대행사의 제안 조치, 대행사의 완료된 조치 또는 대행사의 시기 적절한 결정 실패에 관한 공정 심리 요청.
신청서
신청인 또는 신청인을 대신하여 활동하는 사람이 서면으로 대행사에 제공하고 서명한 혜택에 대한 공식적인 요청. 신청서는 우편, 전화, 팩스, 직접 접수 또는 전자 방식으로 접수할 수 있습니다.
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.
부양가족
An individual who is the financial responsibility of a member of the income unit. 예시: This is someone who could be counted as a tax dependent, if income tax is filed.
보험적용 의약품 목록
A list of approved prescription drugs developed the health plan.
E
Emergency(응급 상황)
중증 통증을 포함한 증상 또는 증상의 응급 및 급성 발병으로서, 합리적으로 행동하는 신중한 비전문가가 즉각적인 의학적 조치가 필요한 질환이 존재한다고 간주하는 상황이며, 의학적 조치를 제공하지 못할 경우 신체 기능의 심각한 장애 또는 신체 기관이나 일부의 심각한 기능 장애를 초래하거나 환자의 건강을 심각한 위험에 빠뜨릴 수 있는 경우를 가리킵니다.
F
사기(Fraud)
받을 자격이 없는 혜택 또는 비용 지급을 받기 위한 고의적인 의도.
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.
청각
심리는 귀하의 플랜이 이의 제기를 거부한 후 건강 프로그램에 사례 검토를 요청하는 것입니다.
I
소득
A gain or recurrent benefit measured in money.
입원 환자
의료 시설에 하룻밤 이상 입원하여 보장 서비스를 받고 있는 환자.
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.
메디케이드
A state health insurance program for people with low income who meet certain eligibility requirements. 프로그램은 주별로 다를 수 있습니다. For information on Washington’s Apple Health (Medicaid) programs, visit https://www.hca.wa.gov/apple-health
메디케어
A federal health insurance program for people who are 65 or older, people with disabilities, or those with end-stage kidney disease. 메디케어 자격 요건은 수입을 바탕으로 하지 않으며 기본 보상 범위는 주마다 동일합니다.
가입자
UnitedHealthcare 건강 플랜에 가입한 적격자.
O
외래 환자
의사 진료실이나 환자 자택, 병원 외래환자 또는 병원 응급실 또는 수술 센터와 같이 병원에서 멀리 떨어진 곳에서 보장 서비스를 받는 비입원 환자.
P
주치의 서비스 제공자(PCP)
귀하의 개인 의료 서비스 제공자. 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.
제공자
의료 서비스 전문가(의사, 간호사, 내과 전문의 등) 또는 시설(병원, 의원 등).
R
Recertification
가족의 소득 및 자격에 대한 정기적 검토. During recertification, you must submit current income and residency documentation to verify your eligibility and/or level of premium subsidy.
S
서비스 지역
The geographic area served by a health plan that provides coverage for Apple Health (Medicaid).
전문의(Specialist)
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 Apple Health (Medicaid) – Integrated Managed Care
Washington's integrated managed care Apple Health (Medicaid) program provides comprehensive free or low-cost health care and behavioral health services to adults, families, people with disabilities, children under 19, children in foster care and pregnant women who meet income requirements.
워싱턴 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.
