U gudub tusmada ugu weyn
Tusmada Ugu Weyn

UnitedHealthcare Community Plan Erey-bixinta

A

  • Ku Xadgudubka Mukhaadaraadka

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

  • Racfaanka

    Codsiga rasmiga ah ee dib-u-eegista tallaabada marka aadan ku qanacsanayn go'aanka uu gaaray qorshaha caafimaadkaaga.

C

  • Lacagta ku soo aado caymis haystaha

    Boqollayada kharashka adeegga ay tahay inaad siiso bixiyaha adeeggaas.

  • Copayment

    Copayments (copays) are a dollar amount that you pay to the doctor at your visit.

D

  • Lacagta caymiska ee la jari karo

    The annual deductible is the total amount of money you must pay for some services that require coinsurance over the eligibility year.  You must pay the annual deductible before UnitedHealthcare will cover services that have coinsurance. 

E

  • Gurmadka

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

G

  • Cabashada

    Bayaankaaga ku qanacsanaan la'aanta qayb kasta oo ka mid ah daryeelkaaga. Cabashada waxaa lagu soo gudbin karaa telefoonka ama qoraal ahaan, waana in si toos ah loogu soo diraa qorshahaaga.

I

  • Immunization

    A shot that protects from a disease.

  • In-Network

    Doctors, specialists, hospitals, pharmacies and other providers who have an arrangement to provide health care services to members.

  • Income Band

    Identification of a group of members based on income and poverty level.

L

  • Living Will

    A document that tells 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, and whether or not to make special efforts to save your life.

M

  • Medically Necessary

    Services that are required to maintain your health and by not receiving those services, could affect your condition or quality of care.

  • Xubinta

    Qofka u qalma oo ka diiwaangashan Qorshaha Caafimaadka ee UnitedHealthcare.

O

  • Out-of-Network

    Doctors, specialists, hospitals, pharmacies and other providers who do not have an arrangement with your plan to provide health care services.

P

  • Carbuunta caymiska

    A monthly fee that you pay to stay enrolled in UnitedHealthcare.

  • Prescription

    A doctor's written instructions for medication or treatment.

  • Bixiyaha Daryeelka Aasaasiga ah (PCP)

    The doctor who treats you for all normal health care needs. Your PCP may refer you to a specialist or admit you to a hospital. PCPs are usually family practitioners, internists, pediatricians, and sometimes nurse practitioners and physician's assistants, and can include Obstetricians and certified nurse midwives for pregnant members.

  • Prior Authorization

    The process of reviewing a request for services to make sure it is a necessary service or plan of treatment and providing approval for those services before you receive them.

  • Bixiyaha

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

R

  • Gudbin

    Process when your primary care provider requests additional care for you from a specialist.

S

  • Second Medical Opinion

    A review of a medical condition that is done by another doctor.

  • Takhasuslaha

    Any doctor who has special training for a specific condition or illness.

Ku laabo qaybta sare bogga

Wax badan ogow


New York State sponsored health insurance programs.
(ku dhex wad bogoskan si aad u aragto)

To learn more about applying for health insurance, including Medicaid, Child Health Plus, Essential Plan, and Qualified Health Plans through NY State of Health, The Official Health Plan Marketplace, visit nystateofhealth.ny.gov or call 1-855-355-5777. To find out if you qualify for Medicaid Managed Care or Child Health Plus offered by UnitedHealthcare Community Plan, please call 1-888-617-8979. UnitedHealthcare does not discriminate on the basis of race, color, national origin, sex, age or disability in health programs and activities. We provide free services to help you communicate with us. Such as, letters in other languages or large print. Or, you can ask for an interpreter. To ask for help, please call Member Services at 1-800-493-4647, TTY 711, 8 sn. – 6 gn., Monday – Friday ATTENTION: Language assistance services, free of charge, are available to you. Call 1-800-493-4647, TTY 711. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-493-4647, TTY 711. 注意：您可以免費獲得語言援助服務。請致電 1-800-493-4647, TTY 711 ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-800-493-4647 (телетайп: TTY 711).

Cusbooneysintii Ugu Dambeysay: 04.18.2024 at 12:11 sn. CDT

Macluumaadka afeefta
(ku dhex wad bogoskan si aad u aragto)

Ma waxaad raadinaysaa mareegta dawladda dhexe ee Medicaid? Halkan ka eeg Medicaid.gov.

UnitedHealthcare Dual Complete Plans

Qorsheyaasha waxaa la doolaa iyadoo loo sii marayo Shirkadda Caymiska UnitedHealthcare ama mid ka mid ah shirkadaheeda xiriirka la leh, Hay'adda Medicare Advantage ee haysata qandaraaska Medicare iyo qandaraaska kula jirto Barnaamijka Medicaid ee Gobolka. Iska diiwaangelinta qorshaha waxay ku xiran tahay heshiiska cusboonaysiinta qorshaha ee Medicare. Qorshahan waxaa heli kara qof kasta oo haysta Medical Assistance ee laga helo Gobolka iyo Medicare. Dheefaha, qaybaha iyo/ama aaladuhu waxay ku kala duwan yihiin qorshe/aagga. Xaddidaadyada, ka-dhaafitaanada iyo/ama xannibaadyada shabakadeed ayaa laga yaabaa in lagu soo dabaqo. Macaashyada, khidmadaha iyo/ama kharashka la wada bixiyo/qaybsiga caymiska ayaa laga yaabaa inay isbeddelaan markay tahay 1-da Janaayo ee sannad kasta.

Khidmadda afeefta billaha ah

Qorshayaasha Dual Special Needs waxay leeyihiin $0 khidmado bille ah oo loogu talagalay xubnaha haysta Caawimaada Dheeraadka ah (Kabka Dadka Dakhligoodu Hooseeyo).

Dheefaha afeefta

Dheefaha, sifooyinka, iyo/ama aaladaha way ku kala duwan yihiin qorshe/aag ahaan. Xaddidaadyada, ka-dhaafitaanada iyo/ama xannibaadyada shabakadeed ayaa laga yaabaa in lagu soo dabaqo.

Afeefta Khadka-furan ee Kalkaalisada

Adeegani waa inaan loo isticmaalin baahiyada gurmadka ama daryeelka ee degdegga ah. Marka ay jirto xaalad degdega ah, wac 911 ama tag qolka gurmadka ee kuugu dhow. Macluumaadka lagu bixiyay adeegan waxaa laga leeyahay ujeedooyin waxbixin oo keliya. Kalkaaliyeyaashu ma sheegi karaan dhibaatooyinka ama kuma talin karaan daaweyn mana u noqon karaan beddel daryeelka daryeel bixiyahaaga. Macluumaadkaaga caafimaad waxaa loo keydiyaa si qarsoodi ah oo waafaqsan sharciga. Adeeggu maaha barnaamij caymis waxaana laga yaabaa in la joojiyo wakhti kasta. Khadka Taleefanka ee Kalkaalisada looma isticmaalo xaaladaha degdegga ah, ujeeddooyin macluumaad oo keliya ayaa loo isticmaalaa.

UnitedHealthcare Connected® ee MyCare Ohio (Medicare-Medicaid Plan)

UnitedHealthcare Connected® ee MyCare Ohio (Medicare-Medicaid Plan) waa qorshe caafimaad oo kunturaad la leh labadaba Medicare iyo Medicaid Ohio si ay u siiso macaashyada labada barnaamij dadka ka diiwaangashan. 

UnitedHealthcare Connected® (Medicare-Medicaid Plan)

UnitedHealthcare Connected® UnitedHealthcare Connected® (Medicare-Medicaid Plan) waa qorshe caafimaad oo kunturaad la leh labadaba Medicare iyo Texas Medicaid si uu u siiyo dheefaha labada barnaamij dadka ka diiwaangashan.

UnitedHealthcare Connected® oo loogu tala galay One Care (Qorshaha Medicaid - Medicare)

UnitedHealthcare Connected® oo loogu talagalay One Care (Medicare-Medicaid Plan) waa qorshe caafimaad oo kunturaad la leh labadaba Medicare iyo MassHealth (Medicaid) si ay u siiso dheefaha labada barnaamij dadka ka diiwaangashan. 

Afeefta dheefaha guud UnitedHealthcare Connected®

Kani ma ahan liis dhammeystiran. Macluumaadka macaashka waa qoraal kooban, ma ahan sharraxaadda dhammeystiran ee macaashyada. Wixii macluumaad intaas ka badan la xiriira qorshaha mise akhri Buug-gacmeedka Xubinta. Xaddidaado, wada-bixinno, iyo xannibaado ayaa lagu dabaqi karaa. Wixii macluumad dheeraad ah, wac Adeegyada Xubnaha ee ku xiran UnitedHealthcare ama aqri Buugyaraha Xubnaha ee UnitedHealthcare Connected®. 

UnitedHealthcare Senior Care Options (HMO SNP) Plan

Dookhyada Daryeelka Waayeeladda ee UnitedHealthcare (SCO) waa qorshaha Daryeelka Isku Dubaridan ee la leh qandaraas Medicare iyo qandaraas kula jira barnaamijka Common Wealth Massachusetts of Medicaid. Iska diiwaangelinta qorshaha waxay ku xiran tahay heshiiska cusboonaysiinta qorshaha ee Medicare. Qorshahan waa barnaamij isxilqaan ah uu heli karo qof kasta oo jira 65 iyo ka weyn oo u-qalma MassHealth Standard iyo Original Medicare oo aan lahayn caymis caafimaad ee kale ee dhamaystiran, marka laga reebo Medicare. Haddii aad leedahay MassHealth Standard, balse aadan u-qalmin Original Medicare, waxaa laga yaabaa inaad weli u-qalanto inaad iska diiwaangeliso qorshaheena MassHealth Senior Care Option oo aad hesho macaashyadaada MassHealth oo dhan adoo u maraya barnaamijkeena Dookhyada Daryeelka Waayeeladda ee UnitedHealthcare (SCO).

Afeefta qiimeynta xidigeed

Sannad kasta, Medicare waxay qiimaysaa qorsheyaasha iyadoo ku salaysa nidaamka qiimeynta 5-ta Xiddig. Qiimeynta 5-ta Xiddig waxay khuseysaa qorshaha sannadka 2024.

Macluumaadka bixiyaha ee muhiimka ah

Go'aanka Adigaa Leh.

Waxaan ku siin doonaa macluumaad kaa caawin doona inaad gaarto go'aano wargal ah, sida aqoonsashada dhakhaatiirta iyo xirfadleyaasha daryeelka caafimaadka. Macluumaadkan, si kastaba ha ahaatee, ma ahan mid ayidaya dhakhtar gaar ah ama xirfadlaha daryeelka caafimaadka ee ku habboon baahidaada.

Bixiyeyaasha la heli karo iyadoo loo marayo codsigan ma ahan inay xaqiiqdii uga turjumayaan si buuxda shabakada UnitedHealthcare ee bixiyeyaasha qandaraaska lagula jiro. Waxaa laga yaabaa inay jiraan bixiyeyaal ama takhasusleyaal gaar ah oo aan lagu darin codsigan oo qayb ka ah shabakadeena. Haddii aadan helin bixiyaha aad raadinayso, waxaad si toos ah ula xiriiri kartaa bixiyaha si aad u xaqiijiso xaaladda kaqaybgalka ee shabakadda UnitedHealthcare, ama kala xiriir Mamber Services lambarka bilaashka ah ee ku qoran kaarkaaga aqoonsiga UnitedHealthcare. Waxaan sidoo kale kugula talineynaa, kahor inta aadan la kulmin dhakhtar kasta, oo ay ku jiraan takhasusleyaal kasta, inaad wacdo xafiiska dhakhtarka si aad u xaqiijiso xaaladda kaqaybgalka iyo helitaanka.

Qaar kamid ah shabakadda bixiyeyaasha ayaa laga yaabaa in lagu daray ama laga saaray shabakadeena kadib markii diiwaankan la cusbooneysiiyay. Ma dammaanad qaadi karno in bixiye kasta weli aqbalayo xubno cusub.

Bixiyeyaasha shabakadda ka baxsan/kuwa aan qandaraaska lahayn kuma khasbana inay daaweeyaan xubnaha kujira qorshaha UnitedHealthcare, marka laga reebo xaaladaha gurmadka dagdagga ah. Fadlan soo wac lambarkeena adeegga macmiilka ama ka eeg Caddayntaada Caymis wixii macluumaad dheeraad ah, oo ay ku jiraan kharash wadaagga khuseeya adeegyada shabakadda ka baxsan.

Ogeysiiska Xeerka Naafada Mareykanka

Sida waafaqsan shuruudaha Xeerka Naafada ee Dawladda Dhexe Maraykanka 1990 iyo Qeybta 504 Xeerka Baxnaaninta 1973 ("ADA"), Shirkadda Caymiska UnitedHealthcare waxay bixisa adeegyada la daboolay oo buuxa oo loo siman yahay mana takooraan shakhsiyaadka u-qalma ee naafada ah iyadoo lagu salaynayo naafanimada markay bixinayaan adeegyadooda, barnaamijyadooda, ama waxqabadooda.

Gudbinta

Bixiyeyaasha shabakadda ayaa idin ka caawin doona adiga iyo xubnaha qoyskaaga ee caymiska leh inaad heshaan daryeelka aad u baahan tihiin. Helitaanka dhakhaatiirta takhasuska leh waxaa isku dubaridi kara dhakhtarkaaga daryeelka aasaasiga ah.

Codsiyada diiwaanka waraaqaha

Nuqullada warqadaha ee ku jira diiwaanka bixiyaha shabakadda waxay ku heli karaan xubnaha si bilaash ah iyagoo wacaya lambarka adeegga macmiilka ee ku yaala gadaasha kaarka aqoonsiga. Dadka aan xubinta ka ahayn waxay natiijooyinka ka soo dejisan karaan oo ka daabacan karaan diiwaanka onlaynka ah.

Macluumaadka khaldan

Si aad uga warbixiso xogta khaldan, u dir iimayl provider_directory_invalid_issues@uhc.com. Bogoskan iimaylka waxaa loogu talagalay xubnaha si ay uga warbixiyaan khaladaadka suurtagalka ah ee macluumaadka qofka (cinwaanka, telefoonka, iwm.) ee ku jira hagaha diiwaanka onlaynka ah ama waraaqaha. Ka warbixinta arrimaha iyadoo loo marayo bogoskan boostada waxay keeni doontaa in la gaaro xafiiska bixiyaha si loo xaqiijiyo dhammaan xogta dadka ee ku jira diiwaanka, taasoo qaadan karta qiyaastii 30 maalmood. Shakhsiyaadka sidoo kale waxay soo sheegi karaan khaladaadka suurtagalka ah iyagoo adeegsanaya telefoonka. Xubnaha UnitedHealthcare waa inay wacaan lambarka ku yaalla dhabarka dambe ee kaarkooda aqoonsiga, halka dadka aan xubinta ka ahayn UnitedHealthcare ay soo wici karaan 1-888-638-6613 TTY 711, ama waxay isticmaali karaan adeegga gudbinta ee ay doorbidayaan.

Ku Dhawaaqida Masiibo ama Xaalad Dagdag ah

Haddii ay ku saamayso ku dhawaaqida musiibo ama xaalad dagdag ah ee Madaxweynaha ama Gobarnatooraha, ama ogeysiiska xaalad caafimaadka dadweynaha ee dagdaga ah oo uu ku dhawaaqay Xoghayaha Caafimaadka iyo Adeegyada Aadanaha, waxa jira taageero dheeraad ah oo gaar ah oo adiga diyaar kuu ah.

  • Qaybta A, Qaybta B, iyo dheefaha qorshaha Qaybta C ee dheeraadka ah waa in lagu bixiyaa xarumo aan kunturaad lahayn oo gaar ah (ogsoonoow in dheefaha Qaybta A iyo Qaybta B ay tahay in laga helo xarumaha shahaadaysan ee Medicare);
  • Meeshii ay ku habboon tahay, shuruudaha loogu talagalay gudbinta albaab-ilaaliyaha si buuxda ayaa looga dhaafay;
  • Wadaagista kharashka shabakada ka baxsan ee qorshaha la ansixiyay ilaa qadarada wadaagista kharashka shabakada ayaa si ku meelgaar ah loo dhimay; iyo
  • Shuruudaha oggeysiiska ee 30-ka maalin ah ee ku aadan xubnaha waa la dhaafay, ilaa inta dhammaan isbeddellada dheefta (sida dhimista wadaagista kharashka iyo oggolaanshaha ka dhaafitaanka) ee xubinta.

Haddii CMS aysan bixin taariikhda dhammaadka ee loogu talagalay musiibada ama xaaladda degdegga ah, qorshooyinka ayaa dib u bilaabi doona maalmaha 30 shaqada ee caadiga ah ka dib ku dhawaaqista hore.

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