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UnitedHealthcare Community Plan
UnitedHealthcare Community Plan

UnitedHealthcare Connected® for MyCare Ohio
H2531-001

Glossary

A

ABUSE – Harming someone on purpose (this includes yelling, ignoring a person's needs and inappropriate touching).

ADVANCE DIRECTIVE – A decision about your health care that you make ahead of time in case you are ever unable to speak for yourself. This will let your family and your doctors know what decisions you would make if you were able to.

APPEAL – An appeal is a dispute made by a member, his or her representative or a provider with the member's permission, challenging an action by the health plan to deny or limit authorization of a service, including the type or level of service or reduce, suspend, or terminate payment for a previously authorized service; or any failure to authorize services in a timely manner or decide a grievance or appeal within the required time frames.

AUTHORIZATION – An O.K. or approval for a service.

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B

BENEFITS – Services, procedures and medications that UnitedHealthcare Community Plan will cover for you.

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C

CLINICAL CARE MANAGEMENT – One-on-one help by a nurse providing education and coordination of UnitedHealthcare Community Plan benefits, tailored to your needs.

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D

DISENROLLMENT – To stop your membership in UnitedHealthcare Community Plan.

DME – Durable Medical Equipment includes things such as wheelchairs, walkers, diabetic glucose meter, IV poles that have to be used for a length of time. It can also be equipment that must be thrown away such as bandages, catheters and needles. DME must be requested by your doctor.

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E

EMERGENCY – A sudden and, at the time, unexpected change in a person's physical or mental condition which, if a procedure or treatment is not performed right away, could be expected to result in 1) the loss of life or limb, 2) signifcant impairment to a bodily function, 3) permanent damage to a body part or health of unborn child.

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F

FRAUD – An untruthful act (example: if someone other than you uses your member ID card and pretends to be you).

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G

GRIEVANCE – A grievance is an expression of dissatisfaction about the health plan, or a practitioner or any matter other than an action taken by the plan. Grievances can include issues with the quality of care or services provided, aspects of interpersonal relationships such as rudeness of a provider or employee, or failure to respect a member's rights.

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H

HEALTH INFORMATION – Facts about your health and care. This information may come from UnitedHealthcare Community Plan or a provider. It includes information about your physical and mental health, as well as payments for care.

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I

ID CARD – An identifcation card that says you are a UnitedHealthcare Community Plan member. You should have this card with you at all times.

IMMUNIZATION – A medicine (usually a shot) that protects, or "immunizes", a member from a disease. Children should receive different shots at different ages. These shots are often given during regular doctor visits.

INFORMED CONSENT – That all medical treatments have been explained to you; you understand and agree to them.

IN-NETWORK – Doctors, specialists, hospitals, pharmacies and other providers who have an arrangement with UnitedHealthcare Community Plan to provide health care services to members.

INPATIENT – When you are admitted into a hospital for a length of time.

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J

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K

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L

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M

MEMBER – An eligible person enrolled with UnitedHealthcare Community Plan in the Medicaid program.

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N

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O

ODJFS – Ohio Department of Job and Family Services

OUT-OF-NETWORK – Doctors, specialists, hospitals, pharmacies and other providers who do not have an arrangement with UnitedHealthcare Community Plan to provide health care services to members.

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P

PRESCRIPTION – A doctor's written instructions for medication or treatment.

PRIMARY CARE PROVIDER (PCP) – A doctor you choose to be your primary care provider who has his/her own private practice. Your PCP will coordinate all of your health care.

PRIOR AUTHORIZATION – Process that your doctor uses to get approval for services that need to be approved before they can be done.

PROVIDER OR PRACTITIONER – A person or facility that offers health care (doctor, pharmacy, dentist, clinic, hospital, etc.).

PROVIDER DIRECTORY – A list of providers who participate with UnitedHealthcare Community Plan to help take care of your healthcare needs.

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Q

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R

REFERRAL – When you and your PCP agree you need to see another doctor and your PCP sends you to a network specialist.

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S

SELF-REFERRED SERVICES – Services for which you do not need to see your PCP for a referral.

SPECIALIST – Any doctor who has special training for a specific condition or illness.

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T

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U

URGENT CARE – When you are sick but it is not an emergency, and you need treatment or medical advice within a 48-hour time period.

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V

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W

WIC – Supplemental Food Program for Women, Infants and Children which provides nutrition counseling, nutrition education, and nutritious foods to pregnant and postpartum women, infants and children up to the age of 2. Children deemed nutritionally deficent are covered up to age 5 if they are low income and are determined to be at nutritional risk.

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X

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Y

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Z

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To file an Appeal or Grievance, please visit or FAQ section.

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UnitedHealthcare Connected®; for MyCare Ohio

Disclaimer Information

Looking for the federal government’s Medicaid website? Look here at Medicaid.gov.

UnitedHealthcare Dual Complete Plans

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the state Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. You must continue to pay your Medicare Part B premium, if not otherwise paid for under Medicaid or by another third party. This information is not a complete description of benefits. Contact the plan for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.

Nurseline Disclaimer

This service should not be used for emergency or urgent care needs. In an emergency, call 911 or go to the nearest emergency room. The information provided through this service is for informational purposes only. The nurses cannot diagnose problems or recommend treatment and are not a substitute for your doctor's care. Your health information is kept confidential in accordance with the law. The service is not an insurance program and may be discontinued at any time.

UnitedHealthcare Connected™ for MyCare Ohio (Medicare-Medicaid Plan)

UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. If you have any problem reading or understanding this or any other UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan) information, please contact our Member Services at 1-877-542-9236 (TTY 711) from 7 a.m. to 8 p.m. Monday through Friday (voice mail available 24 hours a day/7 days a week) for help at no cost to you.

Si tiene problemas para leer o comprender esta o cualquier otra documentación de UnitedHealthcare® Connected™ de MyCare Ohio (plan Medicare-Medicaid), comuníquese con nuestro Departamento de Servicio al Cliente para obtener información adicional sin costo para usted al 1-877-542-9236 (TTY 711) de lunes a viernes de 7 a.m. a 8 p.m. (correo de voz disponible las 24 horas del día, los 7 días de la semana).

UnitedHealthcare Connected™ (Medicare-Medicaid Plan)

UnitedHealthcare Connected (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees.

UnitedHealthcare Connected Benefit Disclaimer

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected Member Services or read the UnitedHealthcare Connected Member Handbook. Benefits and/or copayments may change on January 1 of each year.

UnitedHealthcare Senior Care Options (HMO SNP) Plan

UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our SCO program.

Availability of Non-English Disclaimer

This information is available for free in other languages. Please call our customer service number at 1-800-905-8671, TTY 711, 8 a.m. - 8 p.m. local time, 7 days a week.

Esta información está disponible sin costo en otros idiomas. Comuníquese con nuestro Servicio al Cliente al número 1-800-905-8671, TTY 711, de 8 a.m. – 8 p.m. hora local, los 7 días de la semana.

Star Ratings Disclaimer

Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.

Formularies

The formulary, pharmacy network and provider network may change at any time. You will receive notice when necessary.

NCQA

UnitedHealthcare Connected has a Model of Care approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) through 2016 based on a review of UnitedHealthcare Connected’s Model of Care.