Introducing. UPMC Community Care. UPMC Community Care. Your choice for wellness and recovery. at a glance
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- Kellie Owens
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2 Introducing UPMC Community Care Your choice for wellness and recovery There are two parts to good health behavioral and physical. You ve already taken a step toward good health by accessing behavioral health services in your neighborhood. Now it s time to take steps to get physically healthy. You might want to lose weight, quit tobacco, or get better control over long-term conditions like diabetes or asthma. It can be hard to do these things on your own. UPMC Community Care is health insurance that helps you accomplish these kinds of physical health goals and also supports your behavioral health. We know that a healthy body and a healthy mind are important to your recovery. That s why we work side-byside with your health care providers to give you whole person health support. UPMC Community Care at a glance You are cared for by a behavioral and physical health care team. Your team is made up of people who work with you to understand what you need. They understand your challenges. They want to help you get healthier and feel better. This team is called your care team. Meeting with your care team is easy. Key members of your care team work with you at the behavioral health provider you re already going to. Now it s the place where your physical care is coordinated as well. Key members of your team are here for close, on-site support. Here is where you can focus on feeling better and getting healthy. And, where you will be comfortable doing so.
3 Your care team includes: You You are the leader of your health care team. Your partners are your physical health and behavioral health providers. They will work closely with you, creating a care team to support you. A care manager This is your point person. He or she will talk to you about your needs and your goals. He or she can explain things that are confusing. Your care manager can: Talk to your doctors and your family. Keep your whole team informed. Help you make appointments and keep track of them. A wellness coach This on-site coach supports you to help you meet your physical health-related goals. He or she will: Help you build a health care plan just for you. Work closely with you to accomplish the goals in that plan. Keep a close eye on your overall health, to help prevent small problems from becoming bigger ones. Update your care team on the progress you are making toward your wellness goals. A peer support specialist This person understands what you re going through. He or she has been where you are now. Your peer support specialist is there to listen, talk, share advice, and provide encouragement and emotional support. Community Care Behavioral Health Organization is partnering with UPMC Community Care. Since 1996 Community Care has been dedicated to helping individuals with behavioral health needs to live meaningful lives and achieve personal goals. Community Care has been awarded three-year full accreditation the highest possible level from the National Committee for Quality Assurance. Needed professionals Doctors, nurses, therapists, and pharmacists are also part of your care team. And, you can access specially trained nutrition, condition, and lifestyle coaches at no extra cost. Other specialists may be part of your care team when needed.
4 With UPMC Community Care, you re covered The care, support, and preventive services your care team provides can help you improve your health. We ll help you lose weight, quit tobacco, or better manage a medical condition. You have lots of chances to talk to your care team to get help with meeting your health goals. When you do all these things, you may have fewer hospital stays. You may spend less time in the emergency department. And you will feel better. What you gain: 16 one-way trips to and/or from planapproved locations for medical- and dental-related services. A great fitness membership which includes a gym or home fitness option. Preventive services such as wellness visits, routine blood work, regular screenings, vaccines, and immunizations. No-cost or low-cost prescriptions at most chain stores. Dental benefits ($0 copayment for x-rays, cleanings, and exams once every six months. $0 copayment for fillings and simple tooth extractions). Vision and eyewear benefits, including $200 worth of eyewear every two years. You can count on You are taken care of by the very best.* With UPMC Community Care, you won t have to worry about questions like Is my doctor in the network? or Am I allowed to go to my neighborhood hospital? You ll have access to 7,500 UPMC doctors and 40 hospitals, as well as urgent care centers, community hospitals, and specialty care centers. And you don t need a referral. You are supported Our award-winning customer service includes access to a Health Care Concierge team.** Your Health Care Concierge team can: Answer your coverage questions Help you find a doctor Help you schedule appointments You also have 24/7 use of MyHealth OnLine, a website to help you reach your health and fitness goals, find a doctor, order and refill drugs, and view detailed care coverage and claims information. *UPMC has been recognized by U.S. News & World Report for the 15th time as one of the nation s top-ranked hospitals, and is ranked #1 in Pennsylvania (America s Best Hospitals July 15, 2014). **For more information, visit
5 Why us? This coordination of mind and body care is unique to UPMC Community Care. Enrolling in this plan couldn t be any easier. We ll walk you through it. Call us today. To be eligible to join UPMC Community Care, you must: Have a diagnosis of a serious mental illness Bipolar disorder Major depressive disorder Paranoid disorder Schizophrenia Schizoaffective disorder Be enrolled in Medicare Part A and Part B Live in the service area Not have end-stage renal disease, unless certain criteria are met Toll-free Oct. 1 - Feb. 14 seven days a week 8 a.m. to 8 p.m. and Feb Sept. 30 Monday through Friday 8 a.m. to 8 p.m. TTY users should call
6 UPMC Community Care is an HMO SNP plan with a Medicare contract. Enrollment in UPMC Community Care depends on contract renewal. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium, and/ or copayments/coinsurance may change on January 1 of each year. This plan is available to anyone with Medicare who has been diagnosed with a serious mental illness. You must continue to pay your Medicare Part B premium. Premiums, copayments, coinsurance, and deductibles may vary based on the level of extra help you receive. Please contact the plan for further details. By returning the card on the next page, you are agreeing to a telephone call from a licensed representative to discuss UPMC Community Care. Returning this card does not affect your current enrollment, nor will it enroll you in a Medicare Advantage Plan, Prescription Drug Plan, or other Medicare plan. The person who will be discussing plan options with you is either employed or contracted by a Medicare health plan or prescription drug plan that is not the federal government, and he or she may be compensated based on your enrollment in a plan. It s time to find out how UPMC Community Care can help you! Learn more about the benefits of membership. Please complete this postage-paid card and mail it. Thanks! Name: Address: City: State: ZIP: Phone: County: I am inquiring for myself. I have Medicare Parts A and B. I am inquiring on behalf of someone with Medicare Parts A and B: Family Member Client Other Copyright 2014 UPMC Health Plan, Inc. All rights reserved. UPMC CC-SNP BKLT BR MLR 14SNP0130 HL (MCG) 11/25/14 3M CDI
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