UnitedHealthcare Community Plan of North Carolina offers a Dual Special Needs Plan (DSNP) – UnitedHealthcare Dual Complete (RPPO-SNP), to all North Carolina counties.
- UnitedHealthcare Dual Complete® (HMO SNP) H5253-041
- UnitedHealthcare Dual Complete® RP (Regional PPO SNP) R1548-001
UnitedHealthcare Dual Complete Special Needs Plans (SNP) offer benefits for people with both Medicare and Medicaid. These SNP plans provide benefits beyond Original Medicare, such as transportation to medical appointments and routine vision exams. Members must have Medicaid to enroll.
Dual Complete Regional (RPPO-SNP):
The Dual Complete RP SNP program is a Medicare Advantage plan for members who qualify for both Medicare and Medicaid. DSNPs are a specialized type of Medicare Advantage Prescription Drug Plan (MAPD) and must follow existing Centers for Medicare & Medicaid Services (CMS) rules. DSNPs must:
- Adhere to required MAPD benefits
- Limit enrollment to Medicaid recipients (dually eligible – Medicare and Medicaid),
- Provide Part D benefits, and
- Offer targeted clinical programs, benefits, and services.
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.
Point of Service (HMO-POS) plans include all the features of HMO plans plus the ability to go outside the contracted network for certain health care services - typically at a higher cost. POS plans do not require referrals for specialty care.
Preferred Provider Organization (PPO) plans work with a network of contracted local physicians and hospitals, but also allows members the flexibility to seek covered services from outside of the contracted network, usually at a higher cost. Members do not need a referral for specialty care.
PPO plans are available as either local PPO (certain counties within a state) or regional PPO (RPPO) offerings. RPPOs serve a larger geographic area - either a single state or a multi-state area. RPPOs offer the same premiums, benefits and cost-sharing requirements to all members in the region.
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.
Quick Reference, Directory and FAQs
- North Carolina Frequently Asked Questions - UnitedHealthcare Dual Complete RP (Regional PPO SNP)
- North Carolina Quick Reference Guide - UnitedHealthcare Dual Complete RP (Regional PPO SNP)
- Dual Complete Mental Health Directory
- 2020 UnitedHealthcare Dual Complete® Plan Quick Reference Guide H5253-041
- 2020 UnitedHealthcare Dual Complete® Plan Quick Reference Guide R1548-001
- 2020 UnitedHealthcare Dual Complete® Plan Frequently Asked Questions H5253-041
- 2020 UnitedHealthcare Dual Complete® Plan Frequently Asked Questions R1548-001
- 2020 UnitedHealthcare Dual Complete® Plan Benefit Flyer H5253-041
- 2020 UnitedHealthcare Dual Complete® Plan Benefit Flyer R1548-001
Tools and Resources - UnitedHealthcare Dual Complete® Plans
- HouseCalls Program Overview
- Medicare Advantage Chiropractic and Acupuncture Coverage – Quick Reference Guide
- 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 Reductions for 2020 Frequently Asked Questions
- Optum Behavioral Health Referral Process
- Readmission Review Program Clinical Guidelines
- Readmission Review Program Frequently Asked Questions
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
UnitedHealthcare Dual Complete (RPPO-SNP) product offerings and state-specific administrative materials are available at UHCCommunityPlan.com > For Health Care Professionals > North Carolina.
To learn more about UnitedHealthcare Medicare Advantage plans offered in your area, please visit UHCMedicareSolutions.com and enter your ZIP code.
To learn more about Medicare Part D prescription drug coverage or to access related forms, please 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.