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Los hloov kho koj tus browser kom koj tuaj yeem txaus siab tau ntsib lub vev xaib uas ua hauj lwm tau nrawm dua thiab nyab xeeb dua.
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Kev taw qhia xub thawj
- Rau Cov Tswv Cuab (Qhib hauv phab tshiab)
STAR+PLUS Ntsiab Lus Tshab Txhais
A
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Kev thov kev ncaj ncees
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 Medical Condition
An illness, injury, symptom, or condition so serious that a reasonable person would seek care right away to avoid harm.
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Txoj kev siv tsheb thauj xa neeg mus los thaum muaj xwm txheej ceev
Ground or air ambulance services for an emergency medical condition.
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Emergency Room Care
Emergency services you get in an emergency room.
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Emergency Services
Evaluation of an emergency medical condition and treatment to keep the condition from getting worse.
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Excluded Services
Health care services that your health insurance or plan doesn’t pay for or cover.
G
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Kev tsis txaus siab
A complaint to your health insurer or plan.
H
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Habilitation Services and Devices
Health care services such as physical or occupational therapy that help a person keep, learn, or improve skills and functioning for daily living.
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Health Insurance
A contract that requires your health insurer to pay your covered health care costs in exchange for a premium.
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Kev saib xyuas kho mob rau fab kev noj qab haus huv nyob rau tom vaj tom tsev
Health care services a person receives in a home.
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Hospice Services
Services to provide comfort and support for persons in the last stages of a terminal illness and their families.
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Hospital Outpatient Care
Care in a hospital that usually doesn’t require an overnight stay.
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Kev kho mob hauv tsev kho mob
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
- Cov ntawv sau qhia yuav tshuaj
- Past medical bills
- Medical insurance charges
LUS CIM TSEG: The Medically Needy Program is not for people who qualify for any other Medicaid program.
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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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Tus Kws Muab Kev Pab Kho Mob Uas Koom Rau Hauv
A Provider who has a contract with your health insurer or plan to provide covered services to you.
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Kws kho mob cov kev pab
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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Plan
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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Nyiaj Them (Premium)
The amount that must be paid for your health insurance or plan.
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Kev Pab Them Nqi Tshuaj Raws Li Kws Kho Mob Sau Ntawv Yuav
Health insurance or plan that helps pay for prescription drugs and medications.
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Cov tshuaj kws kho mob sau ntawv yuav
Drugs and medications that by law require a prescription.
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Primary Care Physician
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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TUS KWS KHO MOB XUB THAWJ
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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Kws Pab Kho Mob
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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Kev txawj tu neeg mob
Services from licensed nurses in your own home or in a nursing home.
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Kws Kho Mob Tshwj Xeeb
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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Kev Kho Mob Sai
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.
Kawm ntxiv
STAR+PLUS
Cov Ntaub Ntawv Qhia Kev Tso Npe
The Texas STAR+PLUS plan specialists can answer questions.
Hu Rau Peb:
1-888-887-9003 / TTY: 711
8:00 AM txog 8:00 PM sij hawm hauv cheeb tsam, hnub Monday – Friday
Koj tau xaiv los tso npe rau hauv
Qhov phiaj xwm kho mob nod tam sim no tsis muaj nyob rau hauv tus ZIP code uas tau ntaus nkag mus.
Saib cov phiaj xwm kho mob nyob rau hauv tus ZIP Code no.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.
Get the details
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)
Cov Ntaub Ntawv Qhia Kev Tso Npe
The Texas STAR+PLUS plan specialists can answer questions.
Hu Rau Peb:
1-888-887-9003 / TTY: 711
8:00 AM txog 8:00 PM sij hawm hauv cheeb tsam, hnub Monday – Friday
Koj tau xaiv los tso npe rau hauv
Qhov phiaj xwm kho mob nod tam sim no tsis muaj nyob rau hauv tus ZIP code uas tau ntaus nkag mus.
Saib cov phiaj xwm kho mob nyob rau hauv tus ZIP Code no.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.
Get the details
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)
Cov ntaub ntawv tswv cuab
Koj tuaj yeem nkag mus rau peb lub vev xaib uas yog cov tswv cuab nkaus xwb. Luam koj daim npav ID thiab lwm yam. Saib peb phau ntawv qhia hauv qab no.
Member information is available in paper form, at no cost, upon request, and sent by the health plan within five business days.
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Tswv cuab phau ntawv qhia - Lus Askiv (Qhib mus rau sab window tshiab)
PDF 1.02MB - Tau Hloov Kho Tshiab Zaum Kawg Nkaus: 04/28/2023
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Member handbook - Español (Spanish) (Se abre en una ventana nueva)
PDF 1.06MB - Tau Hloov Kho Tshiab Zaum Kawg Nkaus: 04/28/2023
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State Fair Hearing Update - Lus Askiv and Español (Spanish) (Qhib mus rau sab window tshiab)
PDF 66.22KB - Tau Hloov Kho Tshiab Zaum Kawg Nkaus: 09/01/2023
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In-lieu of services handbook addendum - Lus Askiv and Español (Spanish) (Qhib mus rau sab window tshiab)
PDF 69.23KB - Tau Hloov Kho Tshiab Zaum Kawg Nkaus: 03/19/2024
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STAR+PLUS Nursing Facility Member handbook - Lus Askiv (Qhib mus rau sab window tshiab)
PDF 1.22MB - Tau Hloov Kho Tshiab Zaum Kawg Nkaus: 05/30/2023
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STAR+PLUS Nursing Facility Member handbook - Español (Spanish) (Se abre en una ventana nueva)
PDF 955.24KB - Tau Hloov Kho Tshiab Zaum Kawg Nkaus: 05/30/2023
Koj puas muaj lwm yam xav tau kev pab?
Peb muaj muab cov ntawv uas luam pom loj, ua suab mloog, thiab hom ntawv rau cov neeg dig muag (Braille). Hu rau peb hnub no yog hais tias koj xav tau cov ntaub ntawv ua ib hom txawv.
Cov ntaub ntawv tswv cuab
Koj tuaj yeem nkag mus rau peb lub vev xaib uas yog cov tswv cuab nkaus xwb. Luam koj daim npav ID thiab lwm yam. Saib peb phau ntawv qhia hauv qab no.
Member information is available in paper form, at no cost, upon request, and sent by the health plan within five business days.
-
Tswv cuab phau ntawv qhia - Lus Askiv (Qhib mus rau sab window tshiab)
PDF 1.02MB - Tau Hloov Kho Tshiab Zaum Kawg Nkaus: 04/28/2023
-
Member handbook - Español (Spanish) (Se abre en una ventana nueva)
PDF 1.06MB - Tau Hloov Kho Tshiab Zaum Kawg Nkaus: 04/28/2023
-
State Fair Hearing Update - Lus Askiv and Español (Spanish) (Qhib mus rau sab window tshiab)
PDF 66.22KB - Tau Hloov Kho Tshiab Zaum Kawg Nkaus: 09/01/2023
-
In-lieu of services handbook addendum - Lus Askiv and Español (Spanish) (Qhib mus rau sab window tshiab)
PDF 69.23KB - Tau Hloov Kho Tshiab Zaum Kawg Nkaus: 03/19/2024
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STAR+PLUS Nursing Facility Member handbook - Lus Askiv (Qhib mus rau sab window tshiab)
PDF 1.22MB - Tau Hloov Kho Tshiab Zaum Kawg Nkaus: 05/30/2023
-
STAR+PLUS Nursing Facility Member handbook - Español (Spanish) (Se abre en una ventana nueva)
PDF 955.24KB - Tau Hloov Kho Tshiab Zaum Kawg Nkaus: 05/30/2023
Koj puas muaj lwm yam xav tau kev pab?
Peb muaj muab cov ntawv uas luam pom loj, ua suab mloog, thiab hom ntawv rau cov neeg dig muag (Braille). Hu rau peb hnub no yog hais tias koj xav tau cov ntaub ntawv ua ib hom txawv.