Se yon desizyon ou pran davans sou swen sante w pou si jamè ou pa ta anmezi pou pale pou tèt ou. Sa ap pèmèt fanmi ou ak doktè yo konnen ki desizyon ou ta pran si ou te anmezi pou fè sa.
Apèl
A request for your managed care organization to review a denial or a grievance again.
ASC/SPU
Sant chirijikal anbilatwa/inite pwosedi kout.
Otorizasyon
An O.K. or approval for a service.
B
Avantaj yo
Services, procedures and medications that CHIP will cover for you.
C
Jesyon Swen Klinik
One-on-one help by a nurse providing education and coordination of CHIP benefits, tailored to your needs.
Complaint
A grievance that you communicate to your health insurer or plan.
Copayment
A fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service.
D
Anilasyon Enskripsyon
To stop your membership in CHIP.
Durable Medical Equipment (DME)
Equipment ordered by a health care provider for everyday or extended use. Coverage for DME may include but is not limited to: oxygen equipment, wheelchairs, crutches, or diabetic supplies.
E
Ijans
Lè ou kwè avèk rezon sante ou nan danje grav.
Emergency Medical Condition
An illness, injury, symptom, or condition so serious that a reasonable person would seek care right away to avoid harm.
Transpò medikal ijans
Ground or air ambulance services for an emergency medical condition.
Emergency Room Care
Emergency services you get in an emergency room.
Emergency Services
Evaluation of an emergency medical condition and treatment to keep the condition from getting worse.
Excluded Services
Health care services that your health insurance or plan doesn’t pay for or cover.
F
Federal Poverty Level (FPL)
Poverty income thresholds by family size that are annually updated by the Census Bureau for inflation.
Fwòd
Yon zak ki fo (egzanp: si yon moun ki pa oumenm itilize kat ID ou, epi li fè tankou li se oumenm).
G
Doleyans
A complaint to your health insurer or plan.
H
Habilitation Services and Devices
Health care services such as physical or occupational therapy that help a person keep, learn, or improve skills and functioning for daily living.
Asirans Sante
A contract that requires your health insurer to pay your covered health care costs in exchange for a premium.
Ajans Sante nan Kay
A company hired by CHIP to provide care for you in your home.
Swen sante adomisil
Health care services a person receives in a home.
Hospice Services
Services to provide comfort and support for persons in the last stages of a terminal illness and their families.
Hospital Outpatient Care
Care in a hospital that usually doesn’t require an overnight stay.
Ospitalizasyon
Care in a hospital that requires admission as an inpatient and usually requires an overnight stay.
I
Kat ID
Identification card – a card that says you are a CHIP member. Ou ta dwe gen kat sa a avèk ou toutan.
Konsantman Reflechi
You agree to all medical treatments.
Pasyan entène
Lè yo admèt ou nan yon lopital pandan yon peryòd tan.
M
Nesesite Medikal
Founisè swen sante ou deside si yon tretman, admisyon, pwosedi, founiti medikal, ekipman, sèvis oswa founiti nesesè pou rezon medikal.
Medically Necessary
Health care services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine.
Manm
A person who is eligible for CHIP.
N
Rezo
The facilities, providers, and suppliers your health insurer or plan has contracted with to provide health care services.
Non-participating Provider
A provider who doesn’t have a contract with your health insurer or plan to provide covered services to you. It may be more difficult to obtain authorization from your health insurer or plan to obtain services from a non-participating provider instead of a participating provider. In limited cases, such as when there are no other providers, your health insurer can contract to pay a non-participating provider.
O
Pasyan ekstèn
Lè ou gen yon pwosedi ki fèt ki pa mande pou w entène nan lopital la pandan yon nwit.
P
Founisè Patisipan
A Provider who has a contract with your health insurer or plan to provide covered services to you.
Sèvis doktè
Health-care services a licensed medical physician (M.D. -Medical Doctor or D.O. -Doctor of Osteopathic Medicine) provides or coordinates.
Plan
A benefit, like Medicaid, which provides and pays for your health-care services.
Pre-authorization
A decision by your health insurer or plan that a health-care service, treatment plan, prescription drug, or durable medical equipment that you or your provider has requested, is medically necessary. This decision or approval, sometimes called prior authorization, prior approval, or pre-certification, must be obtained prior to receiving the requested service. Pre-authorization isn’t a promise your health insurance or plan will cover the cost.
Prim
The amount that must be paid for your health insurance or plan.
Pwoteksyon Medikaman Preskripsyon
Health insurance or plan that helps pay for prescription drugs and medications.
Medikaman sou Preskripsyon
Drugs and medications that by law require a prescription.
Primary Care Physician
A physician (M.D. -Medical Doctor or D.O. -Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health-care services for a patient.
Primary Care Provider
A physician (M.D. -Medical Doctor or D.O. -Doctor of Osteopathic Medicine), nurse practitioner, clinical nurse specialist, or physician assistant, as allowed under state law, who provides, coordinates, or helps a patient access a range of health-care services.
Otorizasyon Davans
The process for any service that needs an O.K. from CHIP before it can take place.
Founisè
A physician (M.D. -Medical Doctor or D.O. -Doctor of Osteopathic Medicine), health- care professional, or health-care facility licensed, certified, or accredited as required by state law.
Anyè Founisè
A list of providers who participate with CHIP to help take care of your healthcare needs.
R
Referans
When you and your primary care provider agree you need to see another doctor, your primary care provider will send you to a CHIP specialist.
Rehabilitation Services and Devices
Health-care services such as physical or occupational therapy that help a person keep, get back or improve skills and functioning for daily living that have been lost or impaired because a person was sick, hurt or disabled.
S
Sèvis Oto-Refere
Sèvis ke ou pran san ou pa bezwen wè founisè swen jeneral ou pou yon referans.
Swen enfimye espesyalize
Services from licensed nurses in your own home or in a nursing home.
Special Needs Unit (SNU)
A voluntary service offered by CHIP that can give you extra help in understanding and using your benefits if you have a disability or other special need.
Espesyalis
A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions.
T
TANF
Temporary Assistance for Needy Families.
Tretman
Swen ou gendwa resevwa nan men doktè yo ak etablisman yo.
U
Swen Ijan
Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.
W
WIC
Women, Infants and Children program, a supplemental nutrition program that provides nutritious food, education support and health care referrals for women, infants and children.
Èske w manm deja? Ou gen aksè pou w ale sou sit Entènèt nou an ki pou manm yo sèlman. Enprime Kat Idantifikasyon, kominike avèk yon enfimyè pandan w sou Entènèt la, epi fè plizyè lòt bagay toujou.
Member information is available in paper form, at no cost, upon request, and sent by the health plan within five business days.
Èske w manm deja? Ou gen aksè pou w ale sou sit Entènèt nou an ki pou manm yo sèlman. Enprime Kat Idantifikasyon, kominike avèk yon enfimyè pandan w sou Entènèt la, epi fè plizyè lòt bagay toujou.
Member information is available in paper form, at no cost, upon request, and sent by the health plan within five business days.