Ale nan kontni prensipal la
Kontni Prensipal

STAR Kids Glosè

A

  • Direktiv Davans

    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

    An untruthful act – an example is someone other than you using your CHIP member ID card and pretending to be you.

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.

Retounen anlè paj la

Enfòmasyon sou Enskripsyon

The Texas STAR Kids plan specialists can answer questions and help you enroll.

Rele nou:
1-877-597-7799 / TTY: 711

8:00 AM jiska 5:00 PM lè lokal, 7 jou pa semèn

Etap pou Enskri
Jwenn detay yo

Visit the Texas CHIP & Medicaid site for more information on eligibility and enrollment.

Texas STAR Kids

For information in alternate formats, like large print, Braille or audio, please call Member Services.

Enfòmasyon pou Manm

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.

Sit entènèt pou manm yo


Avètisman pou Plan Endividyèl ak Familyal Mache Asirans Sante ACA yo
(navige nan bwat sa a pou wè)

Yo gendwa pa ofri avantaj ki dekri yo nan tout plan oswa nan tout Eta yo. Kèk plan gendwa egzije kopeman, franchiz ak/oswa ko-asirans pou avantaj sa yo. Kontra asirans sa a gen esklizyon, limit, rediksyon avantaj, ak kondisyon kote kontra a gendwa kontinye anvigè oswa sispann. Pou konnen pri ak detay konplè sou kouvèti a, konsilte dokiman plan ou yo, rele oswa ekri ajan asirans ou an oswa konpayi an, selon sa ki aplikab la. Detay ak avantaj plan yo varye selon zòn kouvèti a ak kategori plan an. Tanpri repase detay plan an pou aprann plis.

Kouvèti plan medikal la nan plan Endividyèl ak Familyal UnitedHealthcare yo ofri pa: UnitedHealthcare of Arizona, Inc.; Rocky Mountain Health Maintenance Organization Incorporated nan CO; UnitedHealthcare of Eta Florid, Inc.; UnitedHealthcare of Georgia, Inc; UnitedHealthcare of Illinois, Inc.; UnitedHealthcare Insurance Company nan AL, KS, LA, MO, NJ, ak TN; Optimum Choice, Inc. nan MD ak VA; UnitedHealthcare Community Plan, Inc. nan MI; UnitedHealthcare of Mississippi, Inc.; UnitedHealthcare of New Mexico, Inc.; UnitedHealthcare of North Carolina, Inc.; UnitedHealthcare of Ohio, Inc.; UnitedHealthcare of Oklahoma, Inc.; UnitedHealthcare of South Carolina, Inc.; UnitedHealthcare of Texas, Inc.; UnitedHealthcare of Oregon, Inc. nan WA; ak UnitedHealthcare of Wisconsin, Inc.  Se United HealthCare Services, Inc. oswa afilye li yo ki ofri Sèvis administratif yo.

Kontra asirans sa a gen esklizyon, limit, rediksyoon avantaj, ak kondisyon kote kontra a ka kontinye anvigè oswa sispann. Pou konnen pri ak detay konplè sou kouvèti a, rele oswa ekri ajan asirans ou an oswa konpayi an, selon sa ki aplikab la. Lè ou reponn òf sa a, ou aksepte yon reprezantan gendwa kontakte ou.

1 Amwenske gen lòt obligasyon, avantaj yo disponib sèlman lè se yon founisè rezo vityèl deziyen ki founi sèvis yo. Vizit Vityèl yo pa la pou reponn a pwoblèm ijans ni pwoblèm medikal ki menase lavi epi ou pa dwe itilize yo nan sikonstans sa yo. Sèvis yo gendwa pa disponib toutan oswa nan tout kote, oswa pou tout manm yo. Tcheke plan avantaj ou pou detèmine si sèvis sa yo disponib. Ou kapab gen pou peye tarif pou done. Sèten preskripsyon gendwa pa disponib, epi lòt restriksyon ka aplike.

2 Preskripsyon Nivo 2 pou $5 oswa mwens pa disponib pou tout medikaman. Ranplisaj 3 mwa aplike pou sèten medikaman antretyen sèlman. Egzijans fòmilè aplikab yo tankou otorizasyon davans ak limit sou kantite ka aplike pou avantaj famasi ou yo. Rabè Walgreens valab jiska 12/31/2024. Rabè valab sèlman pou acha pwodui sante ak byennèt kalifye mak Walgreens manm aktyèl ki kalifye pou pwogram rabè UnitedHealthcare lan fè nan magazen. Rabè yo pa kapab itilize sou entènèt. Pou jwenn yon lis konplè pwodui sante ak byennèt mak Walgreens epi esklizyon yo, tanpri vizite www.walgreens.com/smartsavings.

Dat Dènye Chanjman yo Fèt 04.18.2024 a 12:11 AM CDT

Enfòmasyon sou avètisman
(navige nan bwat sa a pou wè)

W ap chèche sitwèb Medicaid gouvènman federal la? Gade la a nan Medicaid.gov.

Plan UnitedHealthcare Dual Complete yo

Plan yo asire nan konpayi asirans UnitedHealthcare oswa nan youn nan konpayi afilye li yo, yon òganizasyon Medicare Advantage ki gen yon kontra avèk Medicare e yon kontra avèk Pwogram Medicaid Eta a. Ou ka antre nan plan an si yo renouvle kontra plan an avèk Medicare. Plan sa a disponib pou nenpòt moun ki gen Èd Medikal nan Eta a ak Medicare. Avantaj yo, karakteristik yo ak/oswa aparèy yo varye selon plan an/zòn lan. Limit, esklizyon ak/oswa restriksyon pou rezo ka aplike. Avantaj yo, prim asirans lan ak/oswa kopeman/ko-asirans lan ka chanje nan dat 1ye janvye chak ane.

Avètisman konsènan prim

Plan Doub Bezwen Espesyal yo gen yon prim $0 pou manm ki gen Èd Siplemantè (sibvansyon pou revni ki ba).

Avètisman sou avantaj yo

Avantaj yo, karakteristik yo ak/oswa aparèy yo varye selon plan an/zòn lan. Limit, esklizyon ak/oswa restriksyon pou rezo ka aplike.

Avètisman pou Liy Dirèk Enfimyè

Pinga itilize sèvis sa a pou ka ijans oswa pou bezwen swen ijan. Nan yon ka ijans, rele 911 oswa ale nan sal ijans ki pi pre a. Enfòmasyon yo bay atravè sèvis sa a se pou rezon enfòmasyon sèlman. Enfimye/enfimyè yo pa kapab fè dyagnostik pwoblèm ni rekòmande tretman epi yo pa yon ranplasman pou swen founisè swen w lan. Enfòmasyon sou sante w rete konfidansyèl selon ekzijans lalwa. Sèvis la pa yon pwogram asirans, epitou li kapab sispann nenpòt ki lè. Liy asistans enfimyè a pa pou itilize nan ka ijans, se pou bay enfòmasyon sèlman li ye.

UnitedHealthcare Connected® pou MyCare Ohio (Plan Medicare-Medicaid)

UnitedHealthcare Connected® pou MyCare Ohio (Plan Medicare-Medicaid) se yon plan sante ki gen kontra avèk alafwa Medicare ak Medicaid Ohio pou founi avantaj toulède pwogram yo pou manm enskri yo. 

UnitedHealthcare Connected® (Plan Medicare-Medicaid)

UnitedHealthcare Connected® (Plan Medicare-Medicaid) se yon plan sante ki gen kontra avèk ni Medicare ni Medicaid Texas pou founi avantaj toude pwogram yo pou manm enskri yo.

UnitedHealthcare Connected® for One Care (Plan Medicare-Medicaid)

UnitedHealthcare Connected® for One Care (Plan Medicare-Medicaid) se yon plan sante ki gen kontra avèk alafwa Medicare ak MassHealth (Medicaid) pou founi avantaj toulède pwogram yo pou manm enskri yo. 

Avètisman jeneral sou avantaj UnitedHealthcare Connected®

Lis sa a pa yon lis konplè. Enfòmasyon nou bay sou avantaj yo se yon ti rezime, men se pa yon deskripsyon konplè avantaj yo. Pou jwenn plis enfòmasyon, kontakte plan an oswa li manyèl pou manm yo. Limit, kopeman, ak restriksyon ka aplike. Pou jwenn plis enfòmasyon, rele Sèvis Manm UnitedHealthcare Connected® oswa li Manyèl Manm UnitedHealthcare Connected® lan. 

Plan UnitedHealthcare Senior Care Options (HMO SNP)

UnitedHealthcare Senior Care Options (SCO) se yon plan Swen Kowòdone ki gen yon kontra ak Medicare e yon kontra ak pwogram Medicaid Commonwealth of Massachusetts. Ou ka antre nan plan an si yo renouvle kontra plan an avèk Medicare. Plan sa a se yon pwogram volontè ki disponib pou nenpòt moun ki gen laj 65 lane oswa plis epi ki kalifye pou MassHealth Standard ak Original Medicare epi ki pa gen okenn lòt Asirans sante konplè, alesepsyon Medicare. Si ou gen MassHealth Standard, men ou pa kalifye pou Original Medicare, ou ka gen posiblite kanmenm pou w kalifye pou enskri nan plan MassHealth Senior Care Option nou an epi resevwa tout avantaj MassHealth ou yo nan pwogram Senior Care Options (SCO) nou an.

Avètisman sou klasman etwal

Chak ane, Medicare evalye plan yo dapre yon sistèm klasman avèk 5-Etwal. Klasman 5-Etwal la aplike pou ane plan an 2024.

Enfòmasyon enpòtan sou founisè

Chwa a se pou ou

Nou pral ba ou enfòmasyon ki pral ede w fè chwa enfòme, tankou kalifikasyon doktè ak pwofesyonèl swen sante. Men, enfòmasyon sa a pa yon apwobasyon aptitid yon doktè oswa pwofesyonèl swen sante presizeman pou bezwen w.

Founisè yo ki disponib pa mwayen aplikasyon sa a ka pa nesesèman montre tout posiblite rezo founisè UnitedHealthcare ki gen kontra yo. Ka gen founisè oswa sèten espesyalite ki pa nan aplikasyon sa a, men ki fè pati rezo nou an. Si ou pa jwenn founisè w ap chèche a, ou ka kontakte founisè a direktèman pou verifye eta patisipasyon li nan rezo UnitedHealthcare, oswa kontakte Sèvis Kliyan nan nimewo gratis ki endike nan kat ID UnitedHealthcare ou an. Anvan ou wè nenpòt doktè, ankontan nenpòt espesyalis, nou rekòmande tou pou ou rele klinik doktè a pou verifye eta patisipasyon ak disponiblite li.

Nou te ajoute oswa retire sèten founisè rezo nan anyè nou an apre yo fin mete anyè sa a ajou. Nou pa garanti ke chak founisè ap aksepte nouvo manm toujou.

Founisè ki pa nan rezo a/ki pa gen kontra pa anba okenn obligasyon pou trete manm ki nan plan UnitedHealthcare, sof nan sitiyasyon ijans. Tanpri rele nimewo sèvis kliyan nou an oswa gade Prèv Pwoteksyon Asirans ou pou jwenn plis enfòmasyon, ki gen ladan kotizasyon nan frè ki aplike pou sèvis andeyò rezo a.

Avi sou Lwa Anfavè Ameriken Andikape

Annakò avèk egzijans Lwa 1990 Anfavè Ameriken Andikape ak Seksyon 504 nan Lwa 1973 sou Reyabilitasyon ("ADA"), Konpayi Asirans UnitedHealthcare bay aksè konplè ak egal pou sèvis kouvri yo e li pa baze sou andikap pou fè diskriminasyon nan sèvis li, pwogram, oswa aktivite li yo kont moun ki gen andikap ki kalifye.

Rekòmandasyon

Founisè rezo yo ap ede oumenm ak manm fanmi w ki kouvri yo jwenn swen ki nesesè. Doktè swen prensipal ou ka kowòdone aksè pou espesyalis yo.

Demann anyè nan fòma papye

Kopi papye anyè founisè rezo a disponib gratis pou manm yo lè yo rele nimewo telefòn sèvis kliyan ki nan do kat ID w la. Moun ki pa manm ka telechaje epi enprime rezilta rechèch yo apati anyè anliy nan.

Enfòmasyon ki pa kòrèk

Pou rapòte enfòmasyon ki pa kòrèk, voye yon imèl bay provider_directory_invalid_issues@uhc.com. Bwat imèl sa a se pou manm yo rapòte potansyèl enfòmasyon demografik ki pa kòrèk (adrès, nimewo telefòn, elatriye) sou anyè yo ki nan fòma papye oswa elektwonik. Lè w sèvi ak bwat imèl sa a pou rapòte pwoblèm, sa pral fè yo kontakte biwo founisè a pou verifye tout done demografik anyè a, sa ki ka pran apeprè 30 jou. Moun yo kapab rapòte posiblite enfòmasyon ki pa kòrèk nan telefòn tou. Manm UnitedHealthcare yo dwe rele nimewo ki nan do kat ID yo a, epi moun ki pa manm UnitedHealthcare ka rele nan 1-888-638-6613 / TTY 711, oswa itilize sèvis relè ou prefere a.

Deklarasyon pou katastwòf oswa ijans

Si ou afekte ak yon deklarasyon katastwòf oswa deklarasyon ijans Prezidan an oswa Gouvènè a bay, oswa yon anons ijans sante piblik Sekretè Sante ak Sèvis Sosyal la bay, ou gen sèten soutyen anplis aladispozisyon ou.

  • Yo dwe bay avantaj Pati A, Pati B, ak plan siplemantè Pati C nan etablisman ki pa sou kontra yo (konnen ou dwe jwenn avantaj Pati A ak Pati B yo nan etablisman sètifye Medicare yo);
  • Lè sa aplikab, egzijans referans ki limite aksè dirèk (gatekeeper) yo anile okonplè;
  • Pataj frè andeyò rezo plan an apwouve pou montan pataj frè rezo yo redwi tanporèman; epi
  • Egzijans notifikasyon 30 jou pou manm yo anile, toutotan tout chanjman yo (tankou rediksyon pataj frè ak dispans otorizasyon) benefisye manm lan.

Si CMS pa te bay yon dat finisman pou katastwòf la oswa ijans lan, plan yo ap reprann fonksyònman nòmal yo 30 jou apre premye deklarasyon an.

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