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UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) Zouti Rechèch
Jwenn yon Founisè
2024 Provider/Pharmacy Directories
Prior Authorizations
Download the list of services that require prior authorizations.
Prior Authorization Process
Prior authorization is an okay for services that must be approved by UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan).
Your doctor must call Utilization Management (UM) at 1-800-366-7304 before you obtain a service or procedure that is listed as requiring an okay on pages 19-22. Our UM team is available Monday through Friday, 8 AM to 5 PM On-call staff is available 24 hours a day, 7 days a week for emergency okays.
UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) also reviews some of your services and care as they are happening. This is called concurrent review. Examples are when you are:
- A patient in the hospital
- Receiving home care by nurses
- Certain outpatient services such as speech therapy and physical therapy
UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) reviews your progress with your doctor to be sure you still need those services or if other services would be better for you.
UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) has policies and procedures to follow when the UM team makes decisions regarding medical services. The UM doctors and nurses make their decision based on your coverage and what you need for your medical condition. The goal is to make sure that services are medically necessary, that they are provided in an appropriate setting, and that quality care is provided.
We want to help you stay well. If you are sick we want you to get better.
- UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) does not pay employees extra for limiting your care.
- Our network doctors do not receive extra money or rewards if they limit your care.
If you have questions about UM decisions or processes, call Member Services at 1-877-542-9236 (TTY 711).
Appeal or Grievance
To file an Appeal or Grievance, please visit or FAQ section.
Jwenn yon Medikaman
2024 Formularies
Prior Authorizations
Pharmacy Prior Authorization Request to OptumRx
Medikaman Preskripsyon - Ki Pa garanti nan Pati D Medicare
While most of your prescription drugs will be covered by Medicare Part D, there are a few drugs that are not covered by Medicare Part D but are covered by UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan). You can view our plan’s List of Covered Drugs on our website at https://member.uhc.com/communityplan.
Drugs with an asterisk are not covered by Medicare Part D but are covered by UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan). You do not have any co-pays for non-Part D drugs covered by our plan.
Please note that our list of medications that require prior authorization can change so it is important for you and/or your provider to check this information when you need to fill/refill a medication.
Pwosesis Tranzisyon Medikaman Preskripsyon
Kisa pou fè si medikaman preskripsyon aktyèl ou yo pa sou Lis Medikaman an (fòmilè) oswa yo gen restriksyon sou yo nan yon fason kèlkonk
Medikaman yo pa nan seksyon lis la
Pafwa, ou ka ap pran yon medikaman sou preskripsyon ki pa nan Lis Medikaman plan ou an oswa li gen restriksyon sou li nan kèk fason. Kit ou se yon nouvo manm oswa yon manm k ap kontinye, gen yon fason pou w jwenn èd.
Pou kòmanse, pale avèk doktè ou. Doktè w ka ede w deside si gen yon lòt medikaman sou Lis Medikaman ou ka chanje pou w pran. Si pa gen yon bon lòt chwa medikaman, oumenm, reprezantan w oswa doktè w ka mande yon eksepsyon fòmilè. Si yo apwouve eksepsyon an, ou ka kontinye resevwa medikaman w ap pran kounye a pandan yon sèten peryòd tan.
Repase Prèv Kouvèti Asirans ou (Evidence of Coverage, EOC) pou w konnen egzakteman kisa plan ou an kouvri. Si w se yon manm k ap kontinye nan plan an, ou pral resevwa yon Avi Anyèl sou Chanjman (Annual Notice of Changes, ANOC). Repase ANOC la ak anpil atansyon pou w konnen si medikaman w ap pran kounye a ap kouvri menm jan nan ane k ap vini an.
Kit w ap chanje medikaman oswa si w ap tann yon apwobasyon eksepsyon, ou ka kalifye pou yon apwovizyònman tranzisyon nan medikaman w ap pran kounye a.
- Ou dwe jwenn apwovizyònman pou 1 mwa ou, jan li dekri nan EOC an, pandan 90 premye jou yo kòm manm nan plan an antanke nouvo manm OSWA nan premye 90 jou yo nan ane almannak la si ou se yon manm k ap kontinye epi medikaman ou te sibi yon chanjman nan fòmilè a ki negatif.
- Ou gendwa kalifye tou pou yon apwovizyònman tanporè yon sèl fwa pou 1 mwa si ou kalifye pou egzekite preskripsyon an ijans pandan w ap abite nan yon etablisman swen dire long (Long-Term Care, LTC) apre premye 90 jou yo antanke nouvo manm oswa ou te sibi yon nivo chanjman nan swen yo.
- Si doktè ou ekri preskripsyon ou pou mwens jou epi preskripsyon an gen renouvèlman medikaman ladan, ou ka renouvle medikaman an jiskaske ou resevwa omwen yon apwovizyònman pou 1 mwa, jan li dekri nan EOC ou an.
Nouvo manm yo
Antanke yon manm nouvo plan an, ou gendwa ap pran aktyèlman medikaman ki pa sou fòmilè plan an (lis medikaman), oswa yo sou lis lan men yon gen yon restriksyon sou yo nan yon fason kèlkonk.
Nan sikonstans konsa, pale ak doktè w toudabò sou lòt chwa medikaman ki apwopriye ki disponib nan fòmilè a. Si w pa kapab jwenn lòt chwa ki apwopriye, oumenm oswa doktè w ka mande yon eksepsyon fòmilè. Si yo apwouve eksepsyon an, ou gendwa kapab jwenn medikaman an pou yon peryòd tan ki presize.
Pandan premye 90 jou ou kòm manm nan plan an, si ou se yon nouvo manm, ou ka mande omwen yon apwovizyònman pou 1 mwa, jan li dekri nan Prèv Kouvèti Asirans plan ou an.
Pandan premye 90 jou yo nan ane sivil la, si ou te nan plan an ane pase epi medikaman ou an te sibi yon chanjman negatif nan fòmilè a, ou ka mande omwen yon apwovizyònman pou 1 mwa jan li dekri nan Prèv Kouvèti Asirans plan ou an.
Manm ki gen tranzisyon enprevi tankou egzeyat nan lopital (sa gen ladan lopital sikyatrik) oswa chanjman nan nivo swen (sètadi, chanjman etablisman swen dire long, sòti ak antre nan yon etablisman swen dire long, fen kouvèti Pati A nan yon etablisman swen enfimye kalifye, oswa fen nan kouvèti ospis epi retounen nan kouvèti Medicare) nenpòt ki lè pandan ane plan an. Ou ka mande omwen yon apwovizyònman pou 1 mwa, jan li dekri nan Prèv Kouvèti Asirans plan ou an.
Manm k ap kontinye
Antanke manm k ap kontinye nan plan an, ou resevwa yon Avi Anyèl sou Chanjman (Annual Notice of Changes, ANOC). Ou gendwa remake yon medikaman ou ap pran aktyèlman swa pa nan fòmilè k ap vin lòt ane an oswa li sou fòmilè an men li gen restriksyon sou li nan nan yon fason kèlkonk.
Apati octobre 15, 2023, ou gendwa mande yon analiz kouvèti asirans 2024. Si demann ou an apwouve, plan an ap kouvri medikaman an apati janvier 01, 2024.
Si medikaman ou an kapab sibi nouvo restriksyon fòmilè yo nan dat janvier 01, 2024 e ou pa t diskite sou chanje pou pase nan yon lòt medikaman fòmilè oswa ou pa t pousuiv yon eksepsyon fòmilè ak doktè ou an, ou gendwa resevwa yon apwovizyònman tanporè nan premye 90 jou ane sivil lan lè ou ale nan yon famasi rezo an. Sa t ap omwen yon apwovizyonnman pou 1 mwa, jan Prèv sou Kouvèti Asirans plan ou an dekri sa, pou ba ou tan pou diskite sou lòt tretman ak doktè ou an oswa pou pousuiv yon eksepsyon fòmilè.
Si ou ap viv nan yon etablisman pou swen sante sou peryòd ki long, ou ka jwenn plizyè ranplisaj jouk ou atenn omwen yon apwovizyonnman pou 31 jou, ansanm ak lè yo bay medikaman yo pou mwens pase kantite ki ekri an akoz modifikasyon nan itilizasyon medikaman yo ki baze sou etiktaj ki apwouve pou pwodui an.
Gendwa gen tranzisyon ki pa planifye tankou egzeyat lopital oswa chanjman nan nivo swen yo (sa vle di etablisman pou swen sante sou peryòd ki long oswa nan semèn anvan oswa apre yon ranvwa nan yon swen sou peryòd ki long, fen yon sejou nan yon etablisman swen enfimye ki kalifye ak retou nan kouvèti Part D oubyen lè ou ap soti nan yon swen ospis) ki rive nenpòt kilè. Si yo preskri ou yon medikaman ki pa sou fòmilè nou an oswa kapasite ou pou jwenn medikaman ou yo gen restriksyon sou li nan yon fason kèlkonk, ou blije itilize pwosesis eksepsyon plan an. Pou pifò medikaman yo, ou gendwa mande yon apwovizyonnman tanporè pou omwen yon mwa, jan sa dekri nan Prèv sou Kouvèti Asirans plan ou an, pou ba ou tan pou diskite sou lòt tretman ak doktè ou an oswa pousuiv yon eksepsyon fòmilè.
Pou manm ki te nan plan an pandan plis pase 90 jou epi ki abite nan yon etablisman swen dire long (LTC) epi ki bezwen yon apwovizyònman touswit, nou pral kouvri omwen yon pwovizyon tanporè pou 31 jou, jan li dekri nan Prèv Kouvèti Asirans plan ou an.
Si ou gen nenpòt kesyon sou politik tranzisyon sa a oswa ou bezwen èd pou mande yon eksepsyon fòmilè, kontakte yon reprezantan sèvis pou manm yo.
Pou enfòmasyon sou pwosesis tranzisyon medikaman preskripsyon yo an panyòl, ale sou Fòmilè ak Resous yo epi gade seksyon 5.2 sou Prèv sou Kouvèti Asirans ou an (Panyòl) pou plis enfòmasyon.
Si w pran pàn medikaman apre w fin resevwa yon apwovizyònman pou tranzisyon tanporè epi w ap kolabore avèk moun ki preskri w lan pou w chanje al nan yon lòt medikaman oswa pou mande yon eksepsyon, rele nimewo ki sou kat ID manm ou an oswa kontakte Sèvis Kliyantèl UnitedHealthcare.
Enfòmasyon ki anrapò
Fòmilè pou Demann Detèminasyon Kouvèti an twouve l anba seksyon Kontestasyon yon Desizyon Kouvèti nan paj sa a.
Pwogram Jesyon Terapi Medikaman
Yon ekip famasyen ak doktè te prepare pwogram Jesyon Terapi Medikaman (Medication Therapy Management, MTM) UnitedHealthcare lan. Pwogram MTM lan bay manm yo yon evalyasyon konplè sou medikaman (Comprehensive Medication Review, CMR) avèk yon famasyen oswa yon lòt founisè swen sante kalifye. Pwogram lan ede manm yo konprann kouvèti medikaman yo a ak fason pou yo itilize medikaman yo, epitou li edike manm yo sou posiblite entèraksyon medikaman ki kapab danjere ak/oswa risk efè segondè yo.
Kijan pou Kalifye
Kisa Ou Bezwen Fè
Kisa Ki Gen Ansuit
Kijan pou Kalifye
Pwogram sa a disponib san frè anplis. Ou ap enskri otomatikman nan pwogram Jesyon Terapi Medikaman an si ou:
- pran uit (8) oswa plis medikaman kwonik Part D, epi
- gen twa (3) oswa plis pwoblèm sante sou peryòd ki long apati lis ki suiv lan:
- Bwonkonemopati obstriktif ki kwonik (COPD)
- Dyabèt
- Ensifizans Kadyak
- Kolestewòl Wo
- Osteyopowoz
- epi gen chans pou depanse plis pase $5330 chak ane nan medikaman Pati D ki kouvri yo
OSWA
- nan yon Pwogram Jesyon Medikaman pou ede pi byen jere epi itilize san danje medikaman tankou sila yo pou doulè.
Kisa Ou Bezwen Fè
Nan espas 60 jou pou ou vin kalifye pou pwogram MTM lan, ou ap resevwa yon òf nan lapòs pou ranpli yon Egzamen Medikaman Konplè (CMR). Ou gendwa resevwa òf sa a tou nan telefòn.
Ou ka ranpli CMR lan nan telefòn oswa fizikman ak yon founisè swen sante ki kalifye. Li pran anviwon 30 minit. Yon famasyen, oswa founisè CMR ki kalifye, pral egzamine antesedan medikaman ou an, ansanm ak medikaman preskripsyon e medikaman san preskripsyon, epi siveye totu sousi yo.
Kisa Ki Gen Ansuit
Nan 14 jou apre CMR lan, ou pral resevwa yon pake ki gen ladann yon rezime revizyon an, sa gen ladan eleman aksyon ki diskite yo ak yon lis medikaman w ap pran ak poukisa ou pran yo. Sa ka itil lè ou rankontre ak doktè oswa famasyen ou an. Rezilta yo gendwa voye bay doktè ou an. Anplis, manm yo nan pwogram MTM lan ap resevwa enfòmasyon sou fason pou jete san danje medikaman preskripsyon yo ansanm ak sibstans ki kontwole yo.
Epitou, ou kapab telechaje yon Lis Medikaman (PDF) vyèj pou pwòp itilizasyon pèsonèl ou.
Anplis CMR lan, Egzamen Medikaman ki Sible yo fèt omwen chak trimès. Sa fèt pou yo ka twouve tout entèraksyon ant medikaman yo oswa lòt enkyetid ak medikaman yo. Egzamen sa yo ap voye bay doktè ou an.
Pwogram Jesyon Terapi Medikaman an se pa yon plan avantaj li ye. Pou jwenn plis enfòmasyon sou pwogram Jesyon Terapi Medikaman UnitedHealthcare a, tanpri rele nimewo ki sou do kat ID manm plan ou an oswa ou gendwa rele ekip sant apèl klinik OptumRx MTM lan nan 1-866-216-0198, TTY 711, lendi jiska vandredi, 9AM – 9PM EST.
Chèche yon Dantis
Chèche Founisè Swen dantè
Jwenn yon dantis nan zòn ou. Klike sou "Chèche yon Dantis" anba a pou w kòmanse rechèch ou an.
Prior Authorization Request
Prior Authorization Process
Prior authorization is an okay for services that must be approved by UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan).
Your doctor must call Utilization Management (UM) at 1-800-366-7304 before you obtain a service or procedure that is listed as requiring an okay. Our UM team is available Monday through Friday, 8 AM to 5 PM On-call staff is available 24 hours a day, 7 days a week for emergency okays.
UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) also reviews some of your services and care as they are happening. This is called concurrent review. Examples are when you are:
- A patient in the hospital
- Receiving home care by nurses
- Certain outpatient services such as speech therapy and physical therapy
UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) reviews your progress with your doctor to be sure you still need those services or if other services would be better for you.
UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) has policies and procedures to follow when the UM team makes decisions regarding medical services. The UM doctors and nurses make their decision based on your coverage and what you need for your medical condition. The goal is to make sure that services are medically necessary, that they are provided in an appropriate setting, and that quality care is provided.
We want to help you stay well. If you are sick we want you to get better.
- UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) does not pay employees extra for limiting your care.
- Our network doctors do not receive extra money or rewards if they limit your care.
If you have questions about UM decisions or processes, call Member Services at 1-877-542-9236 (TTY 711).
Appeal or Grievance
To file an Appeal or Grievance, please visit or FAQ section.
Jwenn yon Famasi
Jwenn Yon Famasi
Search for a UnitedHealthcare network pharmacy below.
2024 Provider/Pharmacy Directories
Famasi yo
This part of the directory provides a list of pharmacies in UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) network. These network pharmacies are pharmacies that have agreed to provide prescription drugs to you as a member of the plan.
- UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) Members must use network pharmacies to get prescription drugs.
- You must use network pharmacies except in emergency or urgent care situations. If you go to an out-of-network pharmacy for prescriptions when it is not an emergency or urgent care situation, including when you are out of the service area, call UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) toll-free Member Services or 24-hour nurse advice line for assistance in getting your prescription filled.
- If you go to an out-of-network pharmacy for prescriptions when it is not an emergency, you will have to pay out of pocket for the service. Read the UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) Member Handbook for more information.
- Some network pharmacies may not be listed in this Directory.
- Some network pharmacies may have been added or removed from our plan after this Directory was published.
For up to date information about UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) network pharmacies in your area, please visit our web site at www.UHCCommunityPlan.com or call Member Services at 1-877-542-9236, TTY users should call 711, 8 AM - 8 PM, local time, Monday - Friday. Apèl la gratis.
To get a complete description of your prescription coverage, including how to fill your prescriptions, please read the Member Handbook and UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) List of Covered Drugs. You received the List of Covered Drugs in the mail when you became a member of this plan. You may also visit our web site at www.UHCCommunityPlan.com for the drug list.
Identifying Pharmacies in Our Network
Along with retail pharmacies, your plan’s network of pharmacies includes:
- Mail-Order Pharmacies
- Home infusion pharmacies
- Long-term care (LTC) pharmacies
You are not required to continue going to the same pharmacy to fill your prescriptions. You can go to any of the pharmacies in our network.
Mail Order Pharmacy(ies)
You can get prescription drugs shipped to your home through our network mail order delivery program which is called OptumRx® home delivery pharmacy. Prescription orders sent directly from your doctor must have your approval before we can send your medications. This includes new prescriptions and prescriptions refills. We will contact you, by phone, to get your approval. If we are unable to reach you for approval, your prescription will not be sent to you.
You also have the choice to sign up for automated mail order delivery through our OptumRx® home delivery pharmacy. Typically, you should expect to get your prescription drugs from 4 to 6 days from the time that the mail order pharmacy gets the order.
If you do not get your prescription drug(s) within this time, if you would like to cancel an automatic order, or if you need to ask for a refund for prescriptions you got that you did not want or need, please contact us at 1-877-542-9236, TTY 711, 8 AM - 8 PM, local time, Monday - Friday.
Home Infusion Pharmacies
You can get home infusion therapy if UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) has approved your prescription for home infusion therapy and if you get your prescription from an authorized prescriber.
For more information, please see your Member Handbook, or call Member Services at 1-877-542-9236, TTY 711, 8 AM - 8 PM, local time, Monday - Friday.
Long-Term Care Pharmacies
Residents of a long-term care facility, such as a nursing home, may access their prescription drugs covered under UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) through the facility’s pharmacy or another network pharmacy.
For more information, you can call Member Services at 1-877-542-9236, TTY 711, 8 AM - 8 PM, local time, Monday - Friday.
Prior Authorizations
Prior authorization is an okay for services that must be approved by UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan). Your doctor must call Utilization Management (UM) at 1-800-366-7304 before you obtain a service or procedure that is listed as requiring an okay. Our UM team is available Monday through Friday, 8 AM to 5 PM On-call staff is available 24 hours a day, 7 days a week for emergency okays.
UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) also reviews some of your services and care as they are happening. This is called concurrent review. Examples are when you are:
- A patient in the hospital
- Receiving home care by nurses
- Certain outpatient services such as speech therapy and physical therapy
UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) reviews your progress with your doctor to be sure you still need those services or if other services would be better for you.
UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) has policies and procedures to follow when the UM team makes decisions regarding medical services. The UM doctors and nurses make their decision based on your coverage and what you need for your medical condition. The goal is to make sure that services are medically necessary, that they are provided in an appropriate setting, and that quality care is provided.
We want to help you stay well. If you are sick we want you to get better.
- UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) does not pay employees extra for limiting your care.
- Our network doctors do not receive extra money or rewards if they limit your care.
If you have questions about UM decisions or processes, call Member Services at 1-877-542-9236 (TTY 711).
Prior Authorization Request
Pwosesis Tranzisyon Medikaman Preskripsyon
Kisa pou w fè si medikaman preskripsyon ou gen kounye a yo pa sou fòmilè a oswa yo gen limit nan fòmilè a.
Nouvo manm yo
As a new member of UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan), insured through UnitedHealthcare, you may currently be taking drugs that are not on the UnitedHealthcare® formulary (drug list), or they are on the formulary but your ability to get them is limited.
Nan sikonstans konsa, pale ak doktè w toudabò sou lòt chwa medikaman ki apwopriye ki disponib nan fòmilè a. Si w pa kapab jwenn lòt chwa ki apwopriye, oumenm oswa doktè w ka mande yon eksepsyon fòmilè. Si nou apwouve eksepsyon an, w ap kapab jwenn medikaman an pandan yon peryòd tan byen presiz. Pandan oumenm ak doktè w ap detèmine plan daksyon w, ou gendwa kalifye pou w resevwa yon premye pwovizyon tranzisyon pou 31 jou (sof si ou gen yon preskripsyon ki ekri pou mwens jou) nan medikaman an nenpòt lè pandan premye 90 jou yo ou manm plan an.
Pou chak nan medikaman ou yo ki pa sou fòmilè a, oswa si mwayen pou jwenn medikaman ou yo limite, UnitedHealthcare ap garanti yon pwovizyon pou 31 jou lè ou ale nan yon famasi rezo (sof si ou gen yon preskripsyon ki ekri pou mwens jou). Si preskripsyon w lan ekri pou mwens pase 31 jou, yo otorize plizyè renouvèlman jouk rive nan yon total 31 jou medikaman. Apre premye pwovizyon tranzisyon 31 jou w lan, yo pa ka kontinye garanti medikaman sa yo. Pale ak doktè w sou lòt chwa medikaman ki apwopriye. Si pa gen okenn sou fòmilè a, oumenm oswa doktè w ka mande yon eksepsyon fòmilè.
Si w ap viv nan yon etablisman swen alontèm, UnitedHealthcare ap garanti yon pwovizyon tranzisyon tanporè pou 31 jou (sof si ou gen yon preskripsyon ki ekri pou mwens jou). UnitedHealthcare ap garanti plis pase yon sèl renouvèlman pou medikaman sa yo pandan premye 90 jou yo pou manm plan yo, jouk rive nan yon pwovizyon pou 93 jou. Si ou bezwen yon medikaman ki pa sou fòmilè a oswa si mwayen ou limite pou jwenn medikaman ou yo, men ou depase premye 90 jou ou yo kòm manm nan plan an, pwogram tranzisyon an ap garanti yon pwovizyon medikaman pou ijans pou 31 jou nan medikaman an pandan w ap chèche yon eksepsyon fòmilè (sof si ou gen yon preskripsyon pou mwens jou).
You may face unplanned transitions after the first 90 days of plan enrollment, such as hospital discharges or level of care changes (i.e., in the week before a long-term care discharge), If you are prescribed a drug that is not on the formulary or your ability to get your drugs is limited, you are required to use the plan's exception process. Ou ka mande yon pwovizyon dijans pou yon sèl-fwa pou jiska 31 jou pou akòde w tan pou w pale sou lòt chwa tretman avèk doktè w oswa pou w chèche jwenn yon eksepsyon fòmilè.
Manm k ap kontinye
Antanke manm k ap kontinye nan plan an, ou resevwa yon Avi Anyèl sou Chanjman (Annual Notice of Changes, ANOC). Ou ka remake yon medikaman fòmilè w ap pran kounye a swa pa sou fòmilè ane k ap vini an oswa kotizasyon nan frè li oubyen pwoteksyon asirans li limite nan ane k ap vini an.
Pou demann pwoteksyon li resevwa chak ane anvan 15 desanm, epi ki apwouve, plan an ap garanti medikaman an apati 1ye janvye. Pou demann pwoteksyon ki derape nan dat 16 desanm oswa apre, delè nòmal yo pou rezolisyon aplike: w ap resevwa yon repons nan 24 èdtan oplita apre demann ijan yo ak nan 72 èdtan oplita pou tout lòt demann yo. Si y ap travay sou demann ou an toujou nan dat 1ye janvye, ou ka resevwa yon pwovizyon tanporè nan medikaman an pou kotizasyon nan frè plan ou gen kounye a jiskaske yo reponn demann ou an.
Si ou gen nenpòt kesyon sou règleman tranzisyon sa a oswa ou bezwen èd pou w mande yon eksepsyon fòmilè, yon reprezantan UnitedHealthcare ka ede w.
Enfòmasyon ki anrapò
The Coverage Determination Request Form may be found under Appeal a Coverage Decision section on this page.
Konnen Plis
UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) H2531-001-000