U gudub tusmada ugu weyn
Tusmada Ugu Weyn

UnitedHealthcare Connected® (Medicare-Medicaid Plan) Glossary

M

  • Medicaid

    A program that offers health care services to persons who have limited income, are pregnant, and/or persons with disabilities.

  • 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
    • Rijeetooyinka
    • Past medical bills
    • Medical insurance charges

    XUSUUSIN: The Medically Needy Program is not for people who qualify for any other Medicaid program.

  • Medicare

    A health insurance program paid for by the federal government, not by the state.

S

  • SSI

    Supplemental Security Income.

Ku laabo qaybta sare bogga

Macluumaadka diiwaangelinta

The UnitedHealthcare Connected®  (Medicare-Medicaid Plan) plan specialists can answer questions and help you enroll.

Naga soo wac:
1-844-972-4514 / TTY: 711

8 sn.–8 gn. local time, Monday–Friday (voicemail available 24 hours a day, 7 days a week)

Tallaabooyinka Isdiiwaangelinta

Macluumaadka Xubinta

Horay ma u ahayd xubin? Waxaad geli kartaa mareegtayada xubinta loogu talagalay. Print ID cards, chat with a nurse online, and more.

Member information is available in paper form, at no cost, upon request, and sent by the health plan within five business days.

Mareegta Xubinta

2024 Member Handbooks


TX UnitedHealthcare Connected® (Medicare-Medicaid Plan)
(ku dhex wad bogoskan si aad u aragto)

ATTENTION: If you speak an alternative language, language assistance services, free of charge, are available to you. Call the Member Engagement Center 1-800-256-6533 (TTY 711) , 8 sn. - 8 gn., local time, 7 days a week. Wicitaanka waa bilaash.

ATENCIÓN: Si habla español, tiene a su disposición servicios de asistencia gratuitos en su idioma. Llame al Centro de participación de miembros/a Servicio al Cliente al 1-800-256-6533 (TTY 711), de 8 sn. a 8 gn., hora local, los 7 días de la semana. La llamada es gratuita.

ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele Sant Angajman Manm/Sèvis Manm nan 1-800-256-6533 (TTY 711), 8 sn. - 8 gn., lè lokal, 7 jou sou sèt. Apèl la gratis.

សម្គាល់៖ ប្រសិនបើលោកអ្នកនិយាយភាសាខ្មែរ លោកអ្នកអាចរកបានសេវាកម្មជំនួយផ្នែកភាសាដោយឥតគិតថ្លៃបាន។

ទូរសព្ទទៅមជ្ឈមណ្ឌលចូលរួមជាមួយសមាជិក/សេវាកម្មសមាជិក  1-800-256-6533 (TTY 711), 8 ព្រឹក - 8 យប់ ម៉ោងក្នុងមូលដ្ឋាន 7 ថ្ងៃក្នុងមួយសប្ដាហ៍។ ការហៅទូរស័ព្ទគឺឥតគិតថ្ល។]

ເຊີນຊາບ: ຖ້າທ່ານເວົ້າ ພາສາລາວ, ພວກເຮົາມີບໍລິການຊ່ວຍເຫຼືອດ້ານພາສາໂດຍບໍ່ຕ້ອງເສຍຄ່າໃດໆໃຫ້ແກ່ທ່ານ. ໂທຫາສູນຕິດຕໍ່ພົວພັນສະມາຊິກ/ຝ່າຍບໍລິການສະມາຊິກ 1-800-256-6533 (TTY 711), 8 ໂມງເຊົ້າ - 8 ໂມງແລງ, ຕາມເວລາທ້ອງຖິ່ນ, 7 ວັນຕໍ່ອາທິດ. ການໂທແມ່ນບໍ່ເສຍຄ່າ.

ATENÇÃO: Se fala português, é-lhe disponibilizado um serviço gratuito de assistência linguística. Telefone para o Centro de Conexão dos Associados/Serviços de Atendimento a Associados 1-800-256-6533 (TTY 711), 8h00 - 20h00, hora local, 7 dias por semana. A chamada é gratuita.

ВНИМАНИЕ! Если Вы говорите по-русски, можете бесплатно воспользоваться помощью переводчика. Звоните в центр взаимодействия с участниками/отдел обслуживания участников по номеру телефона 1-800-256-6533 (TTY 711), 8:00 - 20:00 по местному времени, без праздничных и выходных. Звонок бесплатный.

LƯU Ý: Nếu quý vị nói tiếng Việt, chúng tôi có dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho quý vị. Xin gọi cho Trung tâm Tham gia Hội viên/Dịch vụ Hội viên 1-800-256-6533 (TTY 711), 8 sn. - 8 gn., giờ địa phương, 7 ngày trong tuần. Cuộc gọi này là miễn phí.][注意：如果您说中文，您可以获得免费语言帮助服务。致电会员服务中心/会员服务 1-800-256-6533 (TTY 7-1-1)，听障专线当地时间<上午 8 点 - 晚上 8 点>，每周 <7> 天。该通话是免费的。

Suurtagalnimada in Lajoojiyo Qandaraaska

Sida loo soo afjaro xubinimada qorshaheena

If you decide to end your membership, tell Texas Medicaid or Medicare that you want to leave UnitedHealthcare Connected®:

•Call MAXIMUS at 1-877-782-6440, 8 sn. – 6 gn. local time, Monday – Friday. TTY/TDD users should call 7-1-1 or 1-800-735-2989; OR

•Send MAXIMUS an Enrollment Change Form. You can get the form by calling MAXIMUS at 1-877-782-6440 (TTY 711 or 1-800-735-2989) if you need them to mail you one; OR

•Call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users (people who have difficulty hearing, or speaking) should call 1-877-486-2048. Markii aad soo wacdo 1-800-MEDICARE, waxaad sidoo kale isu diiwaangalin kartaa qorshe kale oo caafimaadka Medicare ah ama qorshe daawo. More information on getting your Medicare services when you leave our plan is in the chart on page 214 of your EOC/Member Handbook.

Xaaladaha kale ee markii xubinimadaadu dhammaato

These are the cases when UnitedHealthcare Connected® must end your membership in the plan:

  • Haddii waqti uu soo dhex galo Medicare-kaaga Qeybta A iyo ceymiskaaga Qeybta B.
  • If you no longer qualify for Texas Medicaid. Our plan is for people who qualify for both Medicare and Texas Medicaid.

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

H7833_240103_094407 Accepted

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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