Condition Management Services
If you have been diagnosed with or are at risk for developing certain chronic medical conditions you may be eligible to participate in a disease management program at no cost to you. The heart failure, coronary artery disease, diabetes, Chronic Obstructive Pulmonary Disease (COPD) and asthma programs are designed to support you. This means that you will receive free educational information, and may even be called by a registered nurse who is a specialist in your specific medical condition. This nurse will be a resource to advise and help you manage your condition.
These programs offer:
  • Educational materials that provide guidance on managing your specific chronic medical condition. This may include information on symptoms, warning signs, self-management techniques, recommended exams and medications;
  • Access to educational and self-management resources on a consumer website;
  • An opportunity for the disease management nurse to work with your physician to ensure that you are receiving the appropriate care; and
  • Toll-free access to and one-on-one support from a registered nurse who specializes in your condition. Examples of support topics include:
    • education about the specific disease and condition;
    • medication management and compliance;
    • reinforcement of on-line behavior modification program goals;
    • preparation and support for upcoming physician visits;
    • review of psychosocial services and community resources;
    • caregiver status and in-home safety;
    • use of mail-order pharmacy and in-network providers.
Participation is completely voluntary and without extra charge. If you think you may be eligible to participate or would like additional information regarding the program, please contact the number on your ID card.
Cancer Resource Center (CRS)
The Plan pays benefits for oncology services provided by Designated Providers participating in the Cancer Resource Services (CRS) program. Designated providers are defined in "Medical Plan Definitions."
For oncology services and supplies to be considered covered health services, they must be provided to treat a condition that has a primary or suspected diagnosis relating to cancer. If you or a covered dependent has cancer, you may:
To receive benefits for a cancer-related treatment, you are not required to visit a Designated Provider. If you receive oncology services from a facility that is not a Designated Provider, the Plan pays benefits as described for:
  • Physician's office services -sickness and injury
  • Physician fees for surgical and medical services
  • Scopic procedures -outpatient diagnostic and therapeutic
  • Hospital-inpatient stay
  • Surgery -outpatient
Note: Services described for travel and lodging are covered health services only in connection with cancer-related services received at a Designated Provider.
To receive benefits under the CRS program, you must contact CRS prior to obtaining covered health services. The Plan will only pay benefits under the CRS program if CRS provides the proper notification to the Designated Provider performing the services (even if you self-refer to a provider in that network).
Cancer Support Program
UnitedHealthcare provides a program that identifies, assesses and supports members who have cancer. The program is designed to support you. This means that you may be called by a registered nurse who is a specialist in cancer and receive free educational information. You may also call the program and speak with a nurse whenever you need to. This nurse will be a resource and advocate to advise you and to help you manage your condition. This program will work with you and your physicians, as appropriate, to offer education on cancer and self-care strategies and support in choosing treatment options.
Participation is completely voluntary and without extra charge. If you think you may be eligible to participate or would like additional information regarding the program, please call the number on your ID card, or call the program directly at 866 936 6002.
For information regarding specific Benefits for cancer treatment within the Plan, see Section [5][6], Additional Coverage Details under the heading Cancer Resource Services (CRS).
Congenital Heart Disease (CHD) Resource Services
UnitedHealthcare provides a program that identifies and supports a Covered Person who has Congenital Heart Disease (CHD) through all stages of treatment and recovery. This program will work with you and your Physicians, as appropriate, to offer support and education on CHD. Program features include clinical management by specialized CHD Nurses, support from specialized Social Workers, assistance with choosing Physicians and Facilities, and access to Designated Providers.
To learn more about CHD Resource Services program, visit www.myoptumhealthcomplexmedical.com or call UnitedHealthcare at the number on your ID card or you can call the CHD Resource Services Nurse Team at 888 936 7246.
Coverage for CHD surgeries and related services are based on your health plan's terms, exclusions, limitations and conditions, including the plan's eligibility requirements and coverage guidelines. Participation in this program is voluntary. If you are considering any CHD surgeries you must contact CHD Resource Services prior to surgery to enroll in the program in order for the surgery to be a considered a Covered Health Service under the Plan.
Kidney Resource Services (KRS)
Comprehensive Kidney Solution (CKS) Program
For Participants diagnosed with Kidney Disease, your Plan offers the Comprehensive Kidney Solution (CKS) program to help you manage the effects of advanced Chronic Kidney Disease (CKD) Stage 4/5 through End-stage Renal Disease (ESRD).
Should the disease progress to the point of needing dialysis, CKS provides access to top-performing dialysis centers. That means you will receive treatment based on a "best practices" approach from health care professionals with demonstrated expertise.
There are hundreds of contracted dialysis centers across the country, but in situations where you cannot conveniently access a contracted dialysis center, CKS will work to negotiate patient-specific agreements on your behalf.
To learn more about Comprehensive Kidney Solutions, visit www.myoptumhealthcomplexmedical.com or call the number on your ID card.
Coverage for dialysis and kidney-related services are based on your health plan's terms, exclusions, limitations and conditions, including the plan's eligibility requirements and coverage guidelines. Participation in this program is voluntary. If you decide to no longer participate in the program, please contact CKS of your decision.
Your Plan Sponsor is providing you with Travel and Lodging assistance. Refer to the Travel and Lodging Assistance Program.
End-Stage Renal Disease (ESRD)
The Kidney Resource Services program provides Covered Persons with access to a registered nurse advocate who specializes in helping individuals live with kidney disease. As a participant in the KRS program, you'll work with a nurse who will provide you with support and information. The nurse can help you manage other conditions, such as diabetes and high blood pressure. He or she can also help you find doctors, specialists and dialysis centers. This program is available at no extra cost to you.
With KRS, you have access to a registered nurse who specializes in kidney health. This program is designed to help you be your own best advocate for your health. You may have been referred to the KRS program by your medical provider or from past claim information. As part of your health insurance benefits, it's available at no extra cost to you.
KRS nurse advocates are available, Monday through Friday toll-free at 866 561 7518 (TTY: 711).
Coverage for dialysis and kidney-related services are based on your health plan's terms, exclusions, limitations and conditions, including the plan's eligibility requirements and coverage guidelines. Participation in this program is voluntary.
Your Plan Sponsor is providing you with Travel and Lodging assistance. For more information on the Travel and Lodging Assistance Program, refer to the provision below.
Maternity Support Program
If you are pregnant or thinking about becoming pregnant, and you are enrolled in a UHC medical plan, you can get valuable educational information, advice and comprehensive case management by calling the toll-free number on your ID card. Your enrollment in the program will be handled by an OB nurse who is assigned to you.
This program offers:
  • Enrollment by an OB nurse;
  • Pre-conception health coaching;
  • Written and online educational resources covering a wide range of topics;
  • First and second trimester risk screenings;
  • Identification and management of at- or high-risk conditions that may impact pregnancy;
  • Pre-delivery consultation;
  • Coordination with and referrals to other benefits and programs available under the medical plan;
  • A phone call from a nurse approximately two weeks postpartum to provide information on postpartum and newborn care, feeding, nutrition, immunizations and more; and
  • Post-partum depression screening.
Participation is completely voluntary and without extra charge. To take full advantage of the program, you are encouraged to enroll within the first trimester of pregnancy. You can enroll any time, up to your 34th week. To enroll, call the toll-free number on your ID card.
As a program participant, you can always call your nurse with any questions or concerns you might have.
Travel and Lodging Assistance Program
Travel and lodging assistance is available for you or your eligible family member when you meet certain qualifications related to treatment for cancer, congenital heart disease or an organ transplant services. To qualify, you must receive care at a Designated Provider and require traveling a designated distance from your home address to the facility for cancer, congenital heart disease or an organ transplant services. Eligible expenses are reimbursed after the expense forms have been completed and submitted with the appropriate receipts.
If you have specific questions regarding the Travel and Lodging Assistance Program, please call the Travel and Lodging office at 800 842 0843.
Travel and Lodging Expenses
The Plan covers expenses for travel and lodging for the patient, provided he or she is not covered by Medicare, and a companion as follows:
  • Transportation of the patient and one companion who is traveling on the same day(s) to and/or from the site of the qualified procedure provided by a Designated Provider for the purposes of an evaluation, the procedure or necessary post-discharge follow-up.
  • The eligible expenses for lodging for the patient (while not a hospital inpatient) and one companion.
  • If the patient is an enrolled dependent minor child, the transportation expenses of two companions will be covered.
  • Travel and lodging expenses are only available if the patient resides more than 50 miles from the Designated Provider.
  • Reimbursement for certain lodging expenses for the patient and his/her companion(s) may be included in the taxable income of the Plan participant if the reimbursement exceeds the per diem rate.
  • The cancer, congenital heart disease and transplant programs offer a combined overall lifetime maximum of $10,000 per covered person for all transportation and lodging expenses incurred by you and reimbursed under the Plan in connection with all qualified procedures.
UnitedHealthcare must receive valid receipts for such charges before you will be reimbursed. Reimbursement is as follows:
Lodging
  • A per diem rate, up to $50.00 per day, for the patient (when not in the hospital) or the caregiver.
  • Per diem is limited to $100.00 per day, for the patient and one caregiver. When a child is the patient, two persons may accompany the child.
Examples of items that are not covered:
  • Groceries
  • Alcoholic beverages
  • Personal or cleaning supplies
  • Meals
  • Over-the-counter dressings or medical supplies
  • Deposits
  • Utilities and furniture rental, when billed separate from the rent payment
  • Phone calls, newspapers, or movie rentals.
Transportation
  • Automobile mileage (reimbursed at the IRS medical rate) for the most direct route between the patient's home and the Designated Provider
  • Taxi fares (not including limos or car services)
  • Economy or coach airfare
  • Parking
  • Trains
  • Boat
  • Bus
  • Tolls.