직접 말할 수 없는 경우에 대비하여 미리 의료 관리에 대해 결정한 사항들입니다. This will let your family and your doctors know what decisions you would make if you were able to.
이의제기/항소
A request for your managed care organization to review a denial or a grievance again.
ASC/SPU
Ambulatory surgical center/short procedure unit.
승인
서비스에 대한 긍정적 의사 표현 또는 승인
B
혜택
Services, procedures and medications that CHIP will cover for you.
C
Clinical Care Management
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.
코페이먼트/공동부담금
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
Disenrollment
To stop your membership in CHIP.
내구성 의료 장비(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
Emergency(응급 상황)
When you reasonably believe that your health is in serious danger.
응급 의료 상태
An illness, injury, symptom, or condition so serious that a reasonable person would seek care right away to avoid harm.
응급 의료 교통편
Ground or air ambulance services for an emergency medical condition.
응급실 치료
Emergency services you get in an emergency room.
응급 서비스
Evaluation of an emergency medical condition and treatment to keep the condition from getting worse.
제외되는 서비스
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.
사기(Fraud)
An untruthful act – an example is someone other than you using your CHIP member ID card and pretending to be you.
G
고충/불만사항
A complaint to your health insurer or plan.
H
재활 서비스 및 기기
Health care services such as physical or occupational therapy that help a person keep, learn, or improve skills and functioning for daily living.
건강 보험
A contract that requires your health insurer to pay your covered health care costs in exchange for a premium.
Home Health Agency
A company hired by CHIP to provide care for you in your home.
가정간호
Health care services a person receives in a home.
호스피스 서비스
Services to provide comfort and support for persons in the last stages of a terminal illness and their families.
병원 외래환자 치료
Care in a hospital that usually doesn’t require an overnight stay.
입원
Care in a hospital that requires admission as an inpatient and usually requires an overnight stay.
I
ID Card
Identification card – a card that says you are a CHIP member. 이 카드를 항상 소지해야 합니다.
Informed Consent
You agree to all medical treatments.
입원 환자
일정 기간 병원에서 생활하도록 허가되는 경우입니다.
M
Medical Necessity
Your health care provider decides if a treatment, admission, procedure, medical supply, equipment, service or supply is medically necessary.
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.
가입자
A person who is eligible for CHIP.
N
네트워크
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
외래 환자
병원에 입원할 필요가 없는 치료를 받는 경우입니다.
P
참여 제공자
A Provider who has a contract with your health insurer or plan to provide covered services to you.
진료 서비스
Health-care services a licensed medical physician (M.D. -Medical Doctor or D.O. -Doctor of Osteopathic Medicine) provides or coordinates.
플랜
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.
보험료
The amount that must be paid for your health insurance or plan.
처방약 보장
Health insurance or plan that helps pay for prescription drugs and medications.
처방약
Drugs and medications that by law require a prescription.
주치의
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.
PCP(주치의)
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.
Prior Authorization
The process for any service that needs an O.K. from CHIP before it can take place.
제공자
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.
의료 서비스 제공자 주소록
A list of providers who participate with CHIP to help take care of your healthcare needs.
R
추천/의뢰/소개
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
Self-Referred Services
진료 의뢰서를 받기 위해 주치의 서비스 제공자를 만날 필요가 없는 서비스입니다.
전문 간호 시설
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.
전문의(Specialist)
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.
Treatment
The care that you may receive from doctors and facilities.
U
긴급 치료
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.
