Kahilingan para sa patas na pagdinig tungkol sa iminungkahing aksyon ng ahensya, nakumpletong aksyon ng ahensya, o pagkabigo ng ahensya na gumawa ng napapanahong pagpapasya.
Aplikasyon
Pormal na kahilingan para sa mga benepisyong ginawa sa ahensya sa pamamagitan ng sulat at nilagdaan ng aplikante o ng taong kumikilos sa ngalan ng aplikante. Maaaring matanggap ang aplikasyon sa pamamagitan ng mail, telepono, fax, sa personal, o sa elektronikong paraan.
B
Behavioral Health Services Only
This term means those who receive only Behavioral Health benefits based on income requirements.
C
Certificate of Coverage
A description of your health care coverage and benefits. Your member handbook serves as your certificate of coverage.
Countable Resource
A resource that is countable when determining resource eligibility.
D
Decertification
Loss of eligibility to participate as a Medicaid provider, or for a license to operate a Medical facility licensed by DHH.
Department of Social and Health Services (DSHS)
The state agency that administers public assistance programs in Washington State.
Dependent
An individual who is the financial responsibility of a member of the income unit. Halimbawa: This is someone who could be counted as a tax dependent, if income tax is filed.
Pormularyo ng Gamot
A list of approved prescription drugs developed the health plan.
E
Emergency
Ang biglaan at malubhang pagsisimula ng sintomas o mga sintomas, kabilang ang matinding pananakit, na dahilan para maniwala ang isang karaniwang tao nang may katwiran na may umiiral na kondisyong pangkalusugan na nangangailangan ng agarang medikal na atensyon, kung ang kabiguang magbigay ng medikal na atensyon ay magreresulta sa malubhang pagkasira ng mga function ng katawan o malubhang pagpalya ng isang organ o bahagi ng katawan, o maglalagay sa kalusugan ng tao sa matinding panganib.
F
Panloloko
Ang sinasadyang intensyon na makakuha ng mga hindi eligible na benepisyo o bayad.
G
Good Cause
An acceptable reason to defer the requirement to cooperate for certain eligibility factors.
H
Health Care Authority (HCA)
The state agency responsible for administering Washington Apple Health (Medicaid) and other state health programs.
Pandinig
Ang pagdinig ay kapag hiniling mo sa iyong programang pangkalusugan na i-review ang iyong kaso pagkatapos tanggihan ng iyong plano ang iyong apela.
I
Kita
A gain or recurrent benefit measured in money.
Inpatient
Isang pasyente na na-admit para sa isang magdamag o mas matagal na pananatili sa isang pasilidad ng pangangalagang pangkalusugan at tumatanggap ng mga sakop na serbisyo.
L
Legal Guardian
A person who has been granted custody of a minor by court order.
M
Maternity Benefits Program
This Health Care Authority (HCA) program includes all Apple Health (Medicaid) benefits, including maternity benefits, maternity support services, and maternity case management, and is made available to Apple Health (Medicaid) members who become pregnant, notify HCA and UnitedHealthcare Community Plan, and apply for benefits. Eligibility for the program is determined by HCA.
Medicaid
A state health insurance program for people with low income who meet certain eligibility requirements. Maaaring magkakaiba ang mga programa ayon sa bawat estado. For information on Washington’s Apple Health (Medicaid) programs, visit https://www.hca.wa.gov/apple-health
Medicare
A federal health insurance program for people who are 65 or older, people with disabilities, or those with end-stage kidney disease. Ang pagiging karapat-dapat sa Medicare ay hindi batay sa kita, at ang pangunahing saklaw ay pareho sa bawat estado.
Miyembro
Isang kwalipikadong tao na naka-enroll sa Planong Pangkalusugan ng UnitedHealthcare.
O
Outpatient
Isang pasyenteng hindi nakaospital na tumatanggap ng mga saklaw na serbisyo na hindi mula sa isang ospital, tulad ng sa opisina ng doktor o sa sariling tahanan ng pasyente, o sa isang departamento ng ospital para sa pasyenteng hindi nakaospital o departamento ng emergency o sentro ng operasyon.
P
Pangunahing tagapagbigay ng pangangalaga (PCP)
Ang iyong personal na provider ng pangangalagang pangkalusugan. Your primary care provider can be a family or general practitioner, internist, pediatrician, or other provider approved by UnitedHealthcare Community Plan. To receive benefits, your primary care provider must provide or coordinate your care. If you need to see a specialist, your primary care provider will refer you.
Provider
Isang propesyonal sa pangangalagang pangkalusugan (tulad ng doktor, nars, internist, atbp.) o pasilidad (tulad ng isang ospital, klinika, atbp.).
R
Recertification
Pana-panahong review ng kita at eligibility ng iyong pamilya. During recertification, you must submit current income and residency documentation to verify your eligibility and/or level of premium subsidy.
S
Service Area
The geographic area served by a health plan that provides coverage for Apple Health (Medicaid).
Espesyalista
A provider of specialized medicine, such as a cardiologist or a neurosurgeon.
Spouse
An individual who is legally married to another or who presents to the community as a husband or wife in a non-legal relationship.
T
Third Party
An individual, institution, corporation or agency that is responsible for all or part of the medical costs for Medicaid.
W
Washington Apple Health (Medicaid)
Washington's Medicaid program, called Washington Apple Health (Medicaid), provides comprehensive free or low-cost health care to adults, families, individuals with disabilities, children under 19, children in foster care and pregnant individuals who meet income and eligibility requirements.
Washington Healthplanfinder
It's your new way to find, compare and enroll in a health plan that fits your needs and budget. For more information about Apple Health (Medicaid) or to enroll, please visit: wahealthplanfinder.org or call 1-855-WAFINDER (1-855-923-4633) TTY/TTD 1-855-627-9604.
Washington Resident
A person physically residing and maintaining a residence in the state of Washington. You must be a Washington resident to be eligible for Washington Apple Health (Medicaid). To be considered a Washington resident, members who are temporarily out of Washington for any reason:
May be required to prove their intent to return to Washington State; and
May not be out of Washington State for more than three consecutive calendar months.
Dependent children who are attending school out of state may be considered residents if they are out of state during the school year, as long as their primary residence is in Washington State and they return to Washington State during breaks. Dependent children attending school out of state may be required to provide proof that they pay out-of-state tuition, vote in Washington, and file income taxes using a Washington address.
Your residence may be a home you own or are purchasing or renting, a shelter or other physical location where you are staying in lieu of a home, or another person's home.
