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STAR+PLUS Glosaryo
A
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Apela
A request for your managed care organization to review a denial or a grievance again.
C
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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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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 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.
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.
-
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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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.
M
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Medicaid
A program that offers health care services to persons who have limited income, are pregnant, and/or persons with disabilities.
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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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Medically Needy Program
The Medically Needy Program provides Medicaid benefits to children younger than age 19, and pregnant women whose families make too much money for regular Medicaid. This means that the pregnant woman or child may qualify for the Medically Needy Program if they have high medical bills and they do not have enough monthly income to pay these bills. The pregnant woman or child can qualify for this program on a month-to-month basis. Some of these bills may include:
- Doctor's visits
- Mga Reseta
- Past medical bills
- Medical insurance charges
TANDAAN: The Medically Needy Program is not for people who qualify for any other Medicaid program.
-
Medicare
A health insurance program paid for by the federal government, not by the state.
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.
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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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.
R
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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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Bihasang pangangalaga
Services from licensed nurses in your own home or in a nursing home.
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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.
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SSI
Supplemental Security Income.
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STAR+PLUS
A Texas Medicaid managed care program for people who have disabilities or who are elderly (over age 65). STAR+PLUS provides long-term services and supports in your home, such as help with daily activities, home modifications and personal assistance services.
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.
Impormasyon sa Enrollment
The Texas STAR+PLUS plan specialists can answer questions.
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.Face-to-face assessments return
- As of January 2023 some types of assessments will require a face-to-face visit. This means a United Healthcare staff member will need to visit with you in your place of residency.
- Please be advised that missing your assessment could impact your services or eligibility. If you have questions, please contact your Service Coordinator or Member Services.
- Call Member Services at 1-888-887-9003, TTY 7-1-1, Monday-Friday 8 a.m.-8 p.m. or email memberservices_uhccp@uhc.com to get help finding a provider or setting up a visit.
Kunin ang mga detalye
Visit the Texas CHIP & Medicaid site for more information on eligibility and enrollment.
For information in alternate formats, like large print, Braille or audio, please call Member Services. Contract information can be found on STAR PLUS Contract Operational (texas.gov)
Impormasyon sa Enrollment
The Texas STAR+PLUS plan specialists can answer questions.
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.Face-to-face assessments return
- As of January 2023 some types of assessments will require a face-to-face visit. This means a United Healthcare staff member will need to visit with you in your place of residency.
- Please be advised that missing your assessment could impact your services or eligibility. If you have questions, please contact your Service Coordinator or Member Services.
- Call Member Services at 1-888-887-9003, TTY 7-1-1, Monday-Friday 8 a.m.-8 p.m. or email memberservices_uhccp@uhc.com to get help finding a provider or setting up a visit.
Kunin ang mga detalye
Visit the Texas CHIP & Medicaid site for more information on eligibility and enrollment.
For information in alternate formats, like large print, Braille or audio, please call Member Services. Contract information can be found on STAR PLUS Contract Operational (texas.gov)
Impormasyon ng Miyembro
Mayroon kang access sa aming website na para lang sa miyembro. Mag-print ng mga ID card at higit pa. Tingnan ang aming handbook sa ibaba.
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 1.02MB - Huling Na-update: 04/28/2023
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Member handbook - Español (Spanish) (Se abre en una ventana nueva)
PDF 1.06MB - Huling Na-update: 04/28/2023
-
State Fair Hearing Update - Ingles and Español (Spanish) (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 (Spanish) (Nagbubukas sa bagong window)
PDF 69.23KB - Huling Na-update: 03/19/2024
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STAR+PLUS Nursing Facility Member handbook - Ingles (Nagbubukas sa bagong window)
PDF 1.22MB - Huling Na-update: 05/30/2023
-
STAR+PLUS Nursing Facility Member handbook - Español (Spanish) (Se abre en una ventana nueva)
PDF 955.24KB - Huling Na-update: 05/30/2023
Mayroon ka bang ibang mga kinakailangang format?
Iniaalok namin ang aming mga materyales sa malalaking print, mga audio file, at Braille. Tawagan kami ngayon upang maipaalam sa amin kung kailangan mo ng impormasyon sa ibang format.
Impormasyon ng Miyembro
Mayroon kang access sa aming website na para lang sa miyembro. Mag-print ng mga ID card at higit pa. Tingnan ang aming handbook sa ibaba.
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 1.02MB - Huling Na-update: 04/28/2023
-
Member handbook - Español (Spanish) (Se abre en una ventana nueva)
PDF 1.06MB - Huling Na-update: 04/28/2023
-
State Fair Hearing Update - Ingles and Español (Spanish) (Nagbubukas sa bagong window)
PDF 66.22KB - Huling Na-update: 09/01/2023
-
In-lieu of services handbook addendum - Ingles and Español (Spanish) (Nagbubukas sa bagong window)
PDF 69.23KB - Huling Na-update: 03/19/2024
-
STAR+PLUS Nursing Facility Member handbook - Ingles (Nagbubukas sa bagong window)
PDF 1.22MB - Huling Na-update: 05/30/2023
-
STAR+PLUS Nursing Facility Member handbook - Español (Spanish) (Se abre en una ventana nueva)
PDF 955.24KB - Huling Na-update: 05/30/2023
Mayroon ka bang ibang mga kinakailangang format?
Iniaalok namin ang aming mga materyales sa malalaking print, mga audio file, at Braille. Tawagan kami ngayon upang maipaalam sa amin kung kailangan mo ng impormasyon sa ibang format.