UnitedHealthcare Community Plan
STAR Kids Member Handbook
Member Services: 1-877-597-7799, TDD/TTY: 7-1-1, for deaf and hard of hearing
Welcome to
the community
Texas – April 2023
CSTX23MD0113070_000
Member Services
1-877-597-7799, TDD/TTY: 7-1-1, for deaf and hard of hearing
8:00 a.m.–5:00 p.m. CST, Monday–Friday UHCCommunityPlan.com
What to do in an emergency
Call 9-1-1 or go to the nearest hospital/emergency facility if you think you need emergency care. You
can call 9-1-1 for help in getting to the hospital emergency room. If you receive emergency services,
call your doctor to schedule a follow-up visit as soon as possible. Please call us and let us know of the
emergency care you received. An emergency is a condition in which you think you have a serious
medical condition, or not getting medical care right away will be a threat to your life, limb or sight.
What to do in a behavioral health emergency
You should call 9-1-1 if you are having a life-threatening behavioral health emergency. You can
also go to the nearest emergency room. You need to call Optum Behavioral Health toll-free at
1-877-597-7799 as soon as possible.
In case of emergency call 9-1-1
If you think that it is not an Emergency, but you need help, call the NurseLine at 1-844-222-7326.
If you have questions about your health plan, please call us. Our toll-free Member Services number
is 1-877-597-7799, TDD/TTY: 7-1-1, for deaf and hard of hearing. There will be people who can
speak to you in English and Spanish when you call.
This Member Handbook is available in audio, Braille,
larger print and in other languages at your request.
Please call 1-877-597-7799 for help.
© 2023 United HealthCare Services, Inc. All Rights Reserved.
2
Toll-free telephone numbers
Member Services (8:00 a.m.–5:00 p.m., Monday–Friday) ....................1-877-597-7799
except for state-approved holidays (see page 4)
TTY (for deaf and hard of hearing) .............................................. 7-1-1
• After-hours, please contact NurseLine
• Interpreter services available
• How to access covered services and Service Coordination
NurseLine (Available 24 hours a day, 7 days a week) .................1-844-222-7326, TTY: 711
• Se habla Español
• Interpreter services available.
Nurses are knowledgeable about the STAR Kids Program, covered services,
STAR Kids members, and provider resources. Information in English and
Spanish. Interpreter services available through Member Services.
Service Coordination ................................................1-877-352-7798
8:00 a.m.–5:00 p.m., Monday–Friday. Service Coordinators are
knowledgeable about the STAR Kids Program, Covered Services,
STAR Kids members, and provider resources.
For Dental Services, call your child’s Medicaid dental plan.
DentaQuest ...................1-800-516-0165
MCNA Dental ..................1-855-691-6262
UnitedHealthcare Dental .........1-877-901-7321
For Eye Care Appointments, Call Member Services ........................1-877-597-7799
Texas Health and Human Services Commission ..........................1-877-541-7905
Nonemergency Medical Transportation (NEMT) Services –
Where’s My Ride Hotline .....................................1-866-528-0441, TTY: 711
How to access NEMT services: Available 8:00 a.m.–5:00 p.m.,
Monday–Friday, se habla Español. Information and Interpreters
are available in many languages.
Mental Health and Substance Abuse Services
Optum Behavioral Health; available 24 hours a day, 7 days a week ............1-877-597-7799
Information and how to access services. Interpreters are available in many languages.
Medicaid Managed Care Helpline ......................................1-866-566-8989
Medicaid Managed Care Helpline TTY ..................................1-866-222-4306
STAR Kids Program Helpline ..........................................1-800-964-2777
Pharmacy Benefits ..................................................1-877-597-7799
State Ombudsman for Managed Care Assistance Team ....................1-866-566-8989
UnitedHealthcare Community Plan • 14141 Southwest Freeway, Suite 500 • Sugar Land, TX 77478
Phone: 1-877-597-7799
For a crisis and you
have trouble with the
phone line, call 9-1-1
or go to the nearest
emergency room.
3 Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Health plan highlights
Welcome to UnitedHealthcare Community Plan
Thank you for choosing UnitedHealthcare Community Plan as your health plan. The
UnitedHealthcare Community Plan, a trade name of United Healthcare Insurance Company, a
Managed Care Organization (MCO), is committed to helping you get the health care you need.
At UnitedHealthcare Community Plan, our goal is to help all of our members live healthier lives.
You will have your own doctor, called a Primary Care Provider (PCP), who will know your medical
history and will work hard to help you stay healthy. Your PCP knows that managing your health care
is important. Regular checkups with your PCP can help spot problems early. Your PCP wants to help
before problems become serious. Your PCP will give you a referral to specialists when you need one.
UnitedHealthcare Community Plan has a network of doctors, hospitals and other health caregivers
that you can count on. Many are near your home. UnitedHealthcare Community Plan will work hard
to help make sure you get access to the care you need.
Your guide to good health
Please read this Member Handbook. It will tell you about your benefits. It will help you use your health
plan right away. If you feel you need this handbook in Braille, larger print, another language or in
audio, you can call us at 1-877-597-7799. UnitedHealthcare Community Plan Member Services is
always ready to help you.
Look at your UnitedHealthcare Community Plan identification card. Make sure all the information
is right. We want to make it easy for you to use your health plan. If you have questions, please
call us. Our toll-free Member Services number is 1-877-597-7799. We are here to help you
8:00 a.m.–5:00 p.m., Monday–Friday. After-hours and weekend coverage is available via an
automated telephone system.
Note: References to “you,” “my,” or “I” apply if you are a STAR Kids member. References to “my
child” apply if your child is a STAR Kids member.
All phone numbers listed in this handbook are toll-free.
Table of contents
4Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Health plan highlights
Language and interpreter services
UnitedHealthcare Community Plan has staff that speaks English and Spanish. If you speak another
language or are deaf and hard of hearing and need help, call Member Services at 1-877-597-7799
or TDD/TTY: 7-1-1 for deaf and hard of hearing.
Our office locations
UnitedHealthcare Community Plan
Regional Service Delivery Area Office
14141 Southwest Freeway, Suite 500
Sugar Land, TX 77478
Or visit our website at:
UHCCommunityPlan.com
What is Member Services?
UnitedHealthcare Community Plan has a Member
Services department that can answer questions and
give you information in English and Spanish on:
• Membership
• Choosing a PCP
• Specialists, hospitals and other providers
• Covered services
• Extra benefits
• Changing PCPs
• Filing a complaint
• Getting an interpreter
• Anything else you might have a question about
Member Services
1-877-597-7799, TDD/TTY: 7-1-1
Our office is closed on these
major holidays:
• New Year’s Day
• Martin Luther King Jr. Day
• Memorial Day
• Independence Day
• Labor Day
• Thanksgiving Day
• Day After Thanksgiving
• Christmas Day
Table of contents
5 Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Table of contents
Health plan highlights ........................................................ 3
Welcome to UnitedHealthcare Community Plan .................................. 3
Your guide to good health .................................................... 3
Language and interpreter services ............................................. 4
Our office locations ........................................................ 4
What is Member Services? ................................................... 4
Your UnitedHealthcare Community Plan ID card ................................. 13
When and where do I use my UnitedHealthcare Community Plan ID card? ............. 13
How to read your UnitedHealthcare Community Plan ID card ....................... 13
How to replace your card if it is lost ........................................... 13
Your Texas Benefits (YTB) Medicaid Card ...................................... 14
The YourTexasBenefits.com Medicaid Client Portal .............................. 15
Your temporary Medicaid verification form (Form 1027-A) .......................... 16
Going to the doctor ......................................................... 17
What is a Primary Care Provider (PCP)? ........................................17
How do I pick a Primary Care Provider? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
What do I need to bring with me to my doctor’s appointment? .......................17
Can a clinic be my Primary Care Provider? ..................................... 18
Can a specialist ever be considered a Primary Care Provider? ....................... 18
What if my doctor is not in network? ........................................... 18
What if I choose to go to another doctor who is not my Primary Care Provider? .......... 18
How do I know who pays? .................................................. 18
What if I have another insurance? ............................................. 18
Can I stay with my provider if they are not with my health plan? ...................... 19
How can I change my Primary Care Provider? ................................... 19
How many times can I change my/my child’s Primary Care Provider? ................. 19
Table of contents
6Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
When will my Primary Care Provider change be effective? .......................... 19
Are there any reasons why a request to change a Primary Care Provider may
be denied? .............................................................. 19
Can a Primary Care Provider move me to another Primary Care Provider
for non-compliance? ...................................................... 19
Physician incentive plans ................................................... 20
What if I need to see a special doctor (specialist)? ................................ 20
What is a referral? Do I need a referral to see a specialist? .......................... 20
What services do not need a referral? ......................................... 20
How soon can I expect to be seen by a specialist? ................................ 20
How can I ask for a second opinion? ...........................................21
Prior authorization .........................................................21
How do I get help if I have behavioral (mental) health, alcohol, or drug problems?
Do I need a referral for this? ................................................. 22
How do I get my medications? ............................................... 22
How do I find a network drug store? ........................................... 22
What if I go to a drug store not in network? ...................................... 22
What do I bring with me to the drug store? ...................................... 22
What if I need my medications delivered to me? .................................. 23
Who do I call if I have problems getting my medications? ........................... 23
What is a prior approval (authorization) of prescription drugs? ...................... 23
What if I can’t get the medication my doctor ordered approved? ..................... 24
What if I lose my medications? ............................................... 24
What if I need Durable Medical Equipment (DME) or other products normally found
in a pharmacy? ........................................................... 24
What if I also have Medicare? ................................................ 25
How do I get my medications if I am in a Nursing Facility? .......................... 25
What is the Medicaid Lock-in Program? ........................................ 25
Who do I call if I have special health care needs and I need someone to help me? ........ 25
What other programs are available to help me manage my chronic illness? ............. 26
What if I need OB/GYN care? Will I need a referral? ............................... 26
Do I have the right to choose an OB/GYN as my Primary Care Provider? ................27
Can I stay with my OB/GYN if they aren’t with UnitedHealthcare Community Plan? ........27
Table of contents
7 Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
How do I choose an OB/GYN? ................................................27
If I do not choose an OB/GYN, do I have direct access? .............................27
Will I need a referral for OB/GYN services? ......................................27
How soon can I be seen after contacting my OB/GYN for an appointment? ..............27
What if I am pregnant? Who do I need to call? ................................... 28
Where can I find a list of birthing centers? ...................................... 28
What other services/activities/education does UnitedHealthcare Community Plan
offer pregnant women? .................................................... 28
How do I sign up my newborn baby? How and when do I tell my health plan?
How and when do I tell my caseworker? ........................................ 29
How can I receive health care after my baby is born (and I am no longer covered
by Medicaid)? ........................................................... 29
Healthy Texas Women Program .............................................. 29
DSHS Primary Health Care Program .......................................... 30
DSHS Expanded Primary Health Care Program ...................................31
DSHS Family Planning Program ...............................................31
How do I make appointments? ............................................... 32
What do I need to bring with me to my appointment? .............................. 32
How do I get medical care after my Primary Care Provider’s office is closed? ........... 32
What if I get sick when I am out of town or traveling? .............................. 32
What if I am out-of-state? ................................................... 32
What if I am out of the country? .............................................. 33
What do I have to do if I move? ............................................... 33
What if I need to update my address or phone number? ........................... 33
What if I want to change health plans? ......................................... 33
Who do I call? ............................................................ 33
How many times can I change health plans? .................................... 33
When will my health plan change become effective? .............................. 33
Can UnitedHealthcare Community Plan ask that I get dropped from their health
plan (for non-compliance, etc.)? .............................................. 34
Can someone interpret for me when I talk with my doctor? Who do I call for
an interpreter? How far in advance do I need to call? .............................. 34
How can I get a face-to-face interpreter in the provider’s office? ...................... 34
What does Medically Necessary Mean? ....................................... 35
Table of contents
8Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
What is emergency medical care? ............................................ 36
How soon can I expect to be seen?
............................................37
What is post-stabilization? ...................................................37
What is urgent medical care? .................................................37
What should I do if my child or I need urgent medical care? ..........................37
How soon can I expect to be seen? ............................................37
What is routine medical care and how soon can I expect to be seen?
................. 38
How do I get eye care services? .............................................. 38
How do I get dental services for my child? ...................................... 38
Are emergency dental services for children covered by the health plan? ............... 39
What dental services does UnitedHealthcare Community Plan cover for children? ....... 39
What do I do if my child needs emergency dental care? ............................ 39
What is a Health Home? .................................................... 40
What is a Prescribed Pediatric Extended Care Center (PPECC)? ..................... 40
Benefits and services ........................................................ 41
What is Service Coordination? ................................................41
What is Service Coordination and what will a Service Coordinator do for me? ............41
How can I talk with a Service Coordinator? ......................................41
What is a Transition Specialist? What will a Transition Specialist do for me? ..............41
How can I talk to a Transition Specialist? ........................................41
Did you know that you might be able to pick your own health caregiver? ............... 42
Why would I want to pick CDS? .............................................. 42
How does CDS work? ..................................................... 42
Which services can be self-directed in which programs? .......................... 42
What are my health care benefits? ............................................ 43
How do I get these services? ................................................ 44
Are there any limits to any covered services? .................................... 44
What services are not covered benefits? ....................................... 44
What are my prescription drug benefits? ....................................... 45
What are Mental Health Rehabilitation Services and Mental Health Targeted
Case Management? How do I get these services? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
What are LTSS and how do I get these services? ................................. 45
Table of contents
9 Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
What are my long-term services and supports (LTSS) benefits? ..................... 45
How do I get these services? What number do I call to find out about these services? .... 46
What are my acute care benefits? ............................................ 46
Hospital care inpatient ..................................................... 46
Outpatient hospital care ................................................... 46
Walk-in surgery centers .....................................................47
Professional services ......................................................47
Other services ............................................................47
How do I get these services? What number do I call to find out about these services? .... 48
What are Community First Choice services and how do I get those services? ........... 48
I am in the Medically Dependent Children Program (MDCP). How will I receive
my LTSS? .............................................................. 48
I am in the Youth Empowerment Services waiver (YES). How will I receive my LTSS? ..... 48
I am in the Community Living Assistance and Support Services (CLASS) waiver.
How will I receive my LTSS? ................................................. 48
I am in the Deaf Blind with Multiple Disabilities (DBMD) waiver. How will I receive
my LTSS? .............................................................. 48
I am in the Home and Community-Based Services (HCBS) waiver. How will I receive
my LTSS? .............................................................. 49
I am in the Texas Home Living (TxHmL) waiver. How will I receive my LTSS? ............ 49
Will my STAR Kids benefits change if I am in a Nursing Facility? ..................... 49
Will I continue to receive STAR Kids benefits if I go into a Nursing Facility? ............. 49
How can I get family planning services? Do I need a referral for this? .................. 50
Where do I find a family planning services provider? .............................. 50
What extra benefits do I get as a member of UnitedHealthcare Community Plan? ........ 50
How can I get these benefits? ................................................ 55
What health education classes does UnitedHealthcare Community Plan offer? ......... 55
What other services can UnitedHealthcare Community Plan help me get? ............. 56
How do I get these services? ................................................ 56
Texas Health Steps .......................................................... 57
What is Texas Health Steps? ..................................................57
Texas Health Steps gives your child ............................................57
Texas Health Steps checkups .................................................57
Table of contents
10Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
When to set up a checkup ...................................................57
How and when do I get Texas Health Steps medical and dental checkups for my child? ... 58
Does my doctor have to be part of the UnitedHealthcare Community Plan network? ...... 59
Do I have to have a referral? ................................................. 59
What if I need to cancel an appointment? ....................................... 59
What if I am out of town and my child is due for a Texas Health Steps checkup? ......... 59
What if I am a migrant farmworker? ........................................... 59
Other plan details ........................................................... 60
What is Case Management for children and pregnant women? ...................... 60
Who can get a Case Manager?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
What do Case Managers do? ................................................ 60
What kind of help can you get? .............................................. 60
How can you get a Case Manager? ........................................... 60
Early Childhood Intervention (ECI) .............................................61
What is Early Childhood Intervention? ..........................................61
Do I need a referral for this? ..................................................61
Where do I find an ECI provider? ..............................................61
Transportation ........................................................... 62
Non Emergency Medical Transportation (NEMT) Services ......................... 62
What are NEMT services? .................................................. 62
What services are part of NEMT Services? ...................................... 62
How to get a ride? ......................................................... 63
What happens if I lose my Medicaid coverage? .................................. 63
What do I have to do if I need help with completing my renewal application? ............ 64
How to renew ............................................................ 64
Completing the renewal process ............................................. 64
What if I get a bill from my doctor? Who do I call? What information will they need? ....... 65
What do I have to do if I move? ............................................... 65
What if I am a Permanency Care Assistance Caregiver and I need to change my address? . 65
What if I have other health insurance in addition to Medicaid? ....................... 66
Medicaid and private insurance .............................................. 66
Table of contents
11 Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
What if I also have Medicare? ................................................ 66
Can my Medicare provider bill me for services or supplies if I am in both Medicare
and Medicaid? ........................................................... 66
You have the right to respect and dignity, including freedom from abuse, neglect,
and exploitation ...........................................................67
What are abuse, neglect and exploitation? .......................................67
Reporting abuse, neglect and exploitation .......................................67
Report by phone (non-emergency): 24 hours a day, 7 days a week, toll-free. . . . . . . . . . . . . . 67
Report electronically (non-emergency) ........................................ 68
Helpful information for filing a report .......................................... 68
Complaints and appeals ................................................... 68
What should I do if I have a complaint? ......................................... 68
Who do I call? ............................................................ 68
Where can I mail a complaint? ............................................... 68
What are the requirements and time frames for filing a complaint? ................... 69
How long will it take to process my complaint?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Can someone from UnitedHealthcare Community Plan help me file a complaint? ........ 69
What can I do if my doctor asks for a service or medicine that is covered but
UnitedHealthcare Community Plan denies or limits it? ............................. 69
How will I find out if services are denied? ....................................... 69
What are the time frames for the appeal process? ................................ 70
When do I have the right to ask for an appeal? ................................... 70
Does my appeal request have to be in writing? ................................... 70
Can someone from UnitedHealthcare Community Plan help me file an appeal? ......... 70
What happens after my appeal? .............................................. 70
What is an emergency appeal? ...............................................71
How do I ask for an emergency appeal? .........................................71
Does my request have to be in writing? .........................................71
What are the time frames for an emergency appeal? ...............................71
What happens if UnitedHealthcare Community Plan denies the request for
an emergency appeal? ......................................................71
Who can help me file an emergency appeal? .....................................71
State Fair Hearing ........................................................ 72
Table of contents
12Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Can I ask for a State Fair Hearing? ............................................ 72
Can I ask for an emergency State Fair Hearing? ................................. 73
External Medical Review information .......................................... 73
Can a member ask for an External Medical Review? .............................. 73
Can I ask for an emergency External Medical Review? ............................. 74
Advance Directives ........................................................ 75
What are Advance Directives? ............................................... 75
How do I get an Advance Directive? ........................................... 75
Who has the right to make health care decisions? ................................ 75
What if I become unable to make or let providers know of my health care decisions? ..... 75
What if I am too sick to make a decision about my medical care? ..................... 75
What are my options for making an Advance Directive? ............................ 76
Must my Advance Directive be followed? ....................................... 76
Must a lawyer prepare my Advance Directive? ................................... 76
Who should have a copy of my Advance Directive? ............................... 76
Do I have to make an Advance Directive? ....................................... 76
Can I change or cancel my Advance Directive? ...................................77
What if I already have an Advance Directive? .....................................77
Who can legally make health care decisions for me if I cannot make those decisions
and I have no Advance Directive? ..............................................77
Member rights and responsibilities ........................................... 78
What are my health care rights and responsibilities as a member of
UnitedHealthcare Community Plan? .......................................... 78
Each year you have the right to ask UnitedHealthcare Community Plan to send
you certain information .....................................................81
Fraud and abuse ......................................................... 82
Do you want to report waste, abuse or fraud?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
To report waste, abuse or fraud, gather as much information as possible ............... 83
You have the right to respect and dignity, including freedom from abuse, neglect,
and exploitation .......................................................... 83
What are abuse, neglect, and exploitation? ..................................... 83
Glossary of managed care terminology ........................................ 84
Health Plan Notices of Privacy Practices ........................................87
Table of contents
13 Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Health plan highlights
Your UnitedHealthcare Community Plan ID card
When and where do I use my UnitedHealthcare Community Plan ID card?
Every person who becomes a member of UnitedHealthcare Community Plan gets an ID card. The
ID card gives the doctor and office staff important information about your child. You will get a new
ID card if you change your child’s Primary Care Provider (PCP).
Check your child’s card to make sure the information is correct. If you get an ID card that has no PCP
name but says to call 1-877-597-7799, please call Member Services to select a PCP. Give your
child’s ID card to the doctor to verify coverage when getting services. The ID card is not a guarantee
of benefits or coverage. For STAR Kids members who are covered by Medicare, no Primary Care
Provider will be assigned.
Health Plan/Plan de salud (80840) 911-87726-04
Member ID/ID del Miembro:
(281)212-2400
Member/Miembro:
999994217
PCP Name/Nombre del PCP:
DOUGLAS GETWELL
PCP Phone/Teléfono del PCP:
Group/grupo:
TXSTK
0709
Payer ID/ID del Pagador :
Rx Bin: 610494
Rx GRP: ACUTX
Rx PCN: 9999
Administered by UnitedHealthcare Community Plan
Effective Date/
Fecha de vigencia
NEW D ENGLISH
87726
11/01/2011
In case of emergency, call 911 or go to the closest emergency room. Printed: 06/08/17
After treatment, call your child's PCP within 24 hours or as soon as possible. This card
does not guarantee coverage. En caso de emergencia, llame al 911 o vaya a la sala de
emergencias más cercana. Después de recibir tratamiento, llame al PCP de su hijo
dentro de 24 horas o tan pronto como sea posible. Esta tarjeta no garantiza la cobertura.
Service Coordination\Coordinación de Servicio: 877-352-7798
For Members\Para Miembros: TTY 711
Behavioral Health\Salud Mental: 877-597-7799
NurseLine\Línea de Ayuda de Enfermeras: 844-222-7326
For Providers: www.uhccommunityplan.com 888-887-9003
Medical Claims:
PO Box 5290, Kingston, NY, 12402-5290
Pharmacy Claims: OptumRX, P.O. Box 650334, Dallas, TX 75265-0334
For Pharmacists: 877-305-8952
877-597-7799
Health Plan/Plan de salud (80840) 911-87726-04
Member ID/ID del Miembro:
(281)212-2400
Member/Miembro:
999994217
PCP Name/Nombre del PCP:
DOUGLAS GETWELL
PCP Phone/Teléfono del PCP:
Group/grupo:
TXSTK
0709
Payer ID/ID del Pagador :
Rx Bin: 610494
Rx GRP: ACUTX
Rx PCN: 9999
Administered by UnitedHealthcare Community Plan
Effective Date/
Fecha de vigencia
NEW D ENGLISH
87726
11/01/2011
In case of emergency, call 911 or go to the closest emergency room. Printed: 06/08/17
After treatment, call your child's PCP within 24 hours or as soon as possible. This card
does not guarantee coverage. En caso de emergencia, llame al 911 o vaya a la sala de
emergencias más cercana. Después de recibir tratamiento, llame al PCP de su hijo
dentro de 24 horas o tan pronto como sea posible. Esta tarjeta no garantiza la cobertura.
Service Coordination\Coordinación de Servicio: 877-352-7798
For Members\Para Miembros: TTY 711
Behavioral Health\Salud Mental: 877-597-7799
NurseLine\Línea de Ayuda de Enfermeras: 844-222-7326
For Providers: www.uhccommunityplan.com 888-887-9003
Medical Claims:
PO Box 5290, Kingston, NY, 12402-5290
Pharmacy Claims: OptumRX, P.O. Box 650334, Dallas, TX 75265-0334
For Pharmacists: 877-305-8952
877-597-7799
How to read your UnitedHealthcare Community Plan ID card
Your ID card will have the STAR Kids logo and the UnitedHealthcare Community Plan logo. This will
let your provider know that you are a UnitedHealthcare Community Plan member. Your name, ID
number, the date you joined the UnitedHealthcare Community Plan program, and your date of birth
will be seen on your card. Your group number will also be on your card.
Remember to take your card with you and present it whenever you get services. Your provider will
need the information on your card to find out about your benefits and coverage.
How to replace your card if it is lost
If you lose your UnitedHealthcare Community Plan ID card, call Member Services right away at
1-877-597-7799. Member Services will send you a new one. Call TDD/TTY: 7-1-1 for deaf and hard
of hearing.
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14Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Health plan highlights
Your Texas Benefits (YTB) Medicaid Card
When you are approved for Medicaid, you will get a YTB Medicaid Card. This plastic card will be
your everyday Medicaid Card. You should carry and protect it just like your driver’s license or a credit
card. Your doctor can use the card to find out if you have Medicaid benefits when you go for a visit.
You will be issued only one card and will receive a new card only if your card is lost or stolen.
If your Medicaid card is lost or stolen, you can get a new one by calling toll-free 1-800-252-8263,
or by going online to order or print a temporary card at www.YourTexasBenefits.com.
If you are not sure if you are covered by Medicaid, you can find out by calling toll-free at
1-800-252-8263. You can also call 2-1-1. First pick a language and then pick option 2.
Your health information is a list of medical services and drugs that you have gotten through
Medicaid. We share it with Medicaid doctors to help them decide what health care you need.
If you don’t want your doctors to see your medical and dental information through the secure
online network, call toll-free at 1-800-252-8263 or opt out of sharing your health information at
www.YourTexasBenefits.com.
The YTB Medicaid Card has these facts printed on the front:
• Your name and Medicaid ID number
• The date the card was sent to you
• The name of the Medicaid program you’re in if you get:
– Medicare (QMB, MQMB),
– Healthy Texas Women Program (HTW),
– Hospice,
– STAR Health,
– Emergency Medicaid, or
– Presumptive Eligibility for Pregnant Women (PE).
• Facts your drug store will need to bill Medicaid
• The name of your doctor and drug store if you’re in the Medicaid Lock-in program
The back of the YTB Medicaid Card has a website you can visit (www.YourTexasBenefits.com) and
a phone number you can call toll-free (1-800-252-8263) if you have questions about the new card.
If you forget your card, your doctor, dentist, or drug store can use the phone or the Internet to make
sure you get Medicaid benefits.
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15 Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Health plan highlights
The YourTexasBenefits.com Medicaid Client Portal
You can use the Medicaid Client Portal to do all of the following for yourself or anyone whose medical
or dental information you are allowed to access:
• View, print, and order a YTB Medicaid card
• See your medical and dental plans
• See your benefit information
• See STAR and STAR Kids Texas Health Steps alerts
• See broadcast alerts
• See diagnoses and treatments
• See vaccines
• See prescription medicines
• Choose whether to let Medicaid doctors and staff see your available medical and
dental information
To access the portal, go to www.YourTexasBenefits.com.
• Click Log In
• Enter your User name and Password. If you don’t have an account, click Create a new account.
• Click Manage
• Go to the “Quick links” section
• Click Medicaid & CHIP Services
• Click View services and available health information
Note: The YourTexasBenefits.com Medicaid Client Portal displays information for active
clients only. A legally authorized representative may view the information of anyone who is a part
of their case.
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16Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Health plan highlights
Temporary Medicaid verification
form sample – back
Temporary Medicaid verification
form sample – front
Your temporary Medicaid verification form
(Form 1027-A)
You can request a temporary Medicaid verification form if your Your Texas Benefits Medicaid Card is
lost or stolen. You need to contact your local Eligibility office or call 2-1-1 for information on getting
the Temporary Medicaid verification form.
• Take your temporary verification form with you to the doctor and to get other medical care
• Show your UnitedHealthcare Community Plan ID card and your Your Texas Benefits Medicaid
Card every time you go to a doctor’s office or clinic
• If you move or change your phone number, call 2-1-1 or visit your local HHSC benefits office.
Also call Member Services at 1-877-597-7799 so we can update our records. Call TDD/TTY:
7-1-1 for deaf and hard of hearing.
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Going to the doctor
What is a Primary Care Provider (PCP)?
Your PCP has the job of taking care of you. Regular checkups with your PCP are important and can
help you stay healthy. Your PCP will do regular health screenings that can find problems.
Finding and treating problems early can prevent them from becoming bigger problems later. Your
PCP will be your personal doctor from now on. Your PCP will take care of you and refer you to a
specialist when needed. You should talk to your PCP about all of your health care needs.
Always talk to your PCP when you want to visit another doctor. Your PCP will give you a referral form
if you need one. Your relationship with your PCP is important. Get to know your PCP as soon as
possible. It is important to follow the PCP’s advice. A good way to build a relationship with your PCP
is to call and schedule a checkup. You can meet your PCP then. He or she will get to know your
medical history, any medications you are taking and any other health problems. Don’t forget that your
PCP is the first one you call with any health problems or questions.
Depending on your medical needs, a specialist may be your PCP. You, the PCP, the specialist
and UnitedHealthcare Community Plan will make this decision. Please call Member Services
for information.
How do I pick a Primary Care Provider?
Call Member Services for help in choosing a PCP. All members of UnitedHealthcare Community Plan
must pick a PCP. You can also request a UnitedHealthcare Community Plan Provider Directory by
calling Member Services at 1-877-597-7799, or you can look online at UHCCommunityPlan.com.
What do I need to bring with me to my doctor’s appointment?
You must take your UnitedHealthcare Community Plan ID card and your Your Texas Benefits
Medicaid card with you when you receive any health care services. You will need to show your
UnitedHealthcare Community Plan ID card and Your Texas
Benefits Medicaid Card each time you need services. If you
have a new doctor, bring any important medical records you
may have and any medications prescribed by a doctor.
Questions about seeing a
provider?
Call Member Services
toll-free at 1-877-597-7799.
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18Questions? Visit UHCCommunityPlan.com,
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Going to the doctor
Can a clinic be my Primary Care Provider?
Your PCP can be a doctor, a clinic, a Rural Health Center (RHC) or a Federally Qualified Health
Center (FQHC). If you go to a doctor you like, you can keep going to that doctor if he or she is in the
UnitedHealthcare Community Plan network.
For STAR Kids members who are covered by Medicare or commercial insurance, no Primary
Care Provider will be assigned.
Can a specialist ever be considered a Primary Care Provider?
If your doctor is a specialist, he or she might be allowed to be your PCP. UnitedHealthcare
Community Plan will send you a UnitedHealthcare Community Plan ID card with your PCP’s name
and phone number.
What if my doctor is not in network?
If your doctor is NOT in the UnitedHealthcare Community Plan network, please call Member Services
to select a PCP. If you do not pick a doctor, one will be assigned for you.
What if I choose to go to another doctor who is not my Primary Care Provider?
Except in emergencies, always call your PCP before you go to another doctor or the hospital. You can
reach your PCP or back-up doctor 24 hours a day, seven days a week.
If you go to another doctor who is not your PCP, you may need to pay the bill.
How do I know who pays?
• If you have Medicaid and go to a Medicaid doctor, you do not have to pay the deductible
or copay
• If you have Medicaid, but don’t go to a Medicaid doctor, you must pay the deductible and copay,
if required
What if I have another insurance?
• You can select a provider of your choice that is in network with your primary coverage,
however, if that provider is not enrolled in Medicaid, you would be responsible for copays
and deductibles
Please contact us at 1-877-597-7799, TDD/TTY: 7-1-1 if you need assistance locating a provider
that accepts all of your insurance coverage.
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Going to the doctor
Can I stay with my provider if they are not with my health plan?
You should try to choose a PCP that is in your health plan’s Provider Network. Please contact
Member Services if you need help.
How can I change my Primary Care Provider?
It is good to stay with the same PCP. Your PCP knows you, has your medical records, and knows what
medications you take. Your PCP is the best person to make sure you are getting good medical care.
Call Member Services to tell us if you want to change your PCP.
How many times can I change my/my child’s Primary Care Provider?
There is no limit on how many times you can change your or your child’s Primary Care Provider.
You can change Primary Care Providers by calling us toll-free at 1-877-597-7799 or writing to us at:
UnitedHealthcare Community Plan
Attn: Member Advocate Team
14141 Southwest Freeway, Suite 500
Sugar Land, TX 77478
When will my Primary Care Provider change be effective?
The PCP change will become effective the day following the change.
Reasons you might change your PCP:
• You have moved and you need a PCP that is closer to your home
• You are not happy with your PCP
Are there any reasons why a request to change a Primary Care Provider may be denied?
• You asked for a PCP who is not part of the UnitedHealthcare Community Plan health plan
• You asked for a PCP who is not accepting new patients because he or she is seeing too
many patients
Can a Primary Care Provider move me to another Primary Care Provider for non-compliance?
Yes, if your PCP does not feel you are following his/her medical advice or if you miss a lot of
appointments, the doctor can ask you to see another doctor. Your PCP will send you a letter telling
you that you need to find another doctor. If this happens, call Member Services at 1-877-597-7799.
We will help you find another doctor.
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or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Going to the doctor
Physician incentive plans
UnitedHealthcare Community Plan cannot make payments under a physician incentive plan if
the payments are designed to induce providers to reduce or limit Medically Necessary Covered
Services to members. You have the right to know if your Primary Care Provider (main doctor) is
part of this physician incentive plan. You also have a right to know how the plan works. You can call
1-877-597-7799 to learn more about this.
What if I need to see a special doctor (specialist)?
Your PCP might want you to see a special doctor (specialist) for certain health care needs. While your
PCP can take care of most of your health care needs, sometimes they will want you to see a specialist
for your care. A specialist has received training and has more experience taking care of certain
diseases, illnesses and injuries. UnitedHealthcare Community Plan has many specialists who will
work with you and your PCP to care for your needs.
What is a referral? Do I need a referral to see a specialist?
Your PCP will talk to you about your needs and will help make plans for you to see the specialist that
can provide the best care for you, including providing a referral if the specialist asks for one. A referral
is a special kind of agreement between doctors that says the specialist will treat you.
UnitedHealthcare Community Plan does not require referrals for you to see a specialist. You can see
any specialist with or without a referral.
What services do not need a referral?
You do not need a referral for:
• Emergency services
• OB/GYN care
• Behavioral health services
• Routine vision services
• Routine dental services
Contact your PCP or Member Services at 1-877-597-7799 to determine if you need a referral.
How soon can I expect to be seen by a specialist?
In some situations, the specialist may see you right away. Depending on the medical need, it may
take up to a few weeks after you make the appointment to see the specialist.
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Going to the doctor
How can I ask for a second opinion?
You have the right to a second opinion from a UnitedHealthcare Community Plan provider if you
are not satisfied with the plan of care offered by the specialist. Your Primary Care Provider should
be able to give you a referral for a second opinion visit. If your doctor wants you to see a specialist
that is not a UnitedHealthcare Community Plan provider, that visit will have to be approved by
UnitedHealthcare Community Plan. You can call Member Services at 1-877-597-7799 for help
with getting a second opinion.
Prior authorization
In some cases your provider must get permission from the health plan before giving you a certain
service. This is called prior authorization. This is your provider’s responsibility. If they do not get prior
authorization, you will not be able to get those services.
You do not need prior authorization for advanced imaging services that take place in an emergency
room, observation unit, urgent care facility or during an inpatient stay. You do not need a prior
authorization for emergencies. You do not need prior authorization to see a women’s health care
provider for women’s health services or if you are pregnant or receiving Texas Health Steps medical
checkups for members under the age of 21. Emergency services do not require a prior authorization.
A prior authorization may be needed
Some services that need prior authorization include:
• Hospital admissions
• Certain outpatient imaging procedures, including PET scan imaging procedures
• Some Durable Medical Equipment services
• Some prescription medications
• Weight loss surgery
• Physical, speech and occupational therapy
• Cardiology
• Non-emergency ambulance transportation
All non-par services require a prior authorization.
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22Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Going to the doctor
How do I get help if I have behavioral (mental) health,
alcohol, or drug problems? Do I need a referral for this?
UnitedHealthcare Community Plan covers medically necessary Substance Abuse and Behavioral
Health Care services. If you have a drug problem or are very upset about something, you can get
help. Call 1-877-597-7799 for help. You do not need a referral for these services.
There will be people who can speak with you in English or Spanish. If you need help with other
languages, please tell them. Member Services will connect you to the AT&T Language Line and
answer your questions. Please call TDD/TTY: 7-1-1, for deaf and hard of hearing.
If it is a crisis and you have trouble with the phone line, call 9-1-1 or go to the nearest emergency
room and contact UnitedHealthcare Community Plan within 24 hours.
How do I get my medications?
Medicaid pays for most medicine your doctor says you need. Your doctor will write a prescription so
you can take it to the drug store, or may be able to send the prescription for you. UnitedHealthcare
Community Plan covers hundreds of prescription drugs from hundreds of pharmacies. A list of
commonly covered drugs is on the Texas Preferred Drug List (PDL) or Formulary. UnitedHealthcare
Community Plan will pay for any medicine listed on UnitedHealthcare Community Plan’s drug
formulary and may pay for other medicines if they are prior authorized. See below for information on
prior authorization. You can fill your prescription at any in-network pharmacy. All you have to do is
show your health plan ID card, Your Texas Benefits card, and any other health insurance card.
How do I find a network drug store?
Please contact Member Services for assistance at 1-877-597-7799 or look for a pharmacy on our
website at UHCCommunityPlan.com.
What if I go to a drug store not in network?
This may affect your ability to get the medications you need. Please contact Member Services for
assistance at 1-877-597-7799 or to find an in-network pharmacy. You can also look on our website
at UHCCommunityPlan.com.
What do I bring with me to the drug store?
You will need your prescription, your UnitedHealthcare Community Plan member ID card and your
Your Texas Benefits Medicaid Card. If you have coverage with another insurance plan, bring your
other insurance card, too.
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or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Going to the doctor
What if I need my medications delivered to me?
Some drug stores are in our delivery program. Ask the drug store if they deliver to UnitedHealthcare
Community Plan members.
For a list of network pharmacies that deliver, go to this web address:
https://www.uhccommunityplan.com/content/dam/uhccp/plandocuments/findapharmacy/
Texas_Listing_of_Delivery_Pharmacies.pdf
Or
https://www.uhccommunityplan.com/tx/medicaid/star_kids > Pharmacy > Find a Pharmacy
> Search for a Pharmacy > Filters and advanced search > (Select Filter) Retail pharmacy delivery
Who do I call if I have problems getting my medications?
All prescriptions you get from your doctor can be filled at any drug store that accepts
UnitedHealthcare Community Plan. If you need help finding a drug store, call UnitedHealthcare
Community Plan at 1-877-597-7799. Remember — always take your prescription, your
UnitedHealthcare Community Plan ID card and your Your Texas Benefits Medicaid Card with
you to the doctor and to the drug store.
What is a prior approval (authorization) of prescription drugs?
UnitedHealthcare Community Plan has built a pharmacy network to make getting your prescriptions
easier. Your plan covers a long list of prescription medicines. For certain prescriptions, you may need
prior approval. Prior approval means we need to give permission before you get a specific drug. We’ll
let you know if you need prior approval from us for any of your prescriptions. If you have a prescription
to fill, be sure to:
• Check that your prescribed drug is on the Texas Vendor Drug Program (VDP) Medicaid
Formulary, which is a list of all covered products. The Formulary, also known as the Texas Drug
Code Index, is a list of all covered products, including prescription and over-the-counter drugs.
The Formulary is listed on the Texas Vendor Drug website at txvendordrug.com/formulary.
You can use the searchable formulary to search for drugs by name or type (class). Within the
VDP Medicaid Formulary, there is also a Preferred Drug List (PDL), which shows which drugs
the VDP recommends that your doctor try first when writing a prescription for you. See state-
specific PDL here: txvendordrug.com/formulary/prior-authorization/preferred-drugs.
Note: PDL for UnitedHealthcare Community Plan of Texas is managed by the Texas Health and
Human Services Commission (HHSC), not UnitedHealthcare.
• HHSC develops and maintains the Medicaid PDL, and MCOs must adhere to the Medicaid
PDL, which comprises medications in various therapeutic classes that are designated as either
“preferred” or “non-preferred.” The Medicaid PDL contains a subset of many, but not all, drugs
that are on the Medicaid formulary. The Medicaid formulary is a listing of drugs, vitamins and
minerals, and home health supplies available to Medicaid members as pharmacy benefits.
Prescription drugs on the formulary, including the PDL, are covered at no cost to you.
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24Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Going to the doctor
• Show your member ID card at the pharmacy when you get your prescriptions filled
• If you have other primary insurance, show both your primary insurance and your Medicaid
insurance at the drug store. The drug store should bill the primary insurance first, then your
Medicaid insurance. Medicaid is the payer of last resort and should not be the only card
presented to the pharmacy. This confirms your eligibility and helps the pharmacy in processing
your claim.
If you have questions about your prescription drugs, ask your PCP or call member services at the
number on the back of your member ID card.
If your prescription drug is not listed on the PDL, or is listed but requires prior approval, your care
provider can request prior approval for you, so you can still get that drug. We will approve or deny the
request within 24 hours. If a request is approved, you and your doctor will be informed of the decision
in writing including the drug approval length of time. If a request is denied, you and your doctor will
be informed of the decision in writing. The written decision notice will tell you how and when to
appeal this decision and to file a complaint or grievance with UnitedHealthcare Community Plan.
What if I can’t get the medication my doctor ordered approved?
If your doctor cannot be reached to approve a prescription, you may be able to get a three-day
emergency supply of your medication. Call UnitedHealthcare Community Plan at 1-877-597-7799
for help with your medications and refills. For a list of covered medications, please visit
UHCCommunityPlan.com.
What if I lose my medications?
Please contact Member Services for assistance at 1-877-597-7799.
What if I need Durable Medical Equipment (DME) or other products normally found
in a pharmacy?
Some durable medical equipment (DME) and products normally found in a pharmacy are covered by
Medicaid. For all members, UnitedHealthcare Community Plan pays for nebulizers, ostomy supplies,
and other covered supplies and equipment if they are medically necessary. For children (birth
through 20), UnitedHealthcare Community Plan also pays for medically necessary prescribed over-
the-counter drugs, diapers, formula, and some vitamins and minerals.
For more information about these benefits or questions about whether your pharmacy provides DME
or other supplies, call UnitedHealthcare Community Plan at 1-877-597-7799.
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25 Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Going to the doctor
What if I also have Medicare?
Medicare or your Medicare Health Plan will pay for your services before UnitedHealthcare
Community Plan will. UnitedHealthcare Community Plan might cover some services that are not
covered by Medicare for STAR Kids members.
How do I get my medications if I am in a Nursing Facility?
Medicaid pays for most medicine your doctor says you need. Your doctor will write a prescription
and send the prescription for you by calling, faxing or submitting by electronic means to the Nursing
Facility to order, fill, dispense and administer to you.
What is the Medicaid Lock-in Program?
You may be put in the Lock-in Program if you do not follow Medicaid rules. It checks how you use
Medicaid pharmacy services. Your Medicaid benefits remain the same. Changing to a different MCO
will not change the Lock-in status.
To avoid being put in the Medicaid Lock-in Program:
• Pick one drug store at one location to use all the time
• Be sure your main doctor, main dentist, or the specialists they refer you to are the only doctors
who give you prescriptions
• Do not get the same type of medicine from different doctors
To learn more, call 1-877-597-7799.
Who do I call if I have special health care needs
and I need someone to help me?
If you have special health care needs, like a serious ongoing illness, disability or chronic or complex
conditions, please call your Service Coordinator toll-free at 1-877-352-7798 for help with your special
health care needs.
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or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Going to the doctor
What other programs are available to help me manage
my chronic illness?
If you have a special need or need help managing a chronic illness, call 1-877-597-7799 to get in
contact with a Service Coordinator. We have disease management programs that help members with
chronic illnesses such as:
• Asthma
• COPD
• Coronary artery disease
• Diabetes
• Heart failure
• Obesity
Members in these programs receive reminders about their care and advice from a nurse.
What if I need OB/GYN care? Will I need a referral?
Attention female members: UnitedHealthcare Community Plan allows you to pick any OB/GYN,
whether that doctor is in the same network as your Primary Care Provider or not. The OB/GYN you
pick must be in the UnitedHealthcare Community Plan Provider Network.
You have the right to pick an OB/GYN without a referral from your PCP. An OB/GYN can give you:
• One well-woman checkup each year
• Care related to pregnancy
• Care for any female medical condition
• Referral to a special doctor within the network
You can get OB/GYN services from your doctor. You can also pick an OB/GYN specialist to take care
of your female health needs. An OB/GYN can help with pregnancy care, yearly checkups or if you
have female problems.
You do not need a referral from a doctor for these services. Your OB/GYN and doctor will work
together to make sure you get the care you need.
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or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Going to the doctor
Do I have the right to choose an OB/GYN as my Primary Care Provider?
If your OB/GYN is willing to be your Primary Care Provider, have them contact our Member
Services team at 1-877-597-7799.
Can I stay with my OB/GYN if they aren’t with UnitedHealthcare Community Plan?
If you are past the 24th week of your pregnancy, you can keep seeing your current OB/GYN through
the postpartum checkup, even if the provider is Out-of-Network. If you want to change to an in-
network OB/GYN, you are allowed to do so if the Provider agrees to accept you in the last trimester of
your pregnancy. For questions, please contact UnitedHealthcare Community Plan Member Services
at 1-877-597-7799. UnitedHealthcare Community Plan will arrange for you to continue treatment
with the OB/GYN doctor you have been seeing. The doctor may also contact UnitedHealthcare
Community Plan to see if they can become one of our providers.
If you are not pregnant or are not in the last three months of your pregnancy, you may choose any
OB/GYN within the UnitedHealthcare Community Plan network. If you see a doctor who is not in our
Network, you may be responsible for any charges. If you need a provider list, please call Member
Services. You can call us for help in picking an OB/GYN doctor at 1-877-597-7799.
How do I choose an OB/GYN?
Call Member Services at 1-877-597-7799 for help choosing an OB/GYN. You can also request
a UnitedHealthcare Community Plan Provider Directory by calling Member Services at
1-877-597-7799, or you can look online at UHCCommunityPlan.com.
If I do not choose an OB/GYN, do I have direct access?
Yes. If your OB/GYN is not your PCP, you can still get all the services you need from your OB/GYN
including family planning services, OB care, and routine GYN services and procedures.
Will I need a referral for OB/GYN services?
No, you do not need a referral for OB/GYN services.
How soon can I be seen after contacting my OB/GYN for an appointment?
If you need prenatal care, your doctor should see you within two weeks of your request for a visit.
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Going to the doctor
What if I am pregnant? Who do I need to call?
UnitedHealthcare Community Plan knows that healthy moms have healthy babies, that is why we take
special care of all of our moms-to-be. We have a special prenatal program called Healthy First Steps
that provides information and support for you.
If you are or may be pregnant:
• We can help you with your pregnancy
• Healthy First Steps will provide education and support to help reduce problems while you
are pregnant
• See your PCP or an OB/GYN. You don’t have to see your PCP first.
Here’s how:
• Make an appointment with an OB/GYN. You should try to visit in the next 10 days (or as soon as
possible) for your first prenatal visit.
• The OB/GYN you select MUST be in our provider network
• It is important for pregnant women to see their doctor many times while pregnant, even if this is
not your first child
• If you do not have an OB/GYN already, please call Member Services at 1-877-597-7799
Where can I find a list of birthing centers?
To find a birthing center, call UnitedHealthcare Community Plan at 1-877-597-7799.
What other services/activities/education does UnitedHealthcare Community Plan offer
pregnant women?
Pregnant women not only get Case Management Services through our Healthy First Steps Program,
but they get special services too. Pregnant women will be sent a book that is a guide to pregnant
members and offers information on several pregnancy topics. You do not need prior authorization to
see a women’s health care provider for women’s health services or if you are pregnant or receiving
Texas Health Steps medical checkups for members under the age of 21. Emergency services do not
require a prior authorization. We are here to answer your questions and to help you get services you
need. 1-800-599-5985, 8:00 a.m.–5:00 p.m., Monday–Friday. Earn great rewards.
Healthy First Steps rewards you for going to your prenatal and postpartum visits.
• Get a $20 gift card just for signing up
• Earn up to 8 rewards in all
• To sign up, visit UHCHealthyFirstSteps.com
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Going to the doctor
How do I sign up my newborn baby? How and when do I tell my health plan?
How and when do I tell my caseworker?
Call UnitedHealthcare Community Plan Member Services at 1-877-597-7799 and let us know
about your new baby as soon as your baby is born. Ask for a Healthy First Steps nurse. In addition,
call the Texas Health and Human Services Commission Caseworker at 1-800-252-8263 to apply
for Temporary Assistance for Needy Families (TANF) if you need help with buying food for you and
your baby.
How can I receive health care after my baby is born (and I am no longer covered by Medicaid)?
After your baby is born, you may lose Medicaid coverage. You may be able to get some health care
services through the Texas Women’s Health Program and the Department of State Health Services
(DSHS). These services are for women who apply for the services and are approved.
Healthy Texas Women Program
The Healthy Texas Women Program provides family planning exams, related health screenings and
birth control to women ages 18 to 44 whose household income is at or below the program’s income
limits (185 percent of the federal poverty level). You must submit an application to find out if you can
get services through this program.
To learn more about services available through the Healthy Texas Women Program, write, call or visit
the program’s website:
Healthy Texas Women Program
P.O. Box 14000
Midland, TX 79711-9902
Phone: 1-800-335-8957
Website:
https://www.healthytexaswomen.org/healthcare-programs/healthy-texas-women
Fax: (toll-free) 1-866-993-9971
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DSHS Primary Health Care Program
The DSHS Primary Health Care Program serves women, children, and men who are unable to
access the same care through insurance or other programs. To get services through this program, a
person’s income must be at or below the program’s income limits (200 percent of the federal poverty
level). A person approved for services may have to pay a copayment, but no one is turned down for
services because of a lack of money.
Primary Health Care focuses on prevention of disease, early detection and early intervention of
health problems. The main services provided are:
• Diagnosis and treatment
• Emergency services
• Family planning
• Preventive health services, including vaccines (shots) and health education, as well as
laboratory, X-ray, nuclear medicine or other appropriate diagnostic services
Secondary services that may be provided are nutrition services, health screening, home health
care, dental care, rides to medical visits, medicines your doctor orders (prescription drugs), durable
medical supplies, environmental health services, treatment of damaged feet (podiatry services) and
social services.
You will be able to apply for Primary Health Care services at certain clinics in your area. To find a
clinic where you can apply, visit the DSHS Family and Community Health Services Clinic Locator at
http://txclinics.com/.
To learn more about services you can get through the Primary Health Care program, email, call or
visit the program’s website:
Website:
https://www.hhs.texas.gov/services/health/primary-health-care- services-program
Phone: 512-776-7796
Email: [email protected]
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DSHS Expanded Primary Health Care Program
The Expanded Primary Health Care program provides primary, preventive, and screening services
to women age 18 and above whose income is at or below the program’s income limits (200 percent
of the federal poverty level). Outreach and direct services are provided through community clinics
under contract with DSHS. Community health workers will help make sure women get the preventive
and screening services they need. Some clinics may offer help with breastfeeding.
You can apply for these services at certain clinics in your area. To find a clinic where you can apply,
visit the DSHS Family and Community Health Services Clinic Locator at http://txclinics.com/.
To learn more about services you can get through the DSHS Expanded Primary Health Care
program, visit the program’s website, call or email:
Phone: 512-776-7796
Fax: 512-776-7203
Email: [email protected]
DSHS Family Planning Program
The Family Planning Program has clinic sites across the state that provide quality, low-cost, and
easy-to-use birth control for women and men.
To find a clinic in your area, visit the DSHS Family and Community Health Services Clinic Locator at
http://txclinics.com/.
To learn more about services you can get through the Family Planning program, visit the program’s
website, call or email:
Website:
https://www.healthytexaswomen.org/healthcare-programs/family-planning-program
Phone: 512-776-7796
Fax: 512-776-7203
Email: [email protected]
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How do I make appointments?
Call your PCP when you need medical care. Your PCP will arrange for the care you need. The name
and phone number of your PCP is on your UnitedHealthcare Community Plan ID card. If you have
Medicare or commercial insurance, you will not have a PCP listed on your ID card.
What do I need to bring with me to my appointment?
When you go to your appointment, always take your UnitedHealthcare Community Plan member
ID card, your Your Texas Benefits Medicaid Card, any other medical, insurance cards you may have,
a list of problems you are having, and a list of all drugs or herbal medications you are taking.
How do I get medical care after my Primary Care Provider’s office is closed?
If your PCP’s office is closed, your PCP will have a number you can call 24 hours a day and on
weekends. It is best to call your PCP as soon as you need health care. Do not wait until the evening
or a weekend to call your PCP if you can get help during the day. Your illness might get worse as the
day goes on. If you get sick during the night or on a weekend and cannot wait for help, call your PCP
at the phone number on the front of your ID card. If you cannot reach your PCP or want to talk to
someone while you wait for the PCP to call you back, call NurseLine at 1-844-222-7326 to talk to a
nurse. Our nurses are ready to help you 24 hours a day, 7 days a week. If you think you have a real
emergency, call 9-1-1 or go to the nearest Emergency Room.
What if I get sick when I am out of town or traveling?
If you need medical care when traveling, call us toll-free at 1-877-597-7799 and we will help you find
a doctor. If you need emergency services while traveling, go to a nearby hospital, then call us toll-free
at 1-877-597-7799.
What if I am out-of-state?
If you have an emergency out-of-state, go to the nearest emergency room for care. If you get sick and
need medical care while you are out-of-state, call your UnitedHealthcare Community Plan PCP. Your
PCP can tell you what you need to do if you are not feeling well. If you visit a doctor or clinic out-of-
state, they must be enrolled in Texas Medicaid to get paid. Please show your Your Texas Benefits
Medicaid Card and UnitedHealthcare Community Plan ID card before you are seen. Have the doctor
call UnitedHealthcare Community Plan for an authorization number. The phone number to call is on
the back of your UnitedHealthcare Community Plan card.
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What if I am out of the country?
Medical services performed out of the country are not covered by Medicaid.
What do I have to do if I move?
As soon as you have your new address, give it to the local HHSC benefits office by calling 2-1-1, and
UnitedHealthcare Community Plan Member Services at 1-877-597-7799. Before you get Medicaid
services in your new area, you must call UnitedHealthcare Community Plan, unless you need
emergency services. You will continue to get care through UnitedHealthcare Community Plan until
HHSC changes your address.
What if I need to update my address or phone number?
The adoptive parent or permanency care assistance caregiver should contact the DFPS regional
adoption assistance eligibility specialist assigned to his or her case. If the parent or caregiver doesn’t
know who the assigned eligibility specialist is, they can contact the DFPS hotline, 1-800-233-3405, to
find out. The parent or caregiver should contact the adoption assistance eligibility specialist to assist
with the address change.
What if I want to change health plans?
You can change your health plan by calling the Texas STAR Kids Program Helpline at 1-800-964-
2777. You can change health plans as often as you want. If you are in the hospital, a residential
Substance Use Disorder (SUD) treatment facility, or residential detoxification facility for SUD, you
will not be able to change health plans until you have been discharged.
Who do I call?
You can change your health plan by calling the STAR Kids Program Helpline at 1-800-964-2777.
How many times can I change health plans?
You can change health plans as many times as you want.
When will my health plan change become effective?
If you call to change your health plan on or before the 15th of the month, the change will take place
on the first day of the next month. If you call after the 15th of the month, the change will take place the
first day of the second month after that. For example:
• If you call on or before April 15, your change will take place on May 1
• If you call after April 15, your change will take place June 1
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Can UnitedHealthcare Community Plan ask that I get dropped from their health plan
(for non-compliance, etc.)?
Yes. UnitedHealthcare Community Plan might ask that a member be taken out of the plan for “good
cause.” “Good Cause” could be, but is not limited to:
• Fraud or abuse by a member
• Threats or physical acts leading to harming of UnitedHealthcare Community Plan staff
or providers
• Theft
• Refusal to go by UnitedHealthcare Community Plan’s policies and procedures, like:
– Letting someone use your ID card;
– Missing visits over and over again;
– Being rude or acting out against a provider or a staff person; or
– Using a doctor that is not a UnitedHealthcare Community Plan provider.
UnitedHealthcare Community Plan will not ask you to leave the program without trying to work
with you. If you have any questions about this process, call UnitedHealthcare Community Plan at
1-877-597-7799. The Texas Health and Human Services Commission will decide if a member can
be told to leave the program.
Can someone interpret for me when I talk with my
doctor? Who do I call for an interpreter? How far in
advance do I need to call?
It is your right to talk with your doctor in the language you prefer. UnitedHealthcare Community Plan
can arrange interpreter services for you. Please call 1-877-597-7799 if you need a translator. Call
TDD/TTY: 7-1-1 for deaf and hard of hearing. Please call as soon as you make your appointment or
at least 24 hours in advance.
How can I get a face-to-face interpreter in the provider’s office?
Translators can meet you at your doctor’s office and help you talk to your doctor face-to-face in the
language you prefer. Please contact Member Services at 1-877-597-7799 for more information.
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What does Medically Necessary Mean?
Medically Necessary means:
1. For members birth through age 20, the following Texas Health Steps services:
(a) Screening, vision and hearing services; and
(b) Other Health Care Services, including Behavioral Health Services, that are necessary to
correct or ameliorate a defect or physical or mental illness or condition. A determination of
whether a service is necessary to correct or ameliorate a defect or physical or mental illness
or condition:
(i) Must comply with the requirements of the Alberto N., et al. v. Traylor, et al. partial
settlement agreements; and
(ii) May include consideration of other relevant factors, such as the criteria described in parts
(2)(b–g) and (3)(b–g) of this definition.
2. For members over age 20, non-behavioral health-related health care services that are:
(a) Reasonable and necessary to prevent illnesses or medical conditions, or provide early
screening, interventions, and/or treatments for conditions that cause suffering or pain, cause
physical deformity or limitations in function, threaten to cause or worsen a handicap, cause
illness or infirmity of a member, or endanger life;
(b) Provided at appropriate facilities and at the appropriate levels of care for the treatment of a
member’s health conditions;
(c) Consistent with health care practice guidelines and standards that are endorsed by
professionally recognized health care organizations or governmental agencies;
(d) Consistent with the diagnoses of the conditions;
(e) No more intrusive or restrictive than necessary to provide a proper balance of safety,
effectiveness and efficiency;
(f) Are not experimental or investigative; and
(g) Are not primarily for the convenience of the member or provider; and
3. For members over age 20, behavioral health services that:
(a) Are reasonable and necessary for the diagnosis or treatment of a mental health or chemical
dependency disorder, or to improve, maintain or prevent deterioration of functioning
resulting from such a disorder;
(b) Are in accordance with professionally accepted clinical guidelines and standards of practice
in behavioral health care;
(c) Are furnished in the most appropriate and least restrictive setting in which services can be
safely provided;
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(d) Are the most appropriate level or supply of service that can safely be provided;
(e) Could not be omitted without adversely affecting the member’s mental and/or physical
health or the quality of care rendered;
(f) Are not experimental or investigative; and
(g) Are not primarily for the convenience of the member or provider.
What is emergency medical care?
Emergency medical care
Emergency medical care is provided for Emergency Medical Conditions and Emergency Behavioral
Health Conditions.
Emergency medical condition means:
A medical condition manifesting itself by acute symptoms of recent onset and sufficient severity
(including severe pain), such that a prudent layperson, who possesses an average knowledge
of health and medicine, could reasonably expect the absence of immediate medical care could
result in:
1. Placing the patient’s health in serious jeopardy;
2. Serious impairment to bodily functions;
3. Serious dysfunction of any bodily organ or part;
4. Serious disfigurement; or
5. In the case of a pregnant woman, serious jeopardy to the health of a woman or her unborn child.
Emergency behavioral health condition means:
Any condition, without regard to the nature or cause of the condition, which in the opinion of a
prudent layperson, possessing average knowledge of medicine and health:
1. Requires immediate intervention or medical attention without which the member would present
an immediate danger to themselves or others; or
2. Which renders the member incapable of controlling, knowing or understanding the
consequences of their actions.
Emergency services and emergency care means:
Covered inpatient and outpatient services furnished by a provider that is qualified to furnish such
services and that are needed to evaluate or stabilize an Emergency Medical Condition and/or
Emergency Behavioral Health Condition, including post-stabilization care services.
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How soon can I expect to be seen?
Emergency wait time will be based on your medical needs and determined by the emergency facility
that is treating you.
What is post-stabilization?
Post-stabilization care services are services covered by Medicaid that keep your condition stable
following emergency medical care.
What is urgent medical care?
Another type of care is urgent care. There are some injuries and illnesses that are probably
not emergencies but can turn into emergencies if they are not treated within 24 hours. Some
examples are:
• Minor burns or cuts
• Earaches
• Sore throat
• Muscle sprains/strains
What should I do if my child or I need urgent medical care?
For urgent care, you should call your doctor’s office even on nights and weekends. Your doctor will
tell you what to do. In some cases, your doctor may tell you to go to an urgent care clinic. If your
doctor tells you to go to an urgent care clinic, you don’t need to call the clinic before going. You need
to go to a clinic that takes UnitedHealthcare Community Plan Medicaid. For help, call us toll-free at
1-877-597-7799. You can also call our 24-hour Nurse HelpLine at 1-844-222-7326 for help with
getting the care you need.
How soon can I expect to be seen?
You should be able to see your doctor within 24 hours for an urgent care appointment. If your doctor
tells you to go to an urgent care clinic, you do not need to call the clinic before going. The urgent care
clinic must take UnitedHealthcare Community Plan Medicaid.
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What is routine medical care and how soon
can I expect to be seen?
If you need a physical checkup, then the visit is routine. Your doctor should see you within 14 days.
UnitedHealthcare Community Plan will be happy to help you make an appointment, just call us at
1-877-597-7799.
Remember: It is best to see your doctor before you get sick so that you can build your relationship
with him/her. It is much easier to call your doctor with your medical problems if he/she knows who
you are.
You must see a UnitedHealthcare Community Plan provider for routine and urgent care. You can
always call UnitedHealthcare Community Plan at 1-877-597-7799 if you need help picking a
UnitedHealthcare Community Plan provider.
How do I get eye care services?
If you need eye care services, please call UnitedHealthcare Community Plan Member Services at
1-877-597-7799. We can help you find a provider close to you.
How do I get dental services for my child?
Your child’s Medicaid dental plan provides dental services including services that help prevent tooth
decay and services that fix dental problems. Call your child’s Medicaid dental plan to learn more
about the dental services they offer.
UnitedHealthcare Community Plan covers emergency dental services your child gets in a hospital or
ambulatory surgical center. This includes services the doctor provides and other services your child
might need like anesthesia.
There are three Medicaid dental plans for children under age 21:
DentaQuest: 1-800-516-0165
MCNA Dental: 1-855-691-6262
UnitedHealthcare Dental: 1-877-901-7321
For more information, call the Texas STAR Kids Program Helpline at 1-800-964-2777.
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Are emergency dental services for children covered by the health plan?
UnitedHealthcare Community Plan covers limited emergency dental services in a hospital or
ambulatory surgical center, including payment for the following:
• Treatment for dislocated jaw
• Treatment for traumatic damage to teeth and supporting structures
• Removal of cysts
• Treatment of oral abscess of tooth or gum origin
• Hospital, physician, and related medical services such as drugs for any of the above conditions
What dental services does UnitedHealthcare Community Plan cover for children?
UnitedHealthcare Community Plan covers emergency dental services in a hospital or ambulatory
surgical center, including, but not limited to, payment for the following:
• Treatment of dislocated jaw
• Treatment for traumatic damage to teeth and supporting structures
• Removal of cysts
• Treatment of oral abscess of tooth or gum origin
UnitedHealthcare Community Plan covers hospital, physician and related medical services for the
above conditions. This includes services the doctor provides and other services your child might
need, like anesthesia or other drugs.
UnitedHealthcare Community Plan is also responsible for paying for treatment and devices for
craniofacial anomalies.
Your child’s Medicaid dental plan provides all other dental services including services that help
prevent tooth decay and services that fix dental problems. Call your child’s Medicaid dental plan to
learn more about the dental services they offer.
What do I do if my child needs emergency dental care?
During normal business hours, call your child’s main dentist to find out how to get emergency
services. If your child needs emergency dental services after the main dentist’s office has closed,
call us toll-free at 1-877-597-7799 or call 9-1-1.
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What is a Health Home?
A health home offers coordinated care to individuals with multiple chronic health conditions,
including mental health and substance use disorders. The health home is a team-based clinical
approach that includes the consumer, his or her providers, and family members, when appropriate.
The health home connects community supports and resources, and helps coordinate and integrate
primary and behavioral health care to better meet the needs of people with multiple chronic illnesses.
What is a Prescribed Pediatric Extended Care
Center (PPECC)?
Prescribed Pediatric Extended Care Centers (PPECCs) allow minors from birth through age 20 with
medically complex conditions to receive daily medical care in a non-residential setting.
When prescribed by a physician, minors can attend a PPECC up to a maximum of 12 hours per day
to receive medical, nursing, psychosocial, therapeutic and developmental services appropriate to
their medical condition and developmental status.
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Benefits and services
What is Service Coordination?
What is Service Coordination and what will a Service Coordinator do for me?
Service Coordination is a service UnitedHealthcare Community Plan gives you to help with your
health and well-being. A Service Coordinator will review, plan and help you in meeting your health
care needs.
You will be assigned a Service Coordinator when you join UnitedHealthcare Community Plan STAR
Kids. Your Service Coordinator will call you or visit you in person to talk to you about your health care
needs and tell you more about the services you can get. He or she will ask you questions about your
health. Please be honest and open. Your Service Coordinator will keep anything you talk about
confidential. Your Service Coordinator can help you:
• Arrange care with your Primary Care Provider
• Help with any medical, behavioral health and Long-Term Services and Supports
• Solve any problems with your medical care or providers
• Find ways for you to live at home or in other community settings
• Explain service and placement choices to you
How can I talk with a Service Coordinator?
To contact a Service Coordinator, look on your UnitedHealthcare Community Plan ID card for the
phone number. You can also call Member Services at 1-877-597-7799 to help you reach your
Service Coordinator. Call TDD/TTY: 7-1-1 for deaf and hard of hearing.
What is a Transition Specialist? What will a Transition Specialist do for me?
For children with special health care needs, the transition to adulthood often brings many changes.
A Transition Specialist can help you understand and plan for these changes. All STAR Kids members
have access to a Transition Specialist.
How can I talk to a Transition Specialist?
If you want to speak with a Transition Specialist or have a Transition Specialist as part of your Care
Team, let your Service Coordinator know and he or she can help you.
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Benefits and services
Did you know that you might be able to pick your own
health caregiver?
UnitedHealthcare Community Plan can help you manage your home services. Consumer-Directed
Services (CDS) is a program for people with attendant/provider services. With this program, you find,
hire and train your attendant/provider. You also review the budget for the services. You decide how
much to pay your attendant. You decide how much to spend for the supplies and equipment you
need. You can pick the person to handle the services for you. If you pick this program, an agency will
teach you what to do. The agency will also handle the payroll for your services.
If you choose CDS, you are the employer. You can hire, fire and manage your own health service
providers. This can include your attendant(s), back-up attendant(s), in-home and out-of-home respite
providers and habilitation providers. You have control over how your program funds are spent on
salary and benefits for your employee(s). You pick a CDS agency to assist you. Your CDS agency will
provide training and support to help with your employer responsibilities, pays your employees based
on your budget, and files taxes for you.
Why would I want to pick CDS?
When you hire your own employees, you can often find people you prefer to work for you. Within
your allotted service budget, you can set your employees’ wages and benefits. You can hire back-up
employees for times when your regular employees cannot work. You can give benefits, such as
vacation days and bonuses. You pick a CDS agency (CDSA) to do your payroll and federal and
state taxes.
How does CDS work?
You pick the Consumer-Directed Services Administrator (CDSA) to do your payroll and act as your
agent to pay taxes. The CDSA helps you set up a budget. In some programs, the CDSA offers
guidance on recruitment, salaries, benefits and administrative costs.
Which services can be self-directed in which programs?
Program Services
STAR Kids Waiver Program Respite services, flexible family support services,
supported employment, and employment assistance
Long Term Supports and Services Community attendant services,
Personal assistance services
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Benefits and services
What are my health care benefits?
UnitedHealthcare Community Plan STAR Kids covers specified medically necessary services. This
list includes some of your health care benefits:
• Ambulance services
• Audiology services, including hearing aids, for adults and children
• Behavioral health services
• Birthing services
• Cancer screening, diagnostic and treatment services
• Chiropractic services
• Day Activity and Health Services (DAHS)
• Dialysis
• Drugs and biologicals provided in an inpatient setting
• Durable medical equipment and supplies
• Early Childhood Intervention (ECI) services
• Emergency services
• Family planning services
• Home health care services
• Hospital services, inpatient and outpatient
• Laboratory
• Mastectomy, breast reconstruction and related follow-up procedures
• Medical checkups and Comprehensive Care Program (CCP) Services for children through the
Texas Health Steps Program
• Optometry, glasses and contact lenses, if medically necessary
• Oral evaluation and fluoride varnish in the Medical Home in conjunction with Texas Health Steps
medical checkup for children 6 months through 35 months of age
• Outpatient drugs and biologicals
• Personal Care Services (PCS)
• Physical, occupational and speech therapies
• Podiatry
• Prenatal care
• Prescribed Pediatric Extended Care Center (PPECC) services
• Preventive services including an annual adult well check for patients 21 years of age and over
• Primary care services
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Benefits and services
• Private Duty Nursing (PDN) services
• Psychiatry services
• Radiology, imaging and X-rays
• Specialty physician services
• Substance use disorder treatment services
• Transplantation of organs and tissues
• Vision
How do I get these services?
Call UnitedHealthcare Community Plan Member Services at 1-877-597-7799.
Are there any limits to any covered services?
There may be limitations to some of the covered services. If you would like more details, contact
Member Services at 1-877-597-7799 or visit myuhc.com for a comprehensive and most up-to-date
benefits offerings.
What services are not covered benefits?
If you want to know if a procedure or medication is covered under STAR Kids, ask your PCP or call
Member Services at 1-877-597-7799. Call TDD/TTY: 7-1-1, for deaf and hard of hearing.
• Services by non-approved providers
• Services by Christian Science Nurses
• Dentures
• Services or supplies not covered by Medicaid
• Services or supplies given to a member after a finding has been made following a review that
these services or supplies are not medically necessary
• Services or supplies paid by any health, accident, and federal government benefits program or
U.S. public health services hospitals
• Services given solely for beauty reasons
• Sex change operations
• Reversal of self-requested sterility
• Services and supplies to any person who is an inmate of a public institution
• Social and educational counseling services (except parent training)
• Experimental or investigational procedures or services
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Benefits and services
What are my prescription drug benefits?
Contact Member Services for more information on your prescription benefits. For more information,
please refer to page 22 of this Member Handbook.
What are Mental Health Rehabilitation Services
and Mental Health Targeted Case Management?
How do I get these services?
Mental Health Rehabilitative Services are a community-based program. These services are
provided to people with mental health disorders. You will learn new skills. These new skills build
on your strengths and abilities. These new skills will help you during a crisis. Your mental health
provider will assess your need for these services. These services can be provided with other mental
health services.
Mental Health Targeted Case Management is a community-based program. These services are
provided to people with mental health disorders. Your mental health provider will pair you with a
staff member. This is your Case Manager. Your Case Manager will work with you to find services or
resources in your area to help you. The Case Manager may come to your home. You may also see
them at their office. This service can be provided with other mental health services.
What are LTSS and how do I get these services?
Long-Term Services and Supports (LTSS) are services provided by health care professionals who
offer direct in-home and community-based services for persons with disabilities. Contact Member
Services at 1-877-597-7799 to ask for these services.
What are my long-term services and supports (LTSS) benefits?
• Assisted living/residential care services
• Day activity and health services
• Dietician/nutritional services
• Emergency response services
• Home health care services
• Medical supplies
• Member managed attendant care (Consumer-Directed Services)
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Benefits and services
• Minor home modifications — to ensure accessibility and improve mobility
• Nursing services
• Parent training — to enhance parenting and caretaking skills
• Personal assistance services
• Sub-acute care
• Therapy services to include occupational, physical and speech/language therapy
How do I get these services? What number do I call to find out about these services?
Call your UnitedHealthcare Community Plan Service Coordinator at 1-877-352-7798.
What are my acute care benefits?
The medically necessary services that UnitedHealthcare Community Plan STAR Kids covers are
listed below. STAR Kids network hospitals will give all necessary items and services when requested
by your doctor. These services include, but are not limited to:
Hospital care inpatient:
• Bed and board in a semi-private room, critical care or heart unit
• Whole blood required for the treatment of sickness or injury
• Child delivery care (the usual care and special prenatal care for pregnant women with
specific problems)
• Newborn care (regular newborn care and special nursery care for newborns with problems)
• All necessary support services and supplies ordered by a doctor
• Transplant services, including: liver, heart, lung, bone marrow and cornea
• Ambulance services for emergencies and non-emergency situations for severely
disabled members
• Substance abuse and behavioral health services
Outpatient hospital care:
For emergency services, STAR Kids will cover outpatient hospital care as follows:
• Services performed in the emergency room or hospital clinic
• Testing or rehabilitative items or services that are requested by your doctor
• Surgery not requiring a hospital stay
• Substance abuse and behavioral health services (when medically necessary)
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47 Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Benefits and services
Walk-in surgery centers:
• Minor surgery not requiring a hospital stay
Professional services:
• Office visits for regular care including:
– Care to prevent illness (annual physical for adults)
– Regular medical care
– Shots to prevent sickness (immunization)
– Podiatry services
• Laboratory and X-ray services, including tests to prevent birth defects
• Genetic services
• Hearing examinations and medically necessary hearing aids
• Emergency dental services
• Dialysis for kidney problems
• Family planning services
• Licensed professional counselors, social workers and mental health services (1-866-302-3996)
• Eye doctor services — Children under 21 years old can get one eye exam each state fiscal year
(September 1 through August 31)
Other services:
Rural health clinic services, including:
• Physician services and their support services
• Nurses and social workers
• Visiting nurse services
• Basic laboratory services
• Maternity clinic services
• Certified nurse midwife services
• Birthing center, including admission, labor, delivery, postpartum and total obstetrical care
• Texas Health Steps medical checkups
• Occupational, hearing, language or speech therapy
• Federally Qualified Health Centers. (These are community clinics that have served local people
for a long time. You may want to visit one and see what kind of medical services they offer.)
Note: For Medicaid-only members, UnitedHealthcare Community Plan STAR Kids will help the
member transition to Medicare if approved or transition to traditional Medicaid.
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48Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Benefits and services
How do I get these services? What number do I call to find out about these services?
Call Member Services at 1-877-597-7799 for questions on how to get these services.
What are Community First Choice services and how do I get those services?
Community First Choice includes additional services to support your daily care and training and skill
development to help you live in the least-restrictive setting. If you are eligible for Medicaid and have a
level of care determined you are eligible to receive additional services. Call your Service Coordinator
to discuss your needs.
I am in the Medically Dependent Children Program (MDCP). How will I receive my LTSS?
State plan LTSS like Personal Care Services (PCS), Private Duty Nursing (PDN) and Community First
Choice (CFC) as well as all MDCP services will be delivered through your STAR Kids MCO. Please
contact your MCO Service Coordinator if you need assistance with accessing these services.
I am in the Youth Empowerment Services waiver (YES). How will I receive my LTSS?
State plan LTSS like Personal Care Services (PCS), Private Duty Nursing (PDN) and Community
First Choice (CFC) will be delivered through your STAR Kids MCO. Your YES waiver services will
be delivered through the Department of State Health Services. Please contact your MCO Service
Coordinator if you need assistance with accessing these services. You can also contact your Local
Mental Health Authority (LMHA) Case Manager for questions specific to YES waiver services.
I am in the Community Living Assistance and Support Services (CLASS) waiver.
How will I receive my LTSS?
State plan LTSS like Personal Care Services (PCS), Private Duty Nursing (PDN) and Community
First Choice (CFC) will be delivered through your STAR Kids MCO. Your CLASS waiver services will
be delivered through the Department of Aging and Disability Services. Please contact your MCO
Service Coordinator if you need assistance with accessing these services. You can also contact your
CLASS Case Manager for questions specific to CLASS waiver services.
I am in the Deaf Blind with Multiple Disabilities (DBMD) waiver. How will I receive my LTSS?
State plan LTSS like Personal Care Services (PCS), Private Duty Nursing (PDN) and Community
First Choice (CFC) will be delivered through your STAR Kids MCO. Your DBMD waiver services will
be delivered through the Department of Aging and Disability Services. Please contact your MCO
Service Coordinator if you need assistance with accessing these services. You can also contact your
DBMD Case Manager for questions specific to DBMD waiver services.
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49 Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Benefits and services
I am in the Home and Community-Based Services (HCBS) waiver. How will I receive my LTSS?
State plan LTSS like Personal Care Services (PCS), Private Duty Nursing (PDN) and Community
First Choice (CFC) will be delivered through your STAR Kids MCO. Your HCS waiver services will
be delivered through the Department of Aging and Disability Services. Please contact your MCO
Service Coordinator if you need assistance with accessing these services. You can also contact your
HCS Service Coordinator at your local intellectual and developmental disability authority (LIDDA) for
questions specific to HCS waiver services.
I am in the Texas Home Living (TxHmL) waiver. How will I receive my LTSS?
State plan LTSS like Personal Care Services (PCS), Private Duty Nursing (PDN) and Community
First Choice (CFC) will be delivered through your STAR Kids MCO. Your TxHmL waiver services will
be delivered through the Department of Aging and Disability Services. Please contact your MCO
Service Coordinator if you need assistance with accessing these services. You can also contact your
TxHmL Service Coordinator at your local intellectual and developmental disability authority (LIDDA)
for questions specific to TxHmL waiver services.
Will my STAR Kids benefits change if I am in a Nursing Facility?
Starting November 1, 2016, people covered by Medicaid who are eligible for STAR Kids and live in a
Nursing Facility will get their basic health services (acute care) and long-term care services through
STAR Kids. People who get both Medicaid and Medicare (dual eligible) will get their basic health
services through Medicare and their long-term care services through STAR Kids Medicaid.
Will I continue to receive STAR Kids benefits if I go into a Nursing Facility?
A STAR Kids member who enters a Nursing Facility or Intermediate Care Facility for Individuals with
Intellectual Disabilities (ICF/IID) will remain a STAR Kids member. The MCO must provide Service
Coordination and any Covered Services that occur outside of the Nursing Facility or ICF/IID when a
STAR Kids member is a Nursing Facility or ICF/IID resident. Throughout the duration of the Nursing
Facility or ICF/IID stay, the STAR Kids MCO must work with the member and the member’s Legally
Authorized Representative (LAR) to identify Community-Based Services and LTSS programs to help
the member return to the community.
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50Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Benefits and services
How can I get family planning services?
Do I need a referral for this?
You can go to your PCP or any doctor or Family Planning clinic that takes Medicaid to help you with
family planning. You do not need a referral form. Tell your PCP where you are going so your records
can be kept up to date. Family Planning Services are very private. You do not have to worry about
anyone else knowing that you are going there. Providers and family planning agencies cannot require
parental consent for minors to receive family planning services.
Where do I find a family planning services provider?
You can find the locations of family planning providers near you online at www.dshs.state.tx.us/
famplan/, or you can call UnitedHealthcare Community Plan at 1-877-597-7799 for help in finding
a family planning provider.
What extra benefits do I get as a member of
UnitedHealthcare Community Plan?
Value-added services
As a member of UnitedHealthcare Community Plan, you can also receive value-added services.
These unique services are offered, in addition to the required Medicaid services, to benefit your
health and everyday life. For a comprehensive and the most up-to-date Value-added services
offerings please go to myuhc.com. Some of the value-added services that UnitedHealthcare
Community Plan offers are:
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51 Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Benefits and services
Help getting a ride
As a part of your UnitedHealthcare transportation benefits, you may also be eligible for additional
transportation assistance to health care services not currently covered by Medicaid. For example,
transportation to EquineTherapy (members in the Northeast and Harris SDAs only).
Terms: Members must call Modivcare at 1-866-529-2117 at least 2 days before the appointment
to schedule transportation. Members under age 18 must be accompanied by an adult.
Tips for when you call to schedule a ride:
• UnitedHealthcare Member ID
• Provider’s name
• Provider’s address
• Provider’s phone number
• Appointment time
Extra vision services
Members get up to $105 maximum eyewear allowance every 24 months.
• An upgraded selection of frames and lenses
• Contact lenses in place of glasses
• Damaged/lost frames and lenses
Terms: Must use in-network provider. Up to $105 every 24 months. Cannot be used for second
or spare pair.
Mikey’s Guide
Mikey’s Guide is a resource book of disability-related programs. Subjects include educational
information, waiver programs and government benefits, state-wide camps, adapted sport activities,
therapies, day programs and much more. Members with a disability can request Mikey’s Guide to
Summer Camps and Activities for Children with Disabilities.
COVID-19 update: The status of some of the resources in this book may have changed. Please
contact the resource you are interested in directly to get the up-to-date information.
Terms: Includes 1 guide per year,* per family. Members 20 and younger.
*Each state fiscal year, 9/1–8/31.
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52Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Benefits and services
Sports and school exams
Members receive a yearly exam for sports, school and camps.
Terms: Must use in-network provider. One exam per year.* Ages 4 through 20 years.
Hyper sensory sensitivity items
Members with a diagnosis of sensory integration dysfunction are eligible to receive a $75 gift card to
Stacy’s Sensory Solutions for items such as weighted backpacks or blankets, resistance/pressure
products and certain apparel; other items available.
Terms: Members must have sensory integration diagnosis. Eligibility will be recommended by
Service Coordinator. One $75 gift card per year.*
Focused learning bundle
One focused learning bundle, through Stacy’s Sensory Solutions, containing items that promote
focus and engagement during homework tasks or remote learning; for members with a diagnosis of
dyslexia, ADHD, dyscalculia, dysgraphia or processing deficits.
Terms: One bundle per year.*
Roach repellent wall plug-ins:
Members can request a 6-pack of roach repellent wall plug-ins.
Terms: One pack per year.* Members must be under active case management and have a diagnosis
of asthma or COPD.
Hypoallergenic bedding:
Members can request 1 hypoallergenic mattress cover and 1 pillowcase.
Terms: Members must be under case management for asthma or COPD. One mattress cover and
pillowcase per year.*
*Each state fiscal year, 9/1–8/31.
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53 Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Benefits and services
Name bands
Members with Intellectual or Developmental Disabilities (IDD) can get a pack of 10 name bands to
help identify medical needs and emergency contacts.
Terms: Includes 1 pack of name bands per year.* Members with IDD 20 and younger.
Book for expecting moms
Pregnant members get 1 book for educational information such as What to Expect the First Year.
Terms: Eligible Star Kids pregnant members or new mothers. Includes 1 book per year.*
Healthy First Steps® Babyscripts program
The Babyscripts program is a mobile app for pregnant members to access free educational content,
resources, and rewards you for going to your prenatal and postpartum visits.
Terms: Pregnant members are eligible. To sign up, visit the Apple App Store® or Google Play™ store
on your smartphone. Download the Babyscripts myJourney app. Or call 1-800-599-5985. It’s that
simple. Once baby is born child must be in a UnitedHealthcare Community Plan plan to continue to
receive rewards. Earn up to 3 rewards in all.
Get a $20 gift card just for signing up.
Resource book
Adoptive families face unique challenges and this resource book, The Connected Child, aids in
welcoming a new child in the home.
Terms: AAPCA members only. One book per household. Book is only available in English.
Food allergy labels
Members can get 1 pack of “I have allergies” alert labels to make members aware of their own food
allergies and inform others when member is away from their caregiver. Pack includes 24 labels.
Terms: Includes 1 pack of 24 labels per year.* Members 20 and younger.
*Each state fiscal year, 9/1–8/31.
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54Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Benefits and services
Wheelchair bags
Members who regularly use a wheelchair can request a durable personal tote bag for the back of
their wheelchair. This will ease the burden when traveling to school, doctor or therapy visits and will
allow transport of books and other personal items.
Terms: Member must request bag from their Service Coordinator. Member must be wheelchair
bound. Includes 1 bag per member per year.*
Equine therapy
Members with Intellectual or Developmental Disabilities (IDD), autism, or are in cognitive therapy
programs can get up to 10 equine therapy sessions per year.*
Terms: Members who have IDD, autism diagnosis or are currently in trauma-focused or cognitive
therapy program are eligible. Excludes members who get animal therapies through a state waiver.
Up to 10 equine therapy sessions per year.* Must use in-network providers. Harris and MRSA
Northeast only.
Inpatient follow-up program
Members get a $20 gift card for following up with a mental health practitioner after discharge from
an inpatient mental health hospital.
Terms: Members must complete follow up within 7 days of their discharge.
Fire/water-resistant bag
Members can request 1 fire/water-resistant bag to store important documents, medications and
personal items during a natural disaster.
Terms: One bag per year.*
Exercise kit
Members who want to become more active or lose weight can request an exercise kit, which includes
one pedometer, 1 pack of resistance bands and 1 water bottle.
Terms: One exercise kit per year.*
*Each state fiscal year, 9/1–8/31.
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55 Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Benefits and services
Online resources
FindHelp
Access online resources to connect with free or low-cost community resources. For example, food
banks, shelters, education, housing and employment services.
Terms: Members will be able to access FindHelp through Health Plan staff, Member advocates or
by contact members services at 1-888-887-9003.
Online mental health resources
Live and Work Well is an online tool that you can use to get support, answers, and expert care.
Find articles, self-care tools, caring providers, and other mental health and substance use disorder
resources. For more information please visit www.liveandworkwell.com.
How can I get these benefits?
It is easy to get these extra benefits by calling Member Services at 1-877-597-7799. Limitations
or restrictions may apply.
What health education classes does UnitedHealthcare
Community Plan offer?
UnitedHealthcare Community Plan can refer you to Health Education classes such as parenting
courses and classes to help you quit smoking. Call Member Services at 1-877-597-7799 for more
information about Health Education classes and meetings.
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56Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Benefits and services
What other services can UnitedHealthcare
Community Plan help me get?
The STAR Kids program covers the following services. These services are offered by other providers
outside of the UnitedHealthcare Community Plan network. We are happy to refer you to one of these
providers if you are in need of these types of services:
• Case Management for Children and Pregnant Women — Visit the website below to learn more:
https://hhs.texas.gov/doing-business-hhs/provider-portals/health-services-providers/
case-management-providers-children-pregnant-women
• Texas Health Steps dental services
• Tuberculosis (TB) clinics
• Women, Infants and Children Services (WIC)
• Early Childhood Intervention (ECI)
• Services by federal or state hospital doctors
• Mental Health and Mental Retardation (MHMR) Case Management
• Mental Retardation Diagnostic Assessment (MRDA)
• Mental health rehabilitation
• Texas School Health and Related Services (SHARS)
• Texas Commission for the Blind (TCB)
How do I get these services?
Call Member Services at 1-877-597-7799 for questions on how to get these services.
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57 Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Texas Health Steps
What is Texas Health Steps?
Texas Health Steps is the Medicaid health care program for children, teens and young adults, birth
through age 20.
Texas Health Steps gives your child:
• Free regular medical checkups starting at birth
• Free dental checkups starting at 6 months of age
• A Case Manager who can find out what services your child needs and where to get
these services
Texas Health Steps checkups:
• Find health problems before they get worse and are harder to treat
• Prevent health problems that make it hard for children to learn and grow like others their age
• Help your child have a healthy smile
When to set up a checkup:
• You will get a letter from Texas Health Steps telling you when it’s time for a checkup. Call your
child’s doctor to set up the checkup.
• Set up the checkup at a time that works best for your family
If the doctor or dentist finds a health problem during a checkup, your child can get the care he or she
needs, such as:
• Eye tests and eyeglasses
• Hearing tests and hearing aids
• Dental care
• Other health care
• Treatment for other medical conditions
Table of contents
58Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Texas Health Steps
Call UnitedHealthcare Community Plan at 1-877-597-7799 or Texas Health Steps at 1-877-847-8377
(1-877-THSTEPS) (toll-free) if you:
• Need help finding a doctor or dentist
• Need help setting up a checkup
• Have questions about checkups or Texas Health Steps
• Need help finding and getting other services
If you can’t get your child to the checkup, Medicaid may be able to help. Children with Medicaid and
their parent can get free rides to and from the doctor, dentist, hospital or drug store.
• Houston/Beaumont area: 1-855-687-4786
• All other areas: 1-877-633-8747 (1-877-MED-TRIP)
How and when do I get Texas Health Steps medical and dental checkups for my child?
Every parent wants their child to be happy and healthy. Keeping them up to date with all checkups is
one of the ways to promote your child’s well-being. Your children should visit the doctor at these
times for their Texas Health Steps checkups:
Infancy:
• At birth while still in the hospital
• 3 to 5 days of life
• 2 weeks
• At 2, 4, 6 and 9 months
Early childhood:
• At 12, 15 and 18 months
• 2, 3 and 4 years
Late childhood:
• At 5, 6, 7, 8, 9, 10, 11 and 12 years
Adolescence:
• At 14, 15, 16, 17, 18 and 20 years
Your children should visit the dentist at these times for their Texas Health Steps checkups:
• Children need to start seeing the dentist at 6 months, then every 6 months thereafter through
20 years of age
Table of contents
59 Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Texas Health Steps
Contact any Texas Health Steps doctor in Texas when your child is due for a checkup. If you are not
sure your child is up to date with medical, dental, vision or hearing care, please call Member Services
at 1-877-597-7799.
Remember, if you do not keep your child’s Texas Health Steps checkups and vaccines up to date,
the amount of your TANF check could be reduced.
Does my doctor have to be part of the UnitedHealthcare Community Plan network?
No, your child can be seen by any Texas Health Steps doctor. By getting regular checkups, your
doctor is able to find and treat problems before they become serious. You do not need a referral.
You have the freedom to pick any Texas Health Steps doctor.
Do I have to have a referral?
No, you do not need a referral for Texas Health Steps services.
What if I need to cancel an appointment?
Call your doctor’s or dentist’s office if you need to cancel a Texas Health Steps appointment.
Reschedule the checkup as soon as you can so your child will stay healthy.
What if I am out of town and my child is due for a Texas Health Steps checkup?
If you are out of town and your child is due for a Texas Health Steps checkup, call UnitedHealthcare
Community Plan at 1-877-597-7799. They will help you set up a visit with your doctor as soon as you
get home.
What if I am a migrant farmworker?
Children of Migrant Farmworkers can receive a Texas Health Steps medical checkup before it is
due. You can get your checkup sooner if you are leaving the area. The appointment should be made
and the exam done before leaving the area. You can call 1-877-597-7799 for help setting up the
appointment. This is a benefit only to children of Migrant Farmworkers and is considered an
“accelerated” service under Texas Health Steps, or one that is given before it is actually due. Please
call us and let us know if anyone in your family works as a Migrant Farmworker.
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60Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Other plan details
What is Case Management for children
and pregnant women?
Case Management for children and pregnant women
Need help finding and getting services? You might be able to get a Case Manager to help you.
Who can get a Case Manager?
Children, teens, young adults (birth through age 20) and pregnant women who get Medicaid and:
• Have health problems, or
• Are at high risk for getting health problems.
What do Case Managers do?
A Case Manager will visit with you and then:
• Find out what services you need
• Find services near where you live
• Teach you how to find and get other services
• Make sure you are getting the services you need
What kind of help can you get?
Case Managers can help you:
• Get medical and dental services
• Get medical supplies or equipment
• Work on school or education issues
• Work on other problems
How can you get a Case Manager?
For more information contact Member Services at 1-888-887-9003, TDD/TTY: 7-1-1, go online
by visiting UHCCommunityPlan.com, or call Texas Health Steps at 1-877-847-8377 (toll-free),
8:00 a.m.–5:00 p.m., Monday–Friday.
To learn more, go to UHCCommunityPlan.com.
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61 Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Other plan details
Early Childhood Intervention (ECI)
What is Early Childhood Intervention?
ECI means Early Childhood Intervention, a federally mandated program for infants and toddlers
under the age of three (0–36 months) with developmental delays or disabilities. ECI services are
unique because:
• Parents and professionals work together as a team
• Services are convenient for families
• Children learn new skills through everyday activities
• Services are coordinated with others in the community
• Families of all income levels receive ECI services
Do I need a referral for this?
Anyone can make a referral (a parent, family member, health care professional, social worker,
caregiver, friend or neighbor). To find an ECI provider, visit https://www.hhs.texas.gov/services/
disability/early-childhood-intervention-services or contact your Service Coordinator for
assistance at 1-877-352-7798.
A child who already has a medically diagnosed condition, which has a high probability of resulting
in a developmental delay, automatically qualifies for ECI. Contact your Service Coordinator for
assistance at 1-877-352-7798.
Next, an ECI professional will provide an evaluation to determine if your child is eligible and will
discuss with you the need for services.
Where do I find an ECI provider?
All of the professionals in ECI have expertise in working with babies, toddlers and their families.
To find an ECI provider, visit https://www.hhs.texas.gov/services/disability/early-childhood-
intervention-services or contact your Service Coordinator for assistance at 1-877-352-7798.
Licensed and/or credentialed specialties include:
• Early Intervention Specialists
• Speech and Language Pathologists
• Physical Therapists
• Occupational Therapists
• Registered Dietitians
• Professional Counselors
• Hearing and Vision Specialists
• Social Workers
• Nurses
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62Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Other plan details
Transportation
Non Emergency Medical Transportation (NEMT) Services
What are NEMT services?
NEMT services provide transportation to nonemergency health care appointments for members
who have no other transportation options. These trips include rides to the doctor, dentist, hospital,
pharmacy, and other places you get Medicaid services. These trips do NOT include ambulance trips.
What services are part of NEMT Services?
• Passes or tickets for transportation such as mass transit within and between cities or states,
including by rail or bus
• Commercial airline transportation services
• Demand response transportation services, which is curb-to-curb transportation in private
buses, vans, or sedans, including wheelchair-accessible vehicles, if necessary
• Mileage reimbursement for an individual transportation participant (ITP) for a verified
completed trip to a covered healthcare service. The ITP can be you, a responsible party, a family
member, a friend, or a neighbor.
• If you are 20 years old or younger, you may be able to receive the cost of meals associated with
a long-distance trip to obtain health care services. The daily rate for meals is $25 per day for the
member and $25 per day for an approved attendant.
• If you are 20 years old or younger, you may be able to receive the cost of lodging associated with
a long-distance trip to obtain health care services. Lodging services are limited to the overnight
stay and do not include any amenities used during your stay, such as phone calls, room service,
or laundry service.
• If you are 20 years old or younger, you may be able to receive funds in advance of a trip to cover
authorized NEMT services
If you need an attendant to travel to your appointment with you, NEMT services will cover the
transportation costs of your attendant.
Children 14 years old and younger must be accompanied by a parent, guardian, or other authorized
adult. Children 15–17 years old must be accompanied by a parent, guardian, or other authorized
adult or have consent from a parent, guardian, or other authorized adults on file to travel alone.
Parental consent is not required if the health care service is confidential in nature.
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Other plan details
How to get a ride?
Your MCO will provide you with information on how to request NEMT services. You should request
NEMT Services as early as possible, and at least two business days before you need the NEMT
service. In certain circumstances you may request the NEMT service with less notice. These
circumstances include being picked up after being discharged from a hospital; trips to the pharmacy
to pick up medication or approved medical supplies; and trips for urgent conditions. An urgent
condition is a health condition that is not an emergency but is severe or painful enough to require
treatment within 24 hours. You must notify your MCO prior to the approved and scheduled trip if your
medical appointment is canceled.
Call the Where’s My Ride Hotline at 1-866-528-0441, TTY 711, 8:00 a.m.–5:00 p.m., Monday–Friday
to discuss your NEMT transportation needs.
Additional member responsibilities while using NEMT Services
1. When requesting NEMT Services, you must provide the information requested by the person
arranging or verifying your transportation.
2. You must follow all rules and regulations affecting your NEMT Services.
3. You must return unused advanced funds. You must provide proof that you kept your medical
appointment prior to receiving future advanced funds.
4. You must not verbally, sexually, or physically abuse or harass anyone while requesting or
receiving NEMT Services.
5. You must not lose bus tickets or tokens and must return any bus tickets or tokens that you do
not use. You must use the bus tickets o tokens only to go to your medical appointment.
6. You must only use NEMT Services to travel to and from your medical appointments.
7. If you have arranged for an NEMT Service but something changes, and you no longer need
the service, you must contact the person who helped you arrange your transportation as soon
as possible.
What happens if I lose my Medicaid coverage?
If you lose Medicaid coverage but get it back again within six (6) months, you will get your Medicaid
services from the same health plan you had before losing your Medicaid coverage. You will also have
the same PCP you had before.
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Other plan details
What do I have to do if I need help with completing my
renewal application?
How to renew
Families must renew their CHIP or Children’s Medicaid coverage every year. In the months before a
child’s coverage is due to end, HHSC will send the family a renewal packet in the mail. The renewal
packet contains an application. It also includes a letter asking for an update on the family’s income
and cost deductions. The family needs to:
• Look over the information on the renewal application
• Fix any information that is not correct
• Sign and date the application
• Look at the health plan options, if Medicaid health plans are available
• Return the renewal application and documents of proof by the due date
Once HHSC receives the renewal application and documents of proof, staff checks to see if the
children in the family still qualify for their current program or if they qualify for a different program.
If a child is referred to another program (Medicaid or CHIP), HHSC sends the family a letter telling
them about the referral and then looks to see if the child can get benefits in the other program. If the
child qualifies, the coverage in the new program (Medicaid or CHIP) begins the month following the
last month of the other program’s coverage. During renewal, the family can pick new medical and
dental plans by calling the CHIP/Children’s Medicaid call center at 1-800-964-2777. If you need help
completing a renewal application, you can call UnitedHealthcare Community Plan or 2-1-1.
Completing the renewal process
When children still qualify for coverage in their current program (CHIP or Medicaid), HHSC will
send the family a letter showing the start date for the new coverage period. If the children qualify for
CHIP and an enrollment fee is due, the family must pay the enrollment fee by the due date or risk
losing the coverage.
CHIP renewal is complete when the family:
• Pays any enrollment fee due by the due date
• If the family changes their medical or dental plan, then they must sign and send the appropriate
Enrollment/Transfer Form to HHSC showing the change
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If HHSC receives and processes the CHIP enrollment fee before the cutoff in the 12th month of
coverage, then new coverage begins without interruption on the first day of the following month.
If HHSC does not get the enrollment fee in time, then new coverage will not begin until the first day
of the following month.
Medicaid renewal is complete when the family signs and sends to HHSC the appropriate Enrollment/
Transfer Form if the family picks a new medical or dental plan.
What if I get a bill from my doctor? Who do I call?
What information will they need?
If you get a bill from a doctor, hospital or other health care provider, ask why they are billing you. Your
doctor, health care provider or hospital cannot bill you for covered and approved Medicaid services.
You do not have to pay bills that UnitedHealthcare Community Plan should pay.
If you still get a bill, call Member Services at 1-877-597-7799 for help.
Be sure you have your bill in front of you when you call. You will need to tell Member Services who
sent you the bill, the date of service, the amount and the provider’s address and phone number.
What do I have to do if I move?
As soon as you have your new address, give it to the local HHSC benefits office and UnitedHealthcare
Community Plan Member Services department at 1-877-597-7799. Before you get Medicaid
services in your new area, you must call UnitedHealthcare Community Plan, unless you need
emergency services. You will continue to get care through UnitedHealthcare Community Plan until
HHSC changes your address.
What if I am a Permanency Care Assistance Caregiver
and I need to change my address?
The adoptive parent of the Permanency Care Assistance Caregiver should contact (or be referred to)
the Texas Department of Family and Protective Services’ Regional Adoption Assistance Eligibility
Specialist (AAES) assigned to their case. If you do not know who your AAES is, you can contact the
DFPS hotline, 1-800-233-3405, to find out who your assigned eligibility specialist is. The AAES will
then be able to assist you with the address change.
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What if I have other health insurance in addition
to Medicaid?
Medicaid and private insurance
You are required to tell Medicaid staff about any private health insurance you have. You should call
the Medicaid Third Party Resources hotline and update your Medicaid case file if:
• Your private health insurance is canceled
• You get new insurance coverage
• You have general questions about third party insurance
You can call the hotline toll-free at 1-800-846-7307. If you have other insurance, you may still qualify
for Medicaid. When you tell Medicaid staff about your other health insurance, you help make sure
Medicaid only pays for what your other health insurance does not cover.
Important: Medicaid providers cannot turn you down for services because you have private health
insurance as well as Medicaid. If providers accept you as a Medicaid patient, they must also file
with your private health insurance company.
What if I also have Medicare?
Medicare or your Medicare Health Plan will pay for your services before UnitedHealthcare
Community Plan will. UnitedHealthcare Community Plan might cover some services that are not
covered by Medicare for STAR Kids members.
Can my Medicare provider bill me for services or supplies if I am in both Medicare
and Medicaid?
You cannot be billed for Medicare “cost-sharing,” which includes deductibles, coinsurance, and
copayments that are covered by Medicaid.
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You have the right to respect and dignity, including
freedom from abuse, neglect, and exploitation
What are abuse, neglect and exploitation?
Abuse is mental, emotional, physical or sexual injury, or failure to prevent such injury.
Neglect results in starvation, dehydration, overmedicating or undermedicating, unsanitary living
conditions, etc. Neglect also includes lack of heat, running water, electricity, medical care and
personal hygiene.
Exploitation is misusing the resources of another for personal or monetary gain. This includes taking
Social Security or SSI (Supplemental Security Income) checks, abusing a joint checking account,
and taking property and other resources.
Reporting abuse, neglect and exploitation
The law requires that you report suspected abuse, neglect or exploitation, including unapproved use
of restraints or isolation that is committed by a provider.
Call 9-1-1 for life-threatening or emergency situations.
Report by phone (non-emergency): 24 hours a day, 7 days a week, toll-free
Report to the Health and Human Services Commission by calling 1-800-458-9858 if the person being
abused, neglected or exploited lives in or receives services from a:
• Nursing facility;
• Assisted living facility;
• Adult day care center;
• Licensed adult foster care provider; or
• Home and Community Support Services Agency (HCSSA) or Home Health Agency.
Suspected abuse, neglect or exploitation by an HCSSA must also be reported to the Department
of Family and Protective Services (DFPS).
Report all other suspected abuse, neglect or exploitation to DFPS by calling 1-800-252-5400.
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Report electronically (non-emergency)
Go to https://txabusehotline.org. This is a secure website. You will need to create a password-
protected account and profile.
Helpful information for filing a report
When reporting abuse, neglect or exploitation, it is helpful to have the names, ages, addresses and
phone numbers of everyone involved.
Complaints and appeals
What should I do if I have a complaint?
We want to help. If you have a complaint, please call us toll-free at 1-877-597-7799 to tell us about
your problem. A UnitedHealthcare Community Plan Member Services Advocate can help you file a
complaint. Just call 1-877-597-7799. Most of the time, we can help you right away or at the most
within a few days.
Once you have gone through the UnitedHealthcare Community Plan complaint process, you can
complain to the Health and Human Services Commission (HHSC) by calling toll-free 1-866-566-8989.
If you would like to make your complaint in writing, please send it to the following address:
Texas Health and Human Services Commission
Ombudsman Managed Care Assistance Team
P.O. Box 13247
Austin, Texas 78711-3247
If you can get on the Internet, you can submit your complaint at: https://hhs.texas.gov/about-hhs/
your-rights/office-ombudsman/hhs-ombudsman-managed-care-help.
Who do I call?
Call UnitedHealthcare Member Services for help at 1-877-597-7799, TDD/TTY: 7-1-1, for deaf and
hard of hearing.
Where can I mail a complaint?
For written complaints, please send your letter to UnitedHealthcare Community Plan. You must state
your name, your member ID, your telephone number and address, and the reason for your complaint.
Please send your letter to:
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131-0364
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What are the requirements and time frames for filing a complaint?
There is no time limit on filing a complaint with UnitedHealthcare Community Plan. UnitedHealthcare
Community Plan will send you a letter telling you what we did about your complaint.
How long will it take to process my complaint?
Most of the time we can help you right away or at the most within a few days. You will get the letter
within 30 days from when your complaint got to UnitedHealthcare Community Plan.
Can someone from UnitedHealthcare Community Plan help me file a complaint?
Yes, a UnitedHealthcare Community Plan Member Services representative can help you file a
complaint, just call 1-877-597-7799. Most of the time, we can help you right away or at the most
within a few days.
What can I do if my doctor asks for a service or medicine that is covered
but UnitedHealthcare Community Plan denies or limits it?
UnitedHealthcare Community Plan will send you a letter if a covered service that you requested is
not approved or if payment is denied in whole or in part. If you are not happy with our decision, call
UnitedHealthcare Community Plan within 60 days from when you get our letter.
You must appeal within 10 Business Days of the date on the letter, or by the action effective date
in the letter, to make sure your services are not stopped. You can appeal by sending a letter to
UnitedHealthcare Community Plan, by mailing the appeal form included in the letter you received,
or by calling UnitedHealthcare Community Plan. You can ask for an extension for up to 14 days of
extra time for your appeal. UnitedHealthcare Community Plan can take extra time on your appeal if it
is better for you. If this happens, UnitedHealthcare Community Plan will tell you in writing the reason
for the delay.
You can call Member Services and get help with your appeal. When you call Member Services, we
will help you file an appeal. Then we will send you a letter and ask you or someone acting on your
behalf to sign a form.
How will I find out if services are denied?
UnitedHealthcare Community Plan will send you a letter if a covered service requested by your
child’s PCP is denied, delayed, limited or stopped.
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What are the time frames for the appeal process?
UnitedHealthcare Community Plan must complete the entire standard Appeal process within
30 Days after receipt of the initial written or oral request for Appeal. This deadline may be extended
for up to 14 Days at the request of a member; or the MCO shows that there is a need for more
information and how the delay is in the member’s interest. If the MCO needs to extend, the member
must receive written notice of the delay.
When do I have the right to ask for an appeal?
You may request an appeal for denial of payment for services in whole or in part. If you ask for an
appeal within 10 Business Days from the mailing of the notice of the Action or the intended effective
date of the proposed action, you have the right to keep getting any service the health plan denied
or reduced at least until the final appeal decision is made. If you do not request an appeal within
10 Business Days from the time you get the denial notice, the service the health plan denied will
be stopped.
Does my appeal request have to be in writing?
Your request does not have to be in writing. If you would like to send in a written appeal you can mail
written requests to:
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131-0364
Can someone from UnitedHealthcare Community Plan help me file an appeal?
Member Services is available to help you file a complaint or an appeal. You can ask them to help you
when you call 1-877-597-7799.
What happens after my appeal?
You will get a letter telling you what the appeal decided, if your services will change and when,
and any other choices you may have. Member’s option to request an External Medical Review and
State Fair Hearing no later than 120 days after the date the MCO mails the appeal decision notice.
Member’s option to request only a State Fair Hearing Review no later than 120 days after the MCO
mails the appeal decision notice.
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What is an emergency appeal?
An emergency appeal is when the health plan has to make a decision quickly based on the condition
of your health, and taking the time for a standard appeal could jeopardize your life or health.
How do I ask for an emergency appeal?
You may ask for this type of appeal in writing or by phone. Make sure you write “I want a quick
decision or an emergency appeal,” or “I feel my health could be hurt by waiting for a standard
decision.” To request a quick decision by phone, call UnitedHealthcare Community Plan Member
Services at 1-877-597-7799.
Does my request have to be in writing?
Your request does not have to be in writing. We can record your verbal request. Your request will
then be made into a written request. If you would like to mail in your appeal request, you can mail
written requests to:
UnitedHealthcare Community Plan
Attn: Complaint and Appeals Department
P.O. Box 31364
Salt Lake City, UT 84131-0364
What are the time frames for an emergency appeal?
UnitedHealthcare Community Plan must decide this type of appeal within 1 Business Day or 72
hours from the time we get the information and request. If your appeal is for ongoing emergency or
you were denied continued stay in the hospital, we must complete the appeal within 1 Business Day.
What happens if UnitedHealthcare Community Plan denies the request for an
emergency appeal?
If UnitedHealthcare Community Plan denies an emergency appeal, the appeal is processed through
the normal appeal process, which will be resolved within 30 days. You will receive a letter explaining
why and what other choices you may have.
Who can help me file an emergency appeal?
If your child is in the hospital, ask someone to help you mail, fax or call in your request for this type of
appeal. You may also call UnitedHealthcare Community Plan Member Services at 1-877-597-7799
and ask someone to help you start an appeal or ask your child’s doctor to do it for you.
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State Fair Hearing
Can I ask for a State Fair Hearing?
If you, as a member of the health plan, disagree with the health plan’s internal appeal decision, you
have the right to ask for a State Fair Hearing. You may name someone to represent you by writing a
letter to the health plan telling them the name of the person you want to represent you. A provider
may be your representative.
If you want to challenge a decision made by your health plan, you or your representative must ask for
the State Fair Hearing within 120 days of the date on the health plan’s letter with the internal appeal
decision.
If you do not ask for the State Fair Hearing within 120 days, you may lose your right to a State Fair
Hearing. To ask for a State Fair Hearing, you or your representative should call UnitedHealthcare
Community Plan at 1-800-288-2160 or send a letter to the health plan at:
UnitedHealthcare Community Plan
Attn: Fair Hearings Coordinator
14141 Southwest Freeway, Suite 500
Sugar Land, TX 77478
You have the right to keep getting any service the health plan denied or reduced, based on previously
authorized services, at least until the final State Fair Hearing decision is made if you ask for a State
Fair Hearing by the later of: (1) 10 calendar days following the date the health plan mailed the internal
appeal decision letter, or (2) the day the health plan’s internal appeal decision letter says your service
will be reduced or end. If you do not request a State Fair Hearing by this date, the service the health
plan denied will be stopped.
If you ask for a State Fair Hearing, you will get a packet of information letting you know the date, time
and location of the hearing. Most State Fair Hearings are held by telephone. At that time, you or your
representative can tell why you need the service the health plan denied.
HHSC will give you a final decision within 90 days from the date you asked for the State Fair Hearing.
If you go through this process, and the services you asked for after appeal and State Fair Hearing is
denied, you may have to pay for those services.
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If you lose the State Fair Hearing appeal, UnitedHealthcare Community Plan might be able to recover
the costs of the service or benefit you received while the appeal was pending. UnitedHealthcare will
not recover costs for services you received during the appeal or State Fair Hearing without written
permission from HHSC.
Can I ask for an emergency State Fair Hearing?
If you believe that waiting for a State Fair Hearing will seriously jeopardize your life or health, or your
ability to attain, maintain, or regain maximum function, you or your representative may ask for an
emergency State Fair Hearing by writing or calling UnitedHealthcare Community Plan. To qualify for
an emergency State Fair Hearing through HHSC, you must first complete UnitedHealthcare
Community Plan’s internal appeals process.
External Medical Review information
Can a member ask for an External Medical Review?
If a member, as a member of the health plan, disagrees with the health plan’s internal appeal
decision, the member has the right to ask for an External Medical Review. An External Medical
Review is an optional, extra step the member can take to get the case reviewed before the State Fair
Hearing occurs. The member may name someone to represent them by contacting the health plan
and giving the name of the person the member wants to represent him or her. A provider may be the
member’s representative. The member or the member’s representative must ask for the External
Medical Review within 120 days of the date the health plan mails the letter with the internal appeal
decision. If the member does not ask for the External Medical Review within 120 days, the member
may lose his or her right to an External Medical Review. To ask for an External Medical Review, the
member or the member’s representative may either:
• Fill out the “State Fair Hearing and External Medical Review Request Form” that came with the
Member Notice of MCO Internal Appeal Decision letter and mail or fax it to:
UnitedHealthcare Community Plan
Attn: Fair Hearings Coordinator
14141 Southwest Freeway, Suite 500
Sugar Land, TX 77478
Fax: 1-855-322-0672
• Or call UnitedHealthcare by using the address or fax number at the top of the form
– Call UnitedHealthcare at 1-800-288-2160
– Email UnitedHealthcare at [email protected]
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If the member asks for an External Medical Review within 10 days from the time the member gets
the appeal decision from the health plan, the member has the right to keep getting any service the
health plan denied, based on previously authorized services, at least until the final State Fair Hearing
decision is made. If the member does not request an External Medical Review within 10 days from
the time the member gets the appeal decision from the health plan, the service the health plan
denied will be stopped.
The member may withdraw the member’s request for an External Medical Review before it is
assigned to an Independent Review Organization or while the Independent Review Organization
is reviewing the member’s External Medical Review request. An Independent Review Organization
is a third-party organization contracted by HHSC that conducts an External Medical Review during
member appeal processes related to Adverse Benefit Determinations based on functional necessity
or medical necessity. An External Medical Review cannot be withdrawn if an Independent Review
Organization has already completed the review and made a decision.
If the member continues with a State Fair Hearing and the State Fair Hearing decision is different
from the Independent Review Organization decision, it is the State Fair Hearing decision that is final.
The State Fair Hearing decision can only uphold or increase member benefits from the Independent
Review Organization decision.
Can I ask for an emergency External Medical Review?
If you believe that waiting for a standard External Medical Review will seriously jeopardize your life or
health, or your ability to attain, maintain, or regain maximum function, you, your parent or your legally
authorized representative may ask for an emergency External Medical Review and emergency State
Fair Hearing by writing or calling UnitedHealthcare Community Plan. To qualify for an emergency
External Medical Review and emergency State Fair Hearing review through HHSC, you must first
complete UnitedHealthcare’s internal appeals process.
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Advance Directives
What are Advance Directives?
All adults in hospitals, nursing centers and other health care settings have certain rights. For
instance, you have the right to have your personal and medical records kept private. You have the
right to know what treatment you will get. Under federal law, you have the right to fill out an Advance
Directive. Advance Directives are written documents that let you decide and put into writing what
kind of treatment you want or do not want, and any actions you want carried out if you are too sick to
make decisions about your health care. It is our policy to let all adult UnitedHealthcare Community
Plan members know that they can prepare these documents. The federal law on Advance Directives
requires hospitals, nursing centers and other health care providers to give you information about
Advance Directives. The information will explain your legal choices in making decisions about
medical care. The law was written to increase your control over medical treatment decisions.
Advance Directives are written documents that give you the chance to decide and put into writing
what kind of treatment you want or do not want, and any actions you want carried out if you become
too sick to make decisions about your health care.
How do I get an Advance Directive?
Contact your PCP or call Member Services at 1-877-597-7799. Call TDD/TTY: 7-1-1, for deaf and
hard of hearing.
Who has the right to make health care decisions?
You do, if you are an adult and able to let providers know of your health care decisions. You decide
what health care, if any, you will not accept.
What if I become unable to make or let providers know of my health care decisions?
You can still have some control over these decisions if you have signed an Advance Directive. Your
PCP must include in your medical record whether you have signed an Advance Directive. If you have
not named someone in your Advance Directive, your doctor must seek a person authorized by law to
make these decisions.
What if I am too sick to make a decision about my medical care?
You can still have some control over these decisions if you have signed an Advance Directive. Your
PCP must include in your medical record whether you have signed an Advance Directive. If you have
not named someone in your Advance Directive, your doctor must seek a person authorized by law to
make these decisions.
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What are my options for making an Advance Directive?
Under Texas law, you can make the following directives:
1. A Durable Power of Attorney for Health Care — a written document giving the designated
person the power to act in your place and make decisions on your health care. Your Durable
Health Care Power of Attorney will also include any details or guidance about health care you
want or do not want. This could include withholding or withdrawing procedures if you are in a
“terminal condition.” A “terminal condition” is when a patient cannot be cured and will die
without life-sustaining procedures. (Two doctors must state this in writing.) A patient is also in a
“terminal condition” if that patient is in a permanent vegetative state or an irreversible coma.
2. A Living Will — a written statement about health care you want or do not want if you cannot make
these decisions. For example, a Living Will can say whether you would want to be fed through a
tube if you were unconscious and not likely to recover. A Living Will directs doctors to withhold/
withdraw or continue life-sustaining procedures if you are in a “terminal condition.” You can also
tell doctors whether to use other life-sustaining procedures.
Must my Advance Directive be followed?
Yes. Your PCP, other health providers and the person you name in your directive must follow your
Advance Directive.
Must a lawyer prepare my Advance Directive?
No. There are local and national groups that will give you facts on Advance Directives, including
forms. Be sure any Advance Directive you use is valid under Texas law.
Who should have a copy of my Advance Directive?
Give a copy of your Advance Directive to your PCP and to any health care center on admission. If you
have a Durable Power of Attorney for Health Care, give a copy to the person you have named on it.
You should also keep extra copies for yourself.
Do I have to make an Advance Directive?
No. Whether you make an Advance Directive is up to you. A health care provider cannot refuse care
based on whether you have an Advance Directive or not.
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Can I change or cancel my Advance Directive?
Yes. If you change or cancel your Advance Directive, let anyone who has a copy of it know.
What if I already have an Advance Directive?
You might want to review it or have it reviewed. If it has been prepared in another state, make sure it is
valid under Texas law.
Who can legally make health care decisions for me if I cannot make those decisions and I have
no Advance Directive?
A court might appoint a guardian to make health care decisions for you. Otherwise, your PCP must
go down the following list to find someone else to make health care decisions for you:
1. Your husband or wife, unless you are legally separated.
2. Your adult child. If you have more than one adult child, a majority of them.
3. Your mother or father.
4. Your brother or sister.
If your PCP cannot find a person able to make health care decisions for you, then he or she can
decide on your care. Your PCP can do this with the advice of an ethics committee, or the approval of
another doctor. You can make sure your wishes are honored by putting them in writing. The person
you name in your Advance Directive will not have the right to refuse life-sustaining procedures, such
as the use of tubes to give you food or fluids unless:
a. You have appointed that person to make health care decisions for you in a Durable Power of
Attorney for Health Care.
b. A court has appointed that person as your guardian to make health care decisions for you.
c. You have stated in an Advance Directive that you do not want this specific treatment. If you need
any help in learning about Advance Directives, or to order a copy of a Living Will, call Member
Services at 1-877-597-7799.
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Member rights and responsibilities
What are my health care rights and responsibilities as a member
of UnitedHealthcare Community Plan?
Member rights:
1. You have the right to respect, dignity, privacy, confidentiality and nondiscrimination. That
includes the right to:
a. Be treated fairly and with respect.
b. Know that your medical records and discussions with your providers will be kept private
and confidential.
2. You have the right to a reasonable opportunity to choose a health care plan and primary care
provider. This is the doctor or health care provider you will see most of the time and who will
coordinate your care. You have the right to change to another plan or provider in a reasonably
easy manner. That includes the right to:
a. Be told how to choose and change your health plan and your Primary Care Provider.
b. Choose any health plan you want that is available in your area and choose your Primary Care
Provider from that plan.
c. Change your Primary Care Provider.
d. Change your health plan without penalty.
e. Be told how to change your health plan or your Primary Care Provider.
3. You have the right to ask questions and get answers about anything you do not understand.
That includes the right to:
a. Have your provider explain your health care needs to you and talk to you about the different
ways your health care problems can be treated.
b. Be told why care or services were denied and not given.
4. You have the right to agree to or refuse treatment and actively participate in treatment decisions.
That includes the right to:
a. Work as part of a team with your provider in deciding what health care is best for you.
b. Say yes or no to the care recommended by your provider.
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5. You have the right to use each complaint and appeal process available through the managed
care organization and through Medicaid, and get a timely response to complaints, appeals,
External Medical Reviews and State Fair Hearings. That includes the right to:
a. Make a complaint to your health plan or to the state Medicaid program about your health care,
your provider or your health plan.
b. Get a timely answer to your complaint.
c. Use the plan’s appeal process and be told how to use it.
d. Ask for an External Medical Review and State Fair Hearing from the state Medicaid program
and get information about how that process works.
e. Ask for a State Fair Hearing without an External Medical Review from the state Medicaid
program and receive information about how that process works.
6. You have the right to timely access to care that does not have any communication or physical
access barriers. That includes the right to:
a. Have telephone access to a medical professional 24 hours a day, 7 days a week to get any
emergency or urgent care you need.
b. Get medical care in a timely manner.
c. Be able to get in and out of a health care provider’s office. This includes barrier-free access
for people with disabilities or other conditions that limit mobility, in accordance with the
Americans with Disabilities Act.
d. Have interpreters, if needed, during appointments with your providers and when talking to
your health plan. Interpreters include people who can speak in your native language, help
someone with a disability, or help you understand the information.
e. Be given information you can understand about your health plan rules, including the health
care services you can get and how to get them.
7. You have the right to not be restrained or secluded when it is for someone else’s convenience,
or is meant to force you to do something you do not want to do, or is to punish you.
8. You have a right to know that doctors, hospitals and others who care for you can advise you
about your health status, medical care and treatment. Your health plan cannot prevent them
from giving you this information, even if the care or treatment is not a covered service.
9. You have a right to know that you are not responsible for paying for covered services.
Doctors, hospitals and others cannot require you to pay copayments or any other amounts for
covered services.
10. You have a right to make recommendations to your health plan’s member rights and
responsibilities.
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Other plan details
Member responsibilities:
1. You must learn and understand each right you have under the Medicaid program. That includes
the responsibility to:
a. Learn and understand your rights under the Medicaid program.
b. Ask questions if you do not understand your rights.
c. Learn what choices of health plans are available in your area.
2. You must abide by the health plan’s and Medicaid’s policies and procedures. That includes the
responsibility to:
a. Learn and follow your health plan’s rules and Medicaid rules.
b. Choose your health plan and a Primary Care Provider quickly.
c. Make any changes in your health plan and Primary Care Provider in the ways established by
Medicaid and by the health plan.
d. Keep your scheduled appointments.
e. Cancel appointments in advance when you cannot keep them.
f. Always contact your Primary Care Provider first for your non-emergency medical needs.
g. Be sure you have approval from your Primary Care Provider before going to a specialist.
h. Understand when you should and should not go to the emergency room.
3. You must share information about your health with your Primary Care Provider and learn about
service and treatment options. That includes the responsibility to:
a. Tell your PCP about your health.
b. Talk to your providers about your health care needs and ask questions about the different
ways your health care problems can be treated.
c. Help your providers get your medical records.
4. You must be involved in decisions relating to service and treatment options, make personal
choices, and take action to keep yourself healthy. That includes the responsibility to:
a. Work as a team with your provider in deciding what health care is best for you.
b. Understand how the things you do can affect your health.
c. Do the best you can to stay healthy.
d. Treat providers and staff with respect.
e. Talk to your provider about all of your medications
f. Must follow agreed upon plans and instructions for care
If you think you have been treated unfairly or discriminated against, call the U.S. Department of
Health and Human Services (HHS) toll-free at 1-800-368-1019. You can also view information
concerning the HHS Office of Civil Rights online at www.hhs.gov/ocr.
Table of contents
81 Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Other plan details
Each year you have the right to ask UnitedHealthcare Community Plan
to send you certain information
As a member of UnitedHealthcare Community Plan, you can ask for and get this information
each year:
• Information about network providers — at a minimum primary care doctors, specialists and
hospitals in our service area. This information will include names, addresses, telephone
numbers and languages spoken (other than English) for each network provider, plus
identification of providers that are not accepting new patients and, when applicable,
professional qualifications, specialty, medical school attended, residency completion and
board certification status.
• Member has a right to receive info about the organization, its services, its practitioners and
providers and member rights
• Any limits on your freedom of choice among network providers
• Your rights and responsibilities
• Information on complaint, appeal, External Medical Review and State Fair Hearing procedures
• Information about benefits available under the Medicaid program, including amount, duration
and scope of benefits. This is designed to make sure you understand the benefits to which you
are entitled.
• How you get benefits including authorization requirements
• How you get benefits, including family planning services, from out-of-network providers and/or
limits to those benefits
• How you get after hours and emergency coverage and/or limits to those kinds of
benefits, including:
– What makes up emergency medical conditions, emergency services and post-stabilization
services
– The fact that you do not need prior authorization from your Primary Care Provider for
emergency care services
– How to get emergency services, including instructions on how to use the 9-1-1 telephone
system or its local equivalent
– The addresses of any places where providers and hospitals furnish emergency services
covered by Medicaid
– A statement saying you have a right to use any hospital or other settings for emergency care
– Post-stabilization rules
• Policy on referrals for specialty care and for other benefits you cannot get through your Primary
Care Provider
• UnitedHealthcare Community Plan’s practice guidelines
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Other plan details
UnitedHealthcare Community Plan must provide information to members on how it evaluates new
technology for inclusion as a covered benefit. UnitedHealthcare reviews new procedures and
devices to decide if they are safe and effective for members. If they are found to be safe and effective,
they may become covered. If new technology becomes a covered service, it will follow plan rules,
including medical necessity. It may publish this information in newsletters, member handouts or
other member materials. If a newsletter is the chosen method, UnitedHealthcare Community Plan
must publish this information annually.
Fraud and abuse
Do you want to report waste, abuse or fraud?
Let us know if you think a doctor, dentist, pharmacist at a drug store, other health care providers, or a
person getting benefits is doing something wrong. Doing something wrong could be waste, abuse or
fraud, which is against the law. For example, tell us if you think someone is:
• Getting paid for services that weren’t given or necessary
• Not telling the truth about a medical condition to get medical treatment
• Letting someone else use their Medicaid ID
• Using someone else’s Medicaid ID
• Not telling the truth about the amount of money or resources he or she has to get benefits
To report waste, abuse or fraud, choose one of the following:
• Call the OIG Hotline at 1-800-436-6184;
• Visit https://oig.hhs.texas.gov/ and click on “Report Fraud” to complete an online form; or
• You can report directly to your health plan:
UnitedHealthcare Community Plan Compliance
14141 Southwest Freeway, Suite 500
Sugar Land, TX 77478
1-877-597-7799
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Other plan details
To report waste, abuse or fraud, gather as much information
as possible
When reporting about a provider (a doctor, dentist, counselor, etc.) include:
• Name, address and phone number of provider
• Name and address of the facility (hospital, nursing home, home health agency, etc.)
• Medicaid number of the provider and facility, if you have it
• Type of provider (doctor, dentist, therapist, pharmacist, etc.)
• Names and phone numbers of other witnesses who can help in the investigation
• Dates of events
• Summary of what happened
When reporting about someone who gets benefits, include:
• The person’s name
• The person’s date of birth, Social Security number, or case number if you have it
• The city where the person lives
• Specific details about the waste, abuse or fraud
You have the right to respect and dignity, including freedom from
abuse, neglect, and exploitation
What are abuse, neglect, and exploitation?
Abuse is mental, emotional, physical, or sexual injury, or failure to prevent such injury.
Neglect results in starvation, dehydration, overmedicating or undermedicating, unsanitary living
conditions, etc. Neglect also includes lack of heat, running water, electricity, medical care, and
personal hygiene.
Exploitation is misusing the resources of another person for personal or monetary gain. This
includes taking Social Security or SSI (Supplemental Security Income) checks, abusing a joint
checking account, and taking property and other resources.
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Other plan details
Reporting abuse, neglect, and exploitation
The law requires that you report suspected abuse, neglect, or exploitation, including unapproved
use of restraints or isolation that is committed by a provider. Call 9-1-1 for life-threatening or
emergency situations.
Report by phone (non-emergency); 24 hours a day, 7 days a week, toll-free
Report to the Health and Human Services Department by calling 1-800-458-9858 if the person
being abused, neglected, or exploited lives in or receives services from a:
• Nursing facility;
• Assisted living facility;
• Adult day care center;
• Licensed adult foster care provider; or
• Home and Community Support Services Agency (HCSSA) or Home Health Agency.
Suspected abuse, neglect or exploitation by an HCSSA must also be reported to the Department
of Family and Protective Services (DFPS). Report all other suspected abuse, neglect, or exploitation
to DFPS by calling 1-800-252-5400.
Report electronically (non-emergency)
Go to https://txabusehotline.org. This is a secure website. You will need to create a password-
protected account and profile.
Helpful information for filing a report
When reporting abuse, neglect, or exploitation, it is helpful to have the names, ages, addresses,
and phone numbers of everyone involved.
Glossary of managed care terminology
Appeal — A request for your managed care organization to review a denial or a grievance again.
Complaint — A grievance that you communicate to your health insurer or plan.
Durable Medical Equipment (DME) — Equipment ordered by a health care provider for everyday or
extended use. Coverage for DME may include but is not limited to: oxygen equipment, wheelchairs,
crutches, or diabetic supplies.
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Other plan details
Emergency Medical Condition — An illness, injury, symptom, or condition so serious that a
reasonable person would seek care right away to avoid harm.
Emergency Medical Transportation — Ground or air ambulance services for an emergency
medical condition.
Emergency Room Care — Emergency services you get in an emergency room.
Emergency Services — Evaluation of an emergency medical condition and treatment to keep the
condition from getting worse.
Excluded Services — Health care services that your health insurance or plan doesn’t pay for
or cover.
Grievance — A complaint to your health insurer or plan.
Habilitation Services and Devices — Health care services such as physical or occupational therapy
that help a person keep, learn, or improve skills and functioning for daily living.
Home Health Care — Health care services a person receives in a home.
Hospice Services — Services to provide comfort and support for persons in the last stages of a
terminal illness and their families.
Hospitalization — Care in a hospital that requires admission as an inpatient and usually requires an
overnight stay.
Hospital Outpatient Care — Care in a hospital that usually doesn’t require an overnight stay.
Medically Necessary — Health care services or supplies needed to prevent, diagnose, or treat an
illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine.
Network — The facilities, providers, and suppliers your health insurer or plan has contracted with to
provide health care services.
Non-Participating Provider — A provider who doesn’t have a contract with your health insurer or
plan to provide covered services to you. It may be more difficult to obtain authorization from your
health insurer or plan to obtain services from a non-participating provider instead of a participating
provider. In limited cases, such as when there are no other providers, your health insurer can contract
to pay a non-participating provider.
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Other plan details
Participating Provider — A Provider who has a contract with your health insurer or plan to provide
covered services to you.
Physician Services — Health-care services a licensed medical physician (M.D. — Medical Doctor or
D.O. — Doctor of Osteopathic Medicine) provides or coordinates.
Plan — A benefit, like Medicaid, which provides and pays for your health-care services.
Pre-Authorization — A decision by your health insurer or plan that a health-care service, treatment
plan, prescription drug, or durable medical equipment that you or your provider has requested, is
medically necessary. This decision or approval, sometimes called prior authorization, prior approval,
or pre-certification, must be obtained prior to receiving the requested service. Pre-authorization isn’t
a promise your health insurance or plan will cover the cost.
Prescription Drug Coverage — Health insurance or plan that helps pay for prescription drugs
and medications.
Prescription Drugs — Drugs and medications that by law require a prescription.
Primary Care Physician — A physician (M.D. — Medical Doctor or D.O. — Doctor of Osteopathic
Medicine) who directly provides or coordinates a range of health-care services for a patient.
Primary Care Provider — A physician (M.D. — Medical Doctor or D.O. — Doctor of Osteopathic
Medicine), nurse practitioner, clinical nurse specialist, or physician assistant, as allowed under state
law, who provides, coordinates, or helps a patient access a range of health-care services.
Provider — A physician (M.D. — Medical Doctor or D.O. — Doctor of Osteopathic Medicine), health-
care professional, or health-care facility licensed, certified, or accredited as required by state law.
Rehabilitation Services and Devices — Health-care services such as physical or occupational
therapy that help a person keep, get back or improve skills and functioning for daily living that have
been lost or impaired because a person was sick, hurt or disabled.
Skilled Nursing Care — Services from licensed nurses in your own home or in a nursing home.
Specialist — A physician specialist focuses on a specific area of medicine or a group of patients to
diagnose, manage, prevent or treat certain types of symptoms and conditions.
Urgent Care — Care for an illness, injury or condition serious enough that a reasonable person would
seek care right away, but not so severe as to require emergency room care.
Table of contents
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Other plan details
Health Plan Notices of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED
AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW
IT CAREFULLY.
Effective January 1, 2023
By law, we
1
must protect the privacy of your health information (“HI”). We must send you this notice.
It tells you:
• How we may use your HI.
• When we can share your HI with others.
• What rights you have to access your HI.
By law, we must follow the terms of this notice.
HI is information about your health or health care services. We have the right to change our privacy
practices for handling HI. If we change them, we will notify you by mail or e-mail. We will also post
the new notice at this website (www.uhccommunityplan.com). We will notify you of a breach of your
HI. We collect and keep your HI to run our business. HI may be oral, written or electronic. We limit
employee and service provider access to your HI. We have safeguards in place to protect your HI.
How we collect, use, and share your information
We collect, use, and share your HI with:
• You or your legal representative.
• Government agencies.
We have the right to collect, use and share your HI for certain purposes. This must be for your
treatment, to pay for your care, or to run our business. We may use and share your HI as follows.
• For Payment. We may collect, use, and share your HI to process premium payments and
claims. This may include coordinating benefits.
• For Treatment or Managing Care. We may collect, use, and share your HI with your providers
to help with your care.
• For Health Care Operations. We may suggest a disease management or wellness program.
We may study data to improve our services.
• To Tell You about Health Programs or Products. We may tell you about other treatments,
products, and services. These activities may be limited by law.
Table of contents
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Other plan details
• For Plan Sponsors. We may give enrollment, disenrollment, and summary HI to your employer.
We may give them other HI if they properly limit its use.
• For Underwriting Purposes. We may collect, use, and share your HI to make underwriting
decisions. We will not use your genetic HI for underwriting purposes.
• For Reminders on Benefits or Care. We may collect, use and share your HI to send you
appointment reminders and information about your health benefits.
• For Communications to You. We may use the phone number or email you gave us to contact
you about your benefits, healthcare or payments.
We may collect, use, and share your HI as follows:
• As Required by Law.
• To Persons Involved with Your Care. This may be to a family member in an emergency. This
may happen if you are unable to agree or object. If you are unable to object, we will use our best
judgment. If permitted, after you pass away, we may share HI with family members or friends
who helped with your care.
• For Public Health Activities. This may be to prevent disease outbreaks.
• For Reporting Abuse, Neglect or Domestic Violence. We may only share with entities allowed
by law to get this HI. This may be a social or protective service agency.
• For Health Oversight Activities to an agency allowed by the law to get the HI. This may be for
licensure, audits and fraud and abuse investigations.
• For Judicial or Administrative Proceedings. To answer a court order or subpoena.
• For Law Enforcement. To find a missing person or report a crime.
• For Threats to Health or Safety. This may be to public health agencies or law enforcement.
An example is in an emergency or disaster.
• For Government Functions. This may be for military and veteran use, national security, or the
protective services.
• For Workers’ Compensation. To comply with labor laws.
• For Research. To study disease or disability.
• To Give Information on Decedents. This may be to a coroner or medical examiner. To identify
the deceased, find a cause of death, or as stated by law. We may give HI to funeral directors.
• For Organ Transplant. To help get, store or transplant organs, eyes or tissue.
• To Correctional Institutions or Law Enforcement. For persons in custody: (1) to give health
care; (2) to protect your health and the health of others; and (3) for the security of the institution.
• To Our Business Associates if needed to give you services. Our associates agree to protect
your HI. They are not allowed to use HI other than as allowed by our contract with them.
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Other plan details
• Other Restrictions. Federal and state laws may further limit our use of the HI listed below.
We will follow stricter laws that apply.
1. Alcohol and Substance Abuse
2. Biometric Information
3. Child or Adult Abuse or Neglect, including Sexual Assault
4. Communicable Diseases
5. Genetic Information
6. HIV/AIDS
7. Mental Health
8. Minors’ Information
9. Prescriptions
10. Reproductive Health
11. Sexually Transmitted Diseases
We will only use your HI as described here or with your written consent. We will get your written
consent to share psychotherapy notes about you. We will get your written consent to sell your HI to
other people. We will get your written consent to use your HI in certain promotional mailings. If you let
us share your HI, the recipient may further share it. You may take back your consent. To find out how,
call the phone number on your ID card.
Your rights
You have the following rights.
• To ask us to limit use or sharing for treatment, payment, or health care operations. You can ask
to limit sharing with family members or others. We may allow your dependents to ask for limits.
We will try to honor your request, but we do not have to do so.
• To ask to get confidential communications in a different way or place. For example, at a
P.O. Box instead of your home. We will agree to your request as allowed by state and federal law.
We take verbal requests. You can change your request. This must be in writing. Mail it to
the address below.
• To see or get a copy of certain HI. You must ask in writing. Mail it to the address below. If we
keep these records in electronic form, you can request an electronic copy. You can have your
record sent to a third party. We may send you a summary. We may charge for copies. We may
deny your request. If we deny your request, you may have the denial reviewed.
• To ask to amend. If you think your HI is wrong or incomplete you can ask to change it. You must
ask in writing. You must give the reasons for the change. Mail this to the address below. If we
deny your request, you may add your disagreement to your HI.
Table of contents
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Other plan details
• To get an accounting of HI shared in the six years prior to your request. This will not include
any HI shared for the following reasons. (i) For treatment, payment, and health care operations;
(ii) With you or with your consent; (iii) With correctional institutions or law enforcement. This will
not list the disclosures that federal law does not require us to track.
• To get a paper copy of this notice. You may ask for a paper copy at any time. You may also get
a copy at our website (www.uhccommunityplan.com).
• To ask that we correct or amend your HI. Depending on where you live, you can also ask us to
delete your HI. If we can’t, we will tell you. If we can’t, you can write us, noting why you disagree
and send us the correct information.
Using your rights
• To Contact your Health Plan. Call the phone number on your ID card. Or you may contact the
UnitedHealth Group Call Center at 1-866-633-2446, or TTY/RTT 711.
• To Submit a Written Request. Mail to:
UnitedHealthcare Privacy Office
MN017-E300, P.O. Box 1459, Minneapolis MN 55440
• Timing. We will respond to your phone or written request within 30 days.
• To File a Complaint. If you think your privacy rights have been violated, you may send a
complaint at the address above.
You may also notify the Secretary of the U.S. Department of Health and Human Services. We will
not take any action against you for filing a complaint.
1
This Medical Information Notice of Privacy Practices applies to the following health plans that are
affiliated with UnitedHealth Group: AmeriChoice of New Jersey, Inc.; Arizona Physicians IPA, Inc.;
Care Improvement Plus South Central Insurance Company; Care Improvement Plus of Texas
Insurance Company; Care Improvement Plus Wisconsin Insurance; Health Plan of Nevada, Inc.;
Optimum Choice, Inc.; Oxford Health Plans (NJ), Inc.; Physicians Health Choice of Texas, LLC;
Preferred Care Partners, Inc.; Rocky Mountain Health Maintenance Organization, Incorporated;
UnitedHealthcare Benefits of Texas, Inc.; UnitedHealthcare Community Plan of California, Inc.;
UnitedHealthcare Community Plan of Ohio, Inc.; UnitedHealthcare Community Plan of Texas,
L.L.C.; UnitedHealthcare Community Plan, Inc.; UnitedHealthcare Community Plan of Georgia,
Inc.; UnitedHealthcare Insurance Company; UnitedHealthcare Insurance Company of America;
UnitedHealthcare Insurance Company of River Valley; UnitedHealthcare of Alabama, Inc.;
UnitedHealthcare of Florida, Inc.; UnitedHealthcare of Kentucky, Ltd.; UnitedHealthcare of
Louisiana, Inc.; UnitedHealthcare of the Mid-Atlantic, Inc.; UnitedHealthcare of the Midlands, Inc.;
UnitedHealthcare of the Midwest, Inc.; United Healthcare of Mississippi, Inc.; UnitedHealthcare of
New England, Inc.; UnitedHealthcare of New Mexico, Inc.; UnitedHealthcare of New York, Inc.;
UnitedHealthcare of Pennsylvania, Inc.; UnitedHealthcare of Washington, Inc.; UnitedHealthcare
of Wisconsin, Inc.; and UnitedHealthcare Plan of the River Valley, Inc. This list of health plans is
complete as of the effective date of this notice. For a current list of health plans subject to this notice
go to https://www.uhc.com/privacy/entities-fn-v2.
Table of contents
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Other plan details
Financial Information Privacy Notice
THIS NOTICE SAYS HOW YOUR FINANCIAL INFORMATION MAY BE USED AND SHARED.
REVIEW IT CAREFULLY.
Effective January 1, 2023
We
2
protect your “personal financial information” (“FI”). FI is non-health information. FI identifies you
and is generally not public.
Information we collect
• We get FI from your applications or forms. This may be name, address, age and social
security number.
• We get FI from your transactions with us or others. This may be premium payment data.
Sharing of FI
We will only share FI as permitted by law.
We may share your FI to run our business. We may share your FI with our Affiliates. We do not need
your consent to do so.
• We may share your FI to process transactions.
• We may share your FI to maintain your account(s).
• We may share your FI to respond to court orders and legal investigations.
• We may share your FI with companies that prepare our marketing materials.
Confidentiality and security
We limit employee and service provider access to your FI. We have safeguards in place to protect
your FI.
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Other plan details
Questions about this notice
Please call the toll-free member phone number on health plan ID card or contact the UnitedHealth
Group Customer Call Center at 1-866-633-2446, or TTY/RTT 711.
2
For purposes of this Financial Information Privacy Notice, “we” or “us” refers to the entities listed
in footnote 1, beginning on the last page of the Health Plan Notices of Privacy Practices, plus the
following UnitedHealthcare affiliates: ACN Group of California, Inc.; AmeriChoice Corporation.;
Benefitter Insurance Solutions, Inc.; Claims Management Systems, Inc.; Dental Benefit Providers,
Inc.; Ear Professional International Corporation; Excelsior Insurance Brokerage, Inc.;
gethealthinsurance.com Agency, Inc. Golden Outlook, Inc.; Golden Rule Insurance Company;
HealthMarkets Insurance Agency; Healthplex of CT, Inc.; Healthplex of ME, Inc.; Healthplex of NC,
Inc.; Healthplex, Inc.; HealthSCOPE Benefits, Inc.; International Healthcare Services, Inc.; Level2
Health IPA, LLC; Level2 Health Management, LLC; Life Print Health, Inc.; Managed Physical
Network, Inc.; Optum Care Networks, Inc.; Optum Global Solutions (India) Private Limited; Optum
Health Care Solutions, Inc.; Oxford Benefit Management, Inc.; Oxford Health Plans LLC; Physician
Alliance of the Rockies, LLC; POMCO Network, Inc.; POMCO, Inc.; Real Appeal, LLC; Solstice
Administrators of Alabama, Inc.; Solstice Administrators of Arizona, Inc.; Solstice Administrators of
Missouri, Inc.; Solstice Administrators of North Carolina, Inc.; Solstice Administrators of Texas, Inc.;
Solstice Administrators, Inc.; Solstice Benefit Services, Inc.; Solstice of Minnesota, Inc.; Solstice of
New York, Inc.; Spectera, Inc.; Three Rivers Holdings, Inc.; U.S. Behavioral Health Plan, California;
UHIC Holdings, Inc.; UMR, Inc.; United Behavioral Health; United Behavioral Health of New York
I.P.A., Inc.; UnitedHealthcare, Inc.; United HealthCare Services, Inc.; UnitedHealth Advisors, LLC;
UnitedHealthcare Service LLC; Urgent Care MSO, LLC; USHEALTH Administrators, LLC; and
USHEALTH Group, Inc.; and Vivify Health, Inc. This Financial Information Privacy Notice only
applies where required by law. Specifically, it does not apply to (1) health care insurance products
offered in Nevada by Health Plan of Nevada, Inc. and Sierra Health and Life Insurance Company,
Inc.; or (2) other UnitedHealth Group health plans in states that provide exceptions. This list of
health plans is complete as of the effective date of this notice. For a current list of health plans
subject to this notice go to https://www.uhc.com/privacy/entities-fn-v2.
Table of contents
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UnitedHealthcare Community Plan does not treat members differently because of sex, age, race,
color, disability or national origin.
If you think you were treated unfairly because of your sex, age, race, color, disability or national origin,
you can send a complaint to:
Civil Rights Coordinator
UnitedHealthcare Civil Rights Grievance
P.O. Box 30608
Salt Lake City, UTAH 84130
You must send the complaint within 60 days of when you found out about it. A decision will be sent
to you within 30 days. If you disagree with the decision, you have 15 days to ask us to look at it again.
If you need help with your complaint, please call Member Services toll-free at 1-877-597-7799,
TTY 711, 8 a.m.–5 p.m., Monday–Friday.
You can also file a complaint with the U.S. Dept. of Health and Human Services.
Online:
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
Complaint forms are available at
http://www.hhs.gov/ocr/office/file/index.html
Phone:
Toll-free 1-800-368-1019, 1-800-537-7697 (TDD)
Mail:
U.S. Dept. of Health and Human Services
200 Independence Avenue SW
Room 509F, HHH Building
Washington, D.C. 20201
If you need help with your complaint, please call the toll-free member phone number listed on your
member ID card.
We provide free services to help you communicate with us such
as letters in other languages, large print materials, auxiliary aids
and services, materials in alternate formats, at your request. Or,
you can ask for an interpreter. To ask for help, please call Member
Services toll-free at 1-877-597-7799, TTY 711, 8 a.m.–5 p.m.,
Monday–Friday.
CSTX21MC4914986_000
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Spanish Ofrecemos servicios gratuitos para ayudarle a que se comunique con nosotros.
Por ejemplo, cartas en otros idiomas o en letra grande.
O bien, usted puede pedir un intérprete. Para pedir ayuda, llame al número de
teléfono gratuito para miembros que se encuentra en su tarjeta de ID.
Vietnamese
Chúng tôi cung cấp nhiều dịch vụ miễn phí để giúp quý vị liên lạc với chúng tôi. Thí
dụ như thư viết bằng những ngôn ngữ khác hoặc in với khổ chữ lớn. Hoặc, quý vị
cũng có thể yêu cầu được thông dịch viên giúp quý vị. Ðể được giúp dỡ, xin quý vị vui
lòng gọi số điện thoại miễn phí dành cho hội viên ghi trên thẻ ID hội viên của quý vị.
Chinese
我們提供免費服務幫助您與我們溝通。例如，其他語言版本或大字體信函。或
者，您可要求口譯員。如欲要求協助，請撥打會員卡上所列的免付費會員電話。
Korean
저희는 귀하가 의사소통을 할 수 있도록 도와드리기 위해 무료 서비스를
제공합니다. 예를 들면, 다른 언어 또는 대형 활자로 작성된 서신과 같은
것입니다. 또한 귀하는 통역사를 요청할 수 있습니다. 도움이 필요하신 경우,
귀하의 신분증 카드에 기재된 무료 회원 전화번호로 문의하십시오.
Arabic
Urdu
Tagalog Nagbibigay kami ng mga libreng serbisyo upang maatulungan kang makipag-
ugnayan sa amin. Gaya ng mga liham na nakasulat sa iba pang wika o sa
malalaking titik. Maari ka rin humiling ng
tagasaling-wika. Upang humingi ng tulong, tumawag sa toll-free na numero ng
telepono para sa miyembro na nakalista sa iyong ID card.
French Nous proposons des services gratuits pour vous aider à communiquer avec nous,
notamment des lettres dans d’autres langues ou en gros caractères. Vous pouvez
aussi demander l’aide d’un interprète. Pour demander de l’aide, veuillez appeler le
numéro de téléphone sans frais imprimé sur votre carte d’affilié.
Table of contents
95 Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
Hindi
Persian
German Um Ihnen die Kommunikation mit uns zu erleichtern, stellen wir Ihnen kostenlose
Dienste zur Verfügung. Hierzu zählen u. a. Schreiben in anderen Sprachen
oder Großdruck und die Möglichkeit, einen Dolmetscher anzufordern. Bitte
wenden Sie sich für Unterstützung an die gebührenfreie Rufnummer auf Ihrem
Mitgliedsausweis.
Gujarati
Russian
Мы предоставляем бесплатные услуги перевода для того чтобы помочь
вам свободно общаться с нами. Например, мы переводим письма на другие
языки или предоставляем информацию, напечатанную крупным шрифтом.
Либо вы можете подать запрос о предоставлении вам услуг устного
переводчика. Для того чтобы обратиться за помощью, вам необходимо
позвонить по бесплатному для участников номеру, указанному на вашей
идентификационной карте.
Japanese
お客様のコミュニケーションをお手伝いする無料のサービスをご用意していま
す。これには他の言語や大きな文字での書簡などが含まれ、通訳もご利用いた
だけます。サービスやお手伝いをご希望の方は、IDカードに記載されているメ
ンバー用フリーダイヤルにお電話ください。
Laotian
ພວກເຮ
ົ
າມ
ີ
ການບ
ໍ
ລ
ິ
ການຊ
່
ວຍໃຫ
້
ທ
່
ານຕ
ິ
ດຕ
ໍ
່
ກ
ັ
ບພວກເຮ
ົ
າເຊ
ັ
່
ນ, ຈ
ົ
ດໝາຍໃນພາສາອ
ື
່
ນ ຫຼ
ື
ການພ
ິ
ມຂະໜາດໃຫຍ
່
ຫຼ
ື
ທ
່
ານສາມາດຮ
້
ອງຂ
ໍ
ໃຫ
້
ມ
ີ
ນາຍພາສາ. ຂ
ໍ
ຄວາມຊ
່
ວຍເຫຼ
ື
ອ, ກະລຸນາໂທຫາເບ
ີ
ໂທລະ
ສ
ັ
ບຂອງສະມາຊ
ິ
ກໂທຟຣ
ີ
ທ
ີ
່
ລະບຸໄວ
້
ໃນບ
ັ
ດປະຈ
ໍ
າຕ
ົ
ວຂອງທ
່
ານ.
Table of contents
96Questions? Visit UHCCommunityPlan.com,
or call Member Services at 1-877-597-7799, TDD/TTY: 7-1-1.
UnitedHealthcare Community Plan
Regional Service Delivery Area Office
14141 Southwest Freeway, Suite 500
Sugar Land, TX 77478
UHCCommunityPlan.com
1-877-597-7799, TDD/TTY: 7-1-1, for deaf and hard of hearing
8:00 a.m.–5:00 p.m., Monday–Friday
We’re here for you
Remember, we’re always ready to answer any questions you may have. Just call Member Services
at 1-877-597-7799, TDD/TTY: 7-1-1, for deaf and hard of hearing. You can also visit our website at
UHCCommunityPlan.com.
Table of contents
