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Developmental Disabilities Program Glossary

A

  • Abuse

    Causing harm to a person on purpose. This includes yelling, ignoring a person's need, hurting or inappropriate touching.

  • Appeal

    A formal complaint made where a member is not satisfied with a decision made by UnitedHealthcare Community Plan.

  • Arizona Health Care Cost Containment System (AHCCCS)

    The state agency that manages health care programs and covered health care services provided through contracted health plans.

  • Arizona Long Term Care System (ALTCS)

    An AHCCCS program that delivers long term care to members. Members under ALTCS can be elderly, have physical disabilities or developmental disabilities.

B

  • Behavioral Health Crisis

    A situation where, without immediate help, you might hurt yourself or someone else.

  • Behavioral Health Services

    Behavioral health services may include behavior management, group, family and individual therapy and counseling, and emergency/crisis services.

C

  • Co-payment

    A small charge or fee due at the time covered services are provided.

D

  • DD

    Developmental Disabilities

  • DDD

    Division of Developmental Disabilities

  • Department of Economic Security (DES)

    The state agency that determines if a person is eligible for Medicaid.

E

  • Early and Periodic Screening, Diagnostic and Treatment (EPSDT)

    A health care program for children up to age 21.

  • Emergency

    A situation where a person's health, or the health of an unborn baby, could be threatened. Medical help is needed right away.

F

  • Fraud

    Lying in order to receive AHCCCS benefits. This including lying about personal information to qualify for AHCCCS benefits. Doctors may commit fraud by lying about services provided and then sending AHCCCS a bill.

G

  • Grievance

    A member's expression of dissatisfaction with any part of their care. A grievance can be filed over the phone or in writing. Grievances must be filed directly with UnitedHealthcare Community Plan, not AHCCCS.

H

  • Health Information

    Facts about a member's health care. This information may be received or created by UnitedHealthcare Community Plan or a provider. It includes information about a member's physical and mental health, as well as payments for health care.

  • Health Insurance Flexibility and Accountability Act (HIFA)

    Offers health care coverage to families with and without children who do not qualify for Medicaid.

  • Healthcare Power of Attorney

    Someone to whom you have given the authority to make health care decisions for you if you cannot make them (usually a close friend, relative or spouse).

  • High-risk pregnancy

    A pregnancy for which the mother or baby may be at higher risk for illness or death.

K

  • KidsCare

    AHCCCS program that provides health care coverage to children under age 19. KidsCare is for children who do not have health insurance and would not qualify for Medicaid.

L

  • Licensed midwife

    A person licensed by the Arizona Department of Health Services to provide maternity care. This does not include certified nurse midwives.

  • Living Will

    A document where you write what you want done with your health care. The doctor uses this if you are not able to express what you want. It lists specific treatments you do or do not want. It can also tell your doctor whether or not to make special efforts to save your life.

M

  • Mammogram

    Screening exam for breast cancer. Recommended for women over the age of 35.

  • Managed Care

    A health plan that works like an HMO. Covered services are provided by providers who contract with the health plan.

  • Maternity care

    Includes medically necessary pregnancy counseling, pregnancy testing, prenatal care, labor and delivery services, as well as care after delivery.

  • Maternity care coordination

    Coordination of the mother's needs to ensure her and her baby receive all the necessary care for a healthy pregnancy and delivery.

  • Medical Necessity

    Health care or products that a prudent, or wise, doctor would give to a patient to prevent, diagnose, or treat an illness, injury, disease or its symptoms in a way that follows generally accepted standards for medicine and is not just for the convenience of the patient, physician or other health care provider.

  • Member

    An eligible person enrolled in AHCCCS who has selected UnitedHealthcare Community Plan as their health plan.

P

  • Postpartum care

    Health care provided to the mother for up to 60 days after delivery.

  • Practitioner

    Refers to a certified nurse practitioner, midwife, or physician assistant.

  • Preconception counseling

    This counseling focuses on finding and managing risk factors before pregnancy. The purpose is to make sure that a woman is healthy before pregnancy.

  • Prenatal care

    Health care provided during the pregnancy.

  • Prescription

    A doctor's written instructions for medication or treatment.

  • Primary Care Physician (PCP)

    The doctor who treats the member directly. The PCP may refer the member to a specialist or admit the member to a hospital. PCPs are usually family practitioners, internists, pediatricians, and sometimes nurse practitioners and physicians assistants, but may also include obstetricians and certified nurse midwives for pregnant members.

  • Prior Authorization

    Process by which your PCP or specialist contacts UnitedHealthcare Community Plan for approval to provide special services such as surgery.

  • Provider

    A person or facility that provides health care services and treatment such as a doctor, pharmacy, dentist, clinic or hospital.

  • Provider Network

    Doctors, specialists, hospitals, pharmacies and other providers who work with UnitedHealthcare Community Plan to provide health care services to UnitedHealthcare Community Plan members.

R

  • Referral

    Process by which your PCP requests additional care for you from a specialist.

  • Regional Behavioral Health Authority (RBHA)

    Place where you go for behavioral health services.

S

  • Seriously Mentally Ill (SMI)

    Any person who, as a result of a serious mental disorder, has emotions or behaviors that prevent them from performing everyday activities.

  • Service Area

    A geographic area, usually one or two adjoining counties, where UnitedHealthcare Community Plan has a contract with AHCCCS to arrange covered health care services to members enrolled with UnitedHealthcare Community Plan.

  • Sixth Omnibus Budget Reconciliation Act (SOBRA)

    An eligibility category for pregnant women and children of certain ages. Eligibility is based on different Federal Poverty Income Levels. If you are pregnant, contact DES to see if you are eligible. Contact your DES Case Worker to help determine if any of your children are eligible.

  • Special Health Care Needs

    Members who have serious and chronic physical, developmental or behavioral conditions who require a special type or amount of care.

  • Specialist

    Any doctor who has special training for a specific condition or illness. UnitedHealthcare Community Plan: The AHCCCS health plan you are enrolled with to help provide the medically necessary health care treatment and services you need.

U

  • Urgent Care

    Care provided to members when their situation is not life threatening, but cannot wait until the next day for treatment.

W

  • Women, Infants and Children (WIC)

    A community program that provides food, nutrition counseling and access to health services to low income women, infants and children.

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Individual & Family ACA Marketplace Plans Disclaimer
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The benefits described may not be offered in all plans or in all states. Some plans may require copayments, deductibles and/or coinsurance for these benefits. This policy has exclusions, limitations, reductions of benefits, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, review your plan documents, call or write your insurance agent or the company, whichever is applicable. Plan specifics and benefits vary by coverage area and by plan category. Please review plan details to learn more.

UnitedHealthcare Individual & Family plans medical plan coverage offered by: UnitedHealthcare of Arizona, Inc.; Rocky Mountain Health Maintenance Organization Incorporated in CO; UnitedHealthcare of Florida, Inc.; UnitedHealthcare of Georgia, Inc; UnitedHealthcare of Illinois, Inc.; UnitedHealthcare Insurance Company in AL, KS, LA, MO, NJ, and TN; Optimum Choice, Inc. in MD and VA; UnitedHealthcare Community Plan, Inc. in MI; UnitedHealthcare of Mississippi, Inc.; UnitedHealthcare of New Mexico, Inc.; UnitedHealthcare of North Carolina, Inc.; UnitedHealthcare of Ohio, Inc.; UnitedHealthcare of Oklahoma, Inc.; UnitedHealthcare of South Carolina, Inc.; UnitedHealthcare of Texas, Inc.; UnitedHealthcare of Oregon, Inc. in WA; and UnitedHealthcare of Wisconsin, Inc.  Administrative services provided by United HealthCare Services, Inc. or its affiliates.

This policy has exclusions, limitations, reduction of benefits, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, call or write your insurance agent or the company, whichever is applicable. By responding to this offer, you agree that a representative may contact you.

1 Unless otherwise required, benefits are available only when services are delivered through a Designated Virtual Network Provider. Virtual visits are not intended to address emergency or life-threatening medical conditions and should not be used in those circumstances. Services may not be available at all times, or in all locations, or for all members. Check your benefit plan to determine if these services are available. Data rates may apply. Certain prescriptions may not be available and other restrictions may apply.

2 Tier 2 prescriptions for $5 or less not available on all medications. 3-month fills apply to select maintenance medications only. Applicable formulary requirements such as prior authorization and quantity limits may apply to your pharmacy benefits. Walgreens discount valid until 12/31/24. Discount valid only for in-store purchases of eligible Walgreens brand health and wellness products by current members eligible for the UnitedHealthcare discount program. Discount cannot be used online. For a full list of Walgreens brand health and wellness products and exclusions, please visit www.walgreens.com/smartsavings.

Last Updated: 09.19.2024 at 11:35 PM CDT

Disclaimer information
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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. Benefits, features and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

Premium disclaimer

Dual Special Needs plans have a $0 premium for members with Extra Help (Low Income Subsidy).

Benefit disclaimer

Benefits, features, and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply.

Nurse Hotline 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 provider'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. Nurse Hotline not for use in emergencies, for informational purposes only.

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. 

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® for One Care (Medicare-Medicaid plan)

UnitedHealthcare Connected® for One Care (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and MassHealth (Medicaid) to provide benefits of both programs to enrollees. 

UnitedHealthcare Connected® general 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. 

UnitedHealthcare Senior Care Options (HMO SNP) plan

UnitedHealthcare Senior Care Options (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 and does not have any other comprehensive health Insurance, except 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 Senior Care Options (SCO) program.

Star ratings disclaimer

Every year, Medicare evaluates plans based on a 5-Star rating system. The 5-Star rating applies to plan year 2024.

Important provider information

The choice is yours

We will provide you with information to help you make informed choices, such as physicians' and health care professionals' credentials. This information, however, is not an endorsement of a particular physician or health care professional's suitability for your needs.

The providers available through this application may not necessarily reflect the full extent of UnitedHealthcare's network of contracted providers. There may be providers or certain specialties that are not included in this application that are part of our network. If you don't find the provider you are searching for, you may contact the provider directly to verify participation status with UnitedHealthcare's network, or contact Customer Care at the toll-free number shown on your UnitedHealthcare ID card. We also recommend that, prior to seeing any physician, including any specialists, you call the physician's office to verify their participation status and availability.

Some network providers may have been added or removed from our network after this directory was updated. We do not guarantee that each provider is still accepting new members.

Out-of-network/non-contracted providers are under no obligation to treat UnitedHealthcare plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost- sharing that applies to out-of-network services.

American Disabilities Act notice

In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 ("ADA"), UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

Referrals

Network providers help you and your covered family members get the care needed. Access to specialists may be coordinated by your primary care physician.

Paper directory requests

Paper copies of the network provider directory are available at no cost to members by calling the customer service number on the back of your ID card. Non-members may download and print search results from the online directory.

Inaccurate information

To report incorrect information, email provider_directory_invalid_issues@uhc.com. This email box is for members to report potential inaccuracies for demographic (address, phone, etc.) information in the online or paper directories. Reporting issues via this mail box will result in an outreach to the provider’s office to verify all directory demographic data, which can take approximately 30 days. Individuals can also report potential inaccuracies via phone. UnitedHealthcare Members should call the number on the back of their ID card, and non-UnitedHealthcare members can call 1-888-638-6613 / TTY 711, or use your preferred relay service.

Declaration of disaster or emergency

If you’re affected by a disaster or emergency declaration by the President or a governor, or an announcement of a public health emergency by the Secretary of Health and Human Services, there is certain additional support available to you.

  • Part A, Part B, and supplemental Part C plan benefits are to be provided at specified non-contracted facilities (note that Part A and Part B benefits must be obtained at Medicare certified facilities);
  • Where applicable, requirements for gatekeeper referrals are waived in full;
  • Plan-approved out-of-network cost-sharing to network cost-sharing amounts are temporarily reduced; and
  • The 30-day notification requirement to members is waived, as long as all the changes (such as reduction of cost-sharing and waiving authorization) benefit the member.

If CMS hasn’t provided an end date for the disaster or emergency, plans will resume normal operation 30 days after the initial declaration.