh/Capital areas of Pennsylvania.
UnitedHealthcare Community Plan for Families
UnitedHealthcare Community Plan offers coverage to beneficiaries of Pennsylvania's Medical Assistance (Medicaid) program.
We can help you relax about your health care. You don't need to worry when you have UnitedHealthcare Community Plan. All of your health care needs are met. With UnitedHealthcare, you can count on getting good health care, plus the respect you deserve. You'll have your own personal doctor who really knows you. No more sitting around emergency rooms waiting for basic health care.
Plus, your doctor is there for you and your family around the clock. We check doctors and hospitals in our network often to make sure you're getting the care you deserve.
Medical Assistance recipients can call Pennsylvania Enrollment Services toll free at 1-800-440-3989 (TTY 1-800-618-4225) We can help you between 8 a.m. and 5 p.m. Monday, Tuesday, Thursday, and Friday and 8 a.m. to 8 p.m. on Wednesday in finding other options. This will NOT affect any of our CHIP or Medicare members.
This plan is available in the following counties:
Adams, Allegheny, Armstrong, Beaver, Bedford, Berks, Blair, Bucks, Butler, Cambria, Chester, Cumberland, Dauphin, Delaware, Fayette, Franklin, Fulton, Greene, Huntingdon, Indiana, Lancaster, Lawrence, Lebanon, Lehigh, Montgomery, Northampton, Perry, Philadelphia, Somerset, Washington, Westmoreland, and York.
The Department of Human Services (DHS) determines membership eligibility for UnitedHealthcare Community Plan for Families.
Joining is Easy.
To enroll in UnitedHealthcare Community Plan for Families, just talk with a Health Benefits Consultant and complete an enrollment application. You can speak with a Health Benefits Consultant by calling the HealthChoices Hotline at 1-866-550-4355 or by going to a County Assistance Office.
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.
UnitedHealthcare Community Plan will waive any copays for testing, screening and office visits to diagnose or treat COVID-19 for Pennsylvania Medicaid and CHIP members.
Find providers and coverage for this plan.
Search for doctors, behavioral health providers, hospitals and specialists.
Find medications covered by this plan.
Find a dentist near you.
Find a pharmacy near you.
Benefits & Features
- Visits to your personal doctor
- Specialist care
- Your personal doctor available 24 hours a day
- 24-hour emergency room care when needed
- Immunizations for children
- Prescriptions, based on Medicaid eligibility
- Dental services, based on Medicaid eligibility
- EPSDT screenings and treatment
- Vision care
- Your PCP should see you within 10 business days of when you call for a routine appointment.
- If you have an urgent medical condition, your provider should see you within 24 hours of when you call for an appointment.
- If you have an emergency, the provider must see you immediately or refer you to an emergency room.
Help When You Need It
With UnitedHealthcare, you're never alone. Our Member Services is available to answer your questions and help you get the care you need. Just call us at 1-800-414-9025. We can help you between 8 a.m. and 5 p.m. Monday, Tuesday, Thursday, and Friday and 8 a.m. to 8 p.m. on Wednesday. And remember, you can call your UnitedHealthcare doctor any time, any day.
Want to learn more?
Talk with us to learn more about UnitedHealthcare Community Plan. We'll tell you about our benefits, special programs and doctors. We'll help you choose a doctor for yourself and other members of your family. Just give us a call at 1-800-414-9025. Or, view our Medicaid Brochure.
No person on the grounds of race, color, national origin, sex, age, religion or disability shall be excluded from participation in, be denied benefits of, or be subject to discrimination under any program or service provided by UnitedHealthcare.
These materials tell you about your plan and benefits. They also tell what you should do if you have an emergency.
What is a Prior Authorization and how do I get one?
If you have questions about prior authorization please call Customer Service at 888-887-9003, Monday – Friday, 8 a.m. - 6 p.m. Central Time.
Providers can check on the status of an existing request by calling our clinical authorization services at 866-604-3267, 24 hours a day, seven days a week.
If you have questions about a pharmacy prior authorization, please call our Pharmacy Help Desk at 800-310-6826. You can get answers to prescription prior authorization questions Monday – Friday, 7 a.m. to 7 p.m. Central Time, with voicemail intake after-hours.
Additional information can be found on our Provider Prior Authorization and Notification page.
Fraud and Abuse
Fraud, Waste and Abuse
UnitedHealthcare Community Plan has a hotline if you want to report a medical provider (for example, a doctor, dentist, therapist or hospital) or business (for example, a medical supplier) if you think there is fraudor abuse. You can call the UnitedHealthcare Community Plan fraud and abuse hotline at 1-877-401-9430. Some examples of fraud and abuse are:
- Billing or charging you for services that your health plan covers.
- Offering you gifts or money to receive treatment or services.
- Members loaning their ACCESS or UnitedHealthcare Community Plan ID cards to another person to get services using the member’s name.
- Offering you free services, equipment or supplies in exchange for your ACCESS number.
- Giving you treatment or services that you do not need.
- Physical, mental or sexual abuse by medical staff.
- Being offered prescription or prescription medications without being seen or treated by the prescribing doctor.
- A member who visits an unusually high number of doctors to obtain narcotic drugs.
DHS also has a Medical Assistance Provider Compliance hotline that you can reach by dialing 1-844-DHS-TIPS (1-844-347-8477), Monday through Friday, 8:30 a.m. to 3:30 p.m. You may leave a voice-mail message at other times. You can also report suspected fraud and abuse by visiting http://www.dhs.state.pa.us/learnaboutdhs/fraudandabuse or emailing email@example.com. You don’t have to give your name. If you do, the provider won’t be told that you called. If you don’t speak English, an interpreter will be made available. If you are hearing-impaired, you can call the hotline using your TTY device.
- Review your policy and benefits statements.
- Review the paperwork you receive related to your health care coverage. Make sure you received the treatments for which your health plan was charged, and question suspicious expenses.
- Protect your health plan ID card like your credit card. In the wrong hands, a health plan ID card is a license to steal. Don’t give policy numbers to door-to-door salespeople or telephone solicitors. Never give your card to a friend to use for medical services. Help control the cost of health insurance by reporting suspect behavior. Join the effort to fight fraud and abuse in the health care system.
If you aren’t sure, call us. You can make us aware of potential fraud via our helpline.
Pharmacy Direct Member Reimbursement Form
Member Rights & Responsibilities
Member Rights & Responsibilities
2022 Medicaid Newsletters
2021 Medicaid Newsletters
Special Online Edition
National Flu Campaign Questions & Answers
Questions and Answers about the Flu and the Flu Shot
Stop Smoking Resources
United Healthcare Community Plan wants to help you, whether this is your first try at quitting or even if you have tried before and started smoking again. United Healthcare Community Plan wants to help you become smoke free.
UnitedHealthcare On My Way Progam
UnitedHealthcare OMWTM (UnitedHealthcare On My Way) is an interactive website that helps you get ready for real life. It’s easy and fun, and has important information all on one secure site.
Download the brochure to learn more about:
- Money: Set up a budget and learn about taxes.
- Housing: Understand and compare housing options.
- Work: Create a resume and learn interview tips.
- And more!
UnitedHealthcare Community Plan for Families
This link is being made available so that you may obtain information from a third-party website. This link is provided solely as a convenience and is not an endorsement of the content of the third-party website or any products or services offered on that website. We are not responsible for the products or services offered or the content on any linked website or any link contained in a linked website. We do not make any representations regarding the quality of products or services offered, or the content or accuracy of the materials on such websites.