Apèl

Yon demann pou yon odyans san patipri konsènan yon aksyon ajans lan pwopoze, yon aksyon ajans lan fè, oswa si ajans lan pa pran yon desizyon atan.

Aplikasyon

Yon demann ofisyèl pou avantaj yo te fè bay ajans lan alekri epi kandida oswa yon moun k ap aji nan non kandida a siyen li. Yo ka resevwa aplikasyon yo pa lapòs, nan telefòn, faks, an pèsòn, oswa elektwonikman.

Behavioral Health Services Only

This term means those who receive only Behavioral Health benefits based on income requirements.

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.

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.

Depandan

An individual who is the financial responsibility of a member of the income unit. Example: This is someone who could be counted as a tax dependent, if income tax is filed.

Fòmilè Medikaman

A list of approved prescription drugs developed the health plan.

Ijans

Kòmansman dijans ak grav toudenkou pou yon sentòm oswa plizyè sentòm, sa gen ladan doulè grav, ki ta fè yon pwofàn pridan k ap aji yon fason rezonab kwè ke gen yon pwoblèm sante ki egziste ki mande swen medikal imedyatman, si yo pa bay swen medikal yo, sa t ap lakòz defisyans grav nan fonksyon kòporèl oswa malfonksyònman grav nan yon ògàn oswa yon pati nan kò, oswa ta mete sante moun lan nan danje grav.

Fwòd

Entansyon volontè pou jwenn avantaj oswa peman ki pa kalifye.

Good Cause

An acceptable reason to defer the requirement to cooperate for certain eligibility factors.

Health Care Authority (HCA)

The state agency responsible for administering Washington Apple Health (Medicaid) and other state health programs.

Odisyon (zòrèy)

Yon odyans se lè ou mande pwogram sante ou an revize ka ou an apre plan ou an te refize apèl ou an.

Revni

A gain or recurrent benefit measured in money.

Pasyan entène

Yon pasyan yo admèt pou yon nwit oswa yon sejou ki pi long nan yon etablisman swen sante epi k ap resevwa sèvis ki kouvri.

Legal Guardian

A person who has been granted custody of a minor by court order.

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.

Medicaid

A state health insurance program for people with low income who meet certain eligibility requirements. Pwogram yo kapab pa menm selon eta a. For information on Washington’s Apple Health (Medicaid) programs, visit https://www.hca.wa.gov/apple-health

Medicare

A federal health insurance program for people who are 65 or older, people with disabilities, or those with end-stage kidney disease. Kalifikasyon pou Medicare pa baze sou revni, epi pwoteksyon debaz la se menm nan chak eta.

Manm

Yon moun ki kalifye ki enskri nan Plan Sante UnitedHealthcare.

Pasyan ekstèn

Yon pasyan ki pa entène lopital k ap resevwa sèvis ki kouvri yo lwen yon lopital, pa egzanp nan yon kabinè doktè oswa nan pwòp kay pasyan an, oswa nan yon lopital pasyan ekstèn oswa sèvis dijans lopital oswa sant chirijikal.

Founisè swen prensipal (PCP, Primary Care Provider)

Founisè swen sante pèsonèl ou. 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.

Founisè

Yon pwofesyonèl swen sante (tankou yon doktè, enfimye/enfimyè, entènis, elatriye) oswa yon etablisman (tankou yon lopital, klinik, elatriye).

Recertification

Revizyon peryodik sou revni ak kalifikasyon fanmi ou. During recertification, you must submit current income and residency documentation to verify your eligibility and/or level of premium subsidy.

Zòn Sèvis

The geographic area served by a health plan that provides coverage for Apple Health (Medicaid).

Espesyalis

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.

Third Party

An individual, institution, corporation or agency that is responsible for all or part of the medical costs for Medicaid.

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 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.