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Renewing your Medicaid benefits
UnitedHealthcare Community Plan - Heritage Health
UnitedHealthcare Community Plan offers a range of benefits. It’s for pregnant women, children, families and adults who meet income requirements. There are no costs to you for Medicaid benefits and services. View the benefits below to see all that our plan offers.
This is a current summary of health services and drug coverage provided by UnitedHealthcare Community Plan of Nebraska. A detailed description of the benefits can be found in the Member Handbook.
The State of Nebraska determines Medicaid eligibility for the plan. In general terms, eligibility is limited to those who are unable to pay for medically necessary services and who meet certain eligibility requirements.
Find providers and coverage for this plan.
Search for doctors, hospitals and specialists.
Find medications covered by this plan.
Find a pharmacy near you.
Find a vision provider near you.
Benefits & Features
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.
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.
Medicaid limits coverage of chiropractic services to: (i) Certain spinal X-rays; (ii) Manual manipulation of the spine; (iii) Certain evaluation and management services; (iv) Traction; (v) Electrical stimulation; (vi) Ultrasound; and (vii) Certain therapeutic procedures, activities, and techniques designed and implemented to improve, develop, or maintain the function of the area treated.
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.
This service is provided by Medicaid and Long-Term Care. MCNA Dental is the Medicaid dental plan for the State of Nebraska. MCNA administers the dental benefits for eligible children and adults. MCNA Member Hotline: 1-844-351-6262, TTY (Hearing Impaired) 1-800-833-7352, or visit www.mcnane.net.
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.
If you have chronic or high-risk illnesses, our disease management services may help you. We provide support for:
- Congestive heart failure.
- 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.
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®
Build a healthy future for you and your baby and earn great rewards with Healthy First Steps. Our program will help you take the right steps to keep you and your baby healthy.
We will help you:
- Choose a pregnancy provider and a pediatrician (child’s doctor).
- Schedule visits and exams and arrange rides to your visits.
- Earn rewards for going to visits throughout your pregnancy and baby’s first 15 months of life.
- Get supplies, including breast pumps for nursing moms.
- Connect with community resources such as Women, Infants and Children (WIC) services.
Trouble hearing can affect your everyday life in many ways. Our plan includes services and support to help protect your hearing.
- Exams, aids and tests.
- Hearing aids and batteries.
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.
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 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.
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.
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:
- 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.
You will not have a copayment for care and services covered by our plan.
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.
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.
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.
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.
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.
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.
- 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.
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.
Your coverage for transportation includes rides with ModivCare (formerly Logisticare) for medical visits and other health related appointments. ModivCare (formerly Logisticare) 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 three business days before your appointment.
- Urgent care and same-day rides are accepted.
You can also learn more, schedule rides at www.modivcare.com
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.
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 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.
There are no copayments for preventive care.
UnitedHealthcare Mobile App
This free moble app allows you to access key information on the go. You can search for nearby doctors, view your member handbook or view your member ID card.
The UnitedHealthcare mobile app can be downloaded to an Apple(R) or Android(R) smartphone or tablet.
How to Contact Us
If you have questions about your health plan, call us. Our toll-free Member Services number is 1-800-641-1902, (TTY 711). They can talk to you from 7 a.m. – 7 p.m. local time.
How We Support Cultural Competency
UnitedHealthcare Community Plan of Nebraska seeks to understand the cultural differences of the people we serve. Our goal is to develop and improve our materials and programs to support the diverse needs of Nebraskans. Staff training focused on:
- Using your primary language.
- Being aware of the different cultural groups in Nebraska.
- Ways to support cultural beliefs related to health and wellness.
- Treating each person with care and respect.
- To avoid labels.
- How to work with members with limited English.
- How to support those with special health care needs.
- Cultural sensitivity training.
UnitedHealthcare On My Way
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.
Quality Improvement Program
Quality Improvement - Evaluation Summary
Grievances and Appeals
You are our customer and are very important to us. We want to make your health care program a good one. We want to make sure you are happy with our program, so you can file a complaint at any time.
If you are not happy, please call Member Services at 1-800-641-1902, TTY 711. We want to help you solve any health care problems. We will try to help you on the phone.
We hope we can solve your problem with your first phone call. There may be times when you don’t agree. Maybe you still feel unhappy. So we made “Quality Steps” just for you. These steps give you every chance to let us learn more about your problem.
Quality steps for grievances:
- Call us and tell us your problem. We will try to solve your problem on the first call. Member Services: Toll-free 1-800-641-1902, TTY 711
- If you are not happy with the answer, call or write to us and let us know at: Write to: UnitedHealthcare Community Plan Attn: Appeals and Grievances P.O. Box 31364 Salt Lake City, UT 84131 Call: Toll-free 1-800-641-1902, TTY 711
- When your call or letter is received, our Appeals and Grievance Department will promptly do a thorough review of the case and make a decision.
- Contract allows 90 calendar days to resolve a grievance, estimated timeframe is set to 60 calendar days.
- We welcome your input regarding your complaint.
- You may get help in telling us about your problem or in appealing the decision by calling our Member Services. You may ask them for help with filing a grievance or appeal or filling out forms. You may ask for an interpreter.
- If you have a complaint about Non-Emergent Medical Transportation, please call Member Services at 1-800-641-1902, TTY 711.
- You can ask for a copy of the rules we used to make our decision.
- You can have someone else, such as a family member, friend, health care provider, lawyer or the Medicaid Enrollment Center, help you with the appeal.
- You can ask to see and receive a copy of the information in our files that we used to make our decision.
- You can send written comments or documents for us to look at when we review your appeal
State Fair Hearing
A member or his/her representative may request a State Fair Hearing only after receiving notice that the MCO is upholding the adverse benefit determination.
You can do this at any time within 120 calendar days from the date of the MCO’s notice of resolution. You can ask for services to continue during the State Fair Hearing, so long as the authorization for service has not expired or the service limits have been met.
However, you may need to pay for the health service if you continue the service during the State Fair Hearing and the decision is that you should not have received the service.
You can write to the State at: Department of Health and Human Services MLTC Appeal Coordinator P.O. Box 94967 Lincoln, NE 68509-4967
You can also call our customer service center for assistance: Member Services at 1-800-641-1902, TTY 711.
You may ask them for help with: ∙ Filing a grievance or appeal ∙ Filling out forms ∙ Help if you need an interpreter
You can request additional help by calling Member Services at 1-800-641-1902, TTY 711, 7:00 a.m.–7:00 p.m. CT (6:00 a.m.–6:00 p.m. MT), Monday–Friday.
You may call the Department of Health and Human Services (DHHS) Legal Services at 1-402-471-7237.
Member Newsletters 2016 - Current
UnitedHealthcare Community Plan - Heritage Health
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