Core Benefits

We want to help keep you and your family healthy. We strive to do that by providing the health care benefits you need, when you need them. Below are the core health care benefits that are covered for all our UPHP Medicaid members, regardless of what program you are enrolled in.

Children’s Care

  • Newborn care
  • Immunizations and vaccines
  • Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
  • Lead screening
  • Office visits

Emergency Care

  • Emergency room care, ambulance and other emergency transportation
  • Medical inpatient care
  • Urgent care visits

General Health Care

  • Office visits
  • Specialist visits
  • Flu shots and immunizations
  • Preventive services, such as cancer and disease screenings
  • Out of state/out of network services (covered when UPHP has received prior authorization)

Outpatient Care

  • Office visits
  • Home health care
  • Restorative/rehabilitative services
  • Therapies (including speech, physical, occupational, and aqua therapy)
  • Skilled nursing facility services
  • Long-term acute care hospital (LTACH) services 
  • Specialty care (care provided by a licensed physician specialist focused on a specific area of medicine)
  • Diagnostic testing (blood tests, urine cultures, radiology services)
  • End-stage renal disease (ESRD) services

Surgery

  • Inpatient, ambulatory, outpatient, emergency, and reconstructive surgeries (when medically necessary)
  • Transplants

Women’s Care

  • Family planning
  • Obstetric and maternity care
  • Well-care for women (routine gynecological exams, mammogram/breast cancer screening, surgical breast biopsy)
  • Sterilization
  • Abortions (only covered if medically necessary as defined by Michigan state law)
 

Dental

UPHP Medicaid Members:

  • Non-Pregnant Adults: No dental coverage through UPHP. This benefit is covered through State of Michigan Fee-for-Service.
  • Pregnant Adults: Covered through Delta Dental of Michigan for the duration of the pregnancy through three full months from the date the pregnancy ends. You must see in-network Delta Dental providers for your dental care. You will receive a separate Delta Dental Handbook that explains your dental benefits in more detail.
  • Children up to Age 21 (Pregnant or Non-Pregnant): Covered by the Healthy Kids Dental Program.*

UPHP Healthy Michigan Plan Members:

All Healthy Michigan Plan members are covered through Delta Dental of Michigan. You must see Delta Dental Healthy Michigan Plan dentists for your dental care. You will receive a separate Delta Dental Healthy Michigan Plan Member Handbook that explains your dental benefits in more detail.

MIChild Members:

Covered through the Healthy Kids Dental Program.*

*You and/or your child have dental benefits through the Healthy Kids Dental plan when one of you are a UPHP Medicaid member younger than 21 years old.  The Healthy Kids Dental benefits come from either Delta Dental of Michigan or Blue Cross Blue Shield of Michigan rather than UPHP.

To get dental care, you need to find a dentist who treats patients with Healthy Kids Dental.  Call dentists in your area and ask if they participate with the Healthy Kids Dental.  You can also view the Healthy Kids Dental Dentist Directory on the Healthy Kids Dental website and use your location to find participating dentists in your area.

To see a list of what Healthy Kids Dental covers, look at your Healthy Kids Dental Handbook or view Healthy Kids Dental Covered Services on the Healthy Kids Dental website.

For more information, visit the website or call Customer Service for your Healthy Kids Dental Plan:

Hearing

  • Hearing exams
  • Medically necessary hearing aid evaluations and fittings
  • Medically necessary hearing aids

Vision

  • Routine eye exams (one exam every two years)
  • Eye glasses (one pair of glasses every two years)
  • More visits and eye glasses are covered if medically necessary (may require prior authorization)

Mental Health Care

UPHP provides outpatient mental health care visits. You do not need a referral from a provider for mental health care. You may call a mental health provider listed in the provider directory. Out of network mental health providers require prior authorization. We do not cover inpatient mental health or substance use disorder care. This care is covered through the Prepaid Inpatient Health Plan in your county. 

Mental health care not provided by UPHP is given by your local community mental health agency. Your local community mental health agency is NorthCare Network. To contact them, call:

  • For mental health services: 1-888-906-9060
  • For substance abuse services: 1-800-305-6564

For more information, visit our mental health Web page.

Pharmacy Services (Medicine)

Your provider will give you a prescription when you need medicine. UPHP has a list of drugs (also called a formulary) for all of your providers to use. All providers must get permission to use drugs not on the UPHP list. Medicine prescribed by a specialist your PCP has sent you to will be covered as noted on the drug list. A generic drug will be used when available.

Other Covered Services

  • Maternal Infant Health Program (MIHP) (program to promote healthy pregnancies, positive birth outcomes, and health infant growth)
  • Health department services (such as blood-lead testing, immunizations, and testing and treatment for sexually transmitted infections)
  • Health education
  • Tobacco cessation
  • Durable medical equipment (such as wheelchairs, oxygen equipment or crutches)
  • Prosthetics/orthotics (may require prior authorization)
  • Chiropractic care (18 visits per calendar year)
  • Podiatry services
  • Medically necessary weight-reduction surgery (prior authorization is required)
  • Non-emergent medical transportation

UPHP covers most care without a referral or medical review. Some services require prior authorization, also known as preauthorization. This approval from UPHP may be required before you get a service, medical equipment, or fill a prescription in order to be paid for by UPHP.

For more detail and a full list of benefits, see the UPHP Member Handbook or the Certificate of Coverage specific to your plan:

For benefits specific to the Healthy Michigan Plan, visit the Healthy Michigan Plan Web page.


Page Last Updated: 08/29/2019