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STAR Glosaryo
A
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Paunang Direktiba
Isang pasya sa iyong pangangalagang pangkalusugan na iyong paunang ginawa sa sandaling hindi mo na magagawang magsalita para sa iyong sarili kailanman. This will let your family and your doctors know what decisions you would make if you were able to.
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Apela
A request for your managed care organization to review a denial or a grievance again.
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ASC/SPU
Ambulatory surgical center/short procedure unit.
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Pagpapahintulot
Isang O.K. o pag-apruba para sa isang serbisyo.
B
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Mga Benepisyo
Services, procedures and medications that CHIP will cover for you.
C
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Clinical Care Management
One-on-one help by a nurse providing education and coordination of CHIP benefits, tailored to your needs.
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Complaint
A grievance that you communicate to your health insurer or plan.
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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
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Disenrollment
To stop your membership in CHIP.
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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
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Emergency
When you reasonably believe that your health is in serious danger.
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Emergency na Kondisyong Medikal
An illness, injury, symptom, or condition so serious that a reasonable person would seek care right away to avoid harm.
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Emergency na Medikal na Transportasyon
Ground or air ambulance services for an emergency medical condition.
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Pangangalaga sa Emergency Room
Emergency services you get in an emergency room.
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Mga Pang-emergency na Serbisyo
Evaluation of an emergency medical condition and treatment to keep the condition from getting worse.
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Mga Ibinukod na Serbisyo
Health care services that your health insurance or plan doesn’t pay for or cover.
F
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Federal Poverty Level (FPL)
Poverty income thresholds by family size that are annually updated by the Census Bureau for inflation.
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Panloloko
Isang hindi tapat na pagkilos (halimbawa: kung ginamit ng ibang tao maliban sa iyo ang iyong ID card ng miyembro at nagpanggap na ikaw).
G
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Karaingan
A complaint to your health insurer or plan.
H
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Mga Serbisyo sa Habilitation at mga Device
Health care services such as physical or occupational therapy that help a person keep, learn, or improve skills and functioning for daily living.
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Insurance sa Kalusugan
A contract that requires your health insurer to pay your covered health care costs in exchange for a premium.
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Home Health Agency
A company hired by CHIP to provide care for you in your home.
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Pangangalagang Pangkalusugan sa Tahanan
Health care services a person receives in a home.
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Mga Serbisyo ng Hospice
Services to provide comfort and support for persons in the last stages of a terminal illness and their families.
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Pangangalaga ng Ospital sa Outpatient
Care in a hospital that usually doesn’t require an overnight stay.
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Pagkakaospital
Care in a hospital that requires admission as an inpatient and usually requires an overnight stay.
I
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ID Card
Identification card – a card that says you are a CHIP member. Dapat na nasa iyo ang card na ito sa lahat ng oras.
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Informed Consent
You agree to all medical treatments.
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Inpatient
Kapag ipinasok ka sa isang ospital sa isang partikular na haba ng panahon.
M
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Medical Necessity
Your health care provider decides if a treatment, admission, procedure, medical supply, equipment, service or supply is medically necessary.
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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.
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Miyembro
A person who is eligible for CHIP.
N
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Network
The facilities, providers, and suppliers your health insurer or plan has contracted with to provide health care services.
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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
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Outpatient
Kapag may pinagawa kang pamamaraan na hindi nangangailangan ng magdamag na pananatili sa ospital.
P
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Kalahok na Provider
A Provider who has a contract with your health insurer or plan to provide covered services to you.
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Mga serbisyo ng manggagamot
Health-care services a licensed medical physician (M.D. -Medical Doctor or D.O. -Doctor of Osteopathic Medicine) provides or coordinates.
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Plano
A benefit, like Medicaid, which provides and pays for your health-care services.
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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.
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Premium
The amount that must be paid for your health insurance or plan.
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Saklaw ng Inireresetang Gamot
Health insurance or plan that helps pay for prescription drugs and medications.
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Mga Inireresetang Gamot
Drugs and medications that by law require a prescription.
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Physician sa Pangunahing Pangangalaga
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.
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Pangunahing Provider ng Pangangalaga
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.
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Prior Authorization
The process for any service that needs an O.K. from CHIP before it can take place.
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Provider
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.
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Direktoryo ng Provider
A list of providers who participate with CHIP to help take care of your healthcare needs.
R
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Referral
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.
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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
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Self-Referred Services
Mga serbisyo na kung saan hindi mo na kailangang magpatingin sa iyong provider ng pangunahing pangangalaga para sa isang referral.
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Bihasang pangangalaga
Services from licensed nurses in your own home or in a nursing home.
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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.
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Espesyalista
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
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TANF
Temporary Assistance for Needy Families.
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Treatment
The care that you may receive from doctors and facilities.
U
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Agarang Pangangalaga
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
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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.
Impormasyon sa Enrollment
The Texas STAR plan specialists can answer questions and help you enroll.
Tawagan kami:
1-888-887-9003 / TTY: 711
8:00 AM hanggang 8:00 PM lokal na oras, Lunes – Biyernes
Pinili ninyong magpatala sa
Ang planong ito ay kasalukuyang hindi available sa ZIP code na inilagay.
Tingnan ang mga plano sa ZIP Code na ito.Kunin ang mga detalye
Visit the Texas CHIP & Medicaid site for more information on eligibility and enrollment.
Impormasyon sa Enrollment
The Texas STAR plan specialists can answer questions and help you enroll.
Tawagan kami:
1-888-887-9003 / TTY: 711
8:00 AM hanggang 8:00 PM lokal na oras, Lunes – Biyernes
Pinili ninyong magpatala sa
Ang planong ito ay kasalukuyang hindi available sa ZIP code na inilagay.
Tingnan ang mga plano sa ZIP Code na ito.Kunin ang mga detalye
Visit the Texas CHIP & Medicaid site for more information on eligibility and enrollment.
Impormasyon ng Miyembro
Miyembro na? Mayroon kang access sa aming website na para lang sa miyembro. Mag-print ng mga ID card, makipag-chat sa isang nurse online at higit pa.
Member information is available in paper form, at no cost, upon request, and sent by the health plan within five business days.
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Handbook ng miyembro - Ingles (Nagbubukas sa bagong window)
PDF 998.16KB - Huling Na-update: 10/23/2023
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Handbook ng miyembro - Español (Nagbubukas sa bagong window)
PDF 954.61KB - Huling Na-update: 10/23/2023
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State Fair Hearing Update - Ingles and Español (Nagbubukas sa bagong window)
PDF 66.22KB - Huling Na-update: 09/01/2023
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In-lieu of services handbook addendum - Ingles and Español (Nagbubukas sa bagong window)
PDF 69.23KB - Huling Na-update: 03/19/2024
Impormasyon ng Miyembro
Miyembro na? Mayroon kang access sa aming website na para lang sa miyembro. Mag-print ng mga ID card, makipag-chat sa isang nurse online at higit pa.
Member information is available in paper form, at no cost, upon request, and sent by the health plan within five business days.
-
Handbook ng miyembro - Ingles (Nagbubukas sa bagong window)
PDF 998.16KB - Huling Na-update: 10/23/2023
-
Handbook ng miyembro - Español (Nagbubukas sa bagong window)
PDF 954.61KB - Huling Na-update: 10/23/2023
-
State Fair Hearing Update - Ingles and Español (Nagbubukas sa bagong window)
PDF 66.22KB - Huling Na-update: 09/01/2023
-
In-lieu of services handbook addendum - Ingles and Español (Nagbubukas sa bagong window)
PDF 69.23KB - Huling Na-update: 03/19/2024