Effective January 1, 2017 UnitedHealthcare Community Plan of Delaware launches a new Dual Special Needs Plan (DSNP) – UnitedHealthcare Dual Complete (HMO SNP), in New Castle County.
UnitedHealthcare Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. These SNP plans provide benefits beyond Original Medicare, including transportation to medical appointments and vision exams. Members must have Medicaid to enroll.
- UnitedHealthcare Dual Complete (HMO SNP)
Health Maintenance Organization (HMO) plans use a network of contracted local physicians and hospitals to provide member care. Generally, members must use these care providers to receive benefits for covered services, except in emergencies. Some HMO plans do not require referrals for specialty care.
UnitedHealthcare Medicare Advantage Special Needs Plans (SNPs) combine the hospital and doctor coverage of Medicare Parts A and B with Part D prescription drug coverage, plus additional features and benefits designed to meet the unique needs of identified Medicare consumer populations.
A Special Needs Plan is a Medicare Advantage (MA) coordinated care plan that provides targeted care and services to individuals with unique needs. Dual Special Needs Plans are plans for members eligible for Medicare and Medicaid.
Dual Special Needs Plans must:
- Follow CMS regulations and cover all Medicare Part A (hospital stay) and Part B (doctor’s office) benefits, and must include Medicare Part D (pharmacy) coverage.
- Offer clinical programs and special expertise to serve the target population.
- UnitedHealthcare Dual Complete program will reimburse claims, according to your UnitedHealthcare contractual Medicare fee schedule.
Quick Reference and Overview
Tools and Resources - UnitedHealthcare Dual Complete® Plans
- Medicare Advantage Copayment Guidelines
- Medicare Advantage Durable Medical Equipment (DME) Frequently Asked Questions
- Medicare Advantage Home Health Services Frequently Asked Questions
- Medicare Advantage Member Rights and Responsibilities
- Medicare Advantage Non-Contracted Provider Dispute and Appeal Rights
- Medicare Advantage Non-Contracted Provider Claim Payment Dispute Request Form
- Medicare Advantage Preventive Screening Guidelines
- Medicare Advantage Service Area Reduction Frequently Asked Questions
- Optum Behavioral Health Referral Process
- HouseCalls Program Overview (Program not available in District of Columbia and has limited availability in Georgia)
- Readmission Review Program Clinical Guidelines
- Readmission Review Program Frequently Asked Questions
- Special Needs Plans (SNP) Benefit Plan Name Overview
Guides, Policies, Pharmacy Formulary, Provider Directory and Training
- UnitedHealthcare Administrative Guide
- UnitedHealthcare Medicare Advantage Coverage Summaries
- UnitedHealthcare Medicare Advantage Reimbursement Policies
- Additional Medicare Advantage Policies
- UnitedHealthcare Medicare Prior Authorization Requirements
- Dual Complete Medicare Advantage Pharmacy Formulary
- Search for a Care Provider – Dual Complete Medicare Advantage Provider Directory
- UHC On Air - Training and Presentations
Additional Medicare Advantage Plan Information
To learn more about the Medicare Advantage plans offered in your area, visit UHCMedicareSolutions.com and enter your ZIP code.
Medicare Part D Information
To learn more about Medicare Part D prescription drug coverage or to access related forms, review the materials available on UHCMedicareSolutions.com under Our Plans > Medicare Advantage Plans > What Do I Need to Know? > Medicare Advantage Plan Information and Forms.
Reminder for Special Needs Plan Providers
UnitedHealthcare provides Special Needs Plan (SNP) care providers access to SNP beneficiaries' Health Risk Assessments (HRAs) and Individualized Care Plans (ICPs) in a variety of ways including mailing, faxing, uploading to the Provider Portal or placing Individualized Care Plans in the SNP beneficiary's physical and/or electronic chart.
Care providers should be reviewing the SNP beneficiary's Individualized Care Plans and participating with the SNP Interdisciplinary Care Team to coordinate the beneficiary's care. Special Needs Plan care providers can register online at UHCprovider.com to begin accessing and reviewing SNP beneficiary Individualized Care Plans via the Care Conductor Tool on Link.