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Child Health Plus Glossary

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 request to review an action when you are not satisfied with a decision made by your health plan.

C

  • Coinsurance

    A percentage of the cost of a service that you must pay to the provider for that service.

  • Copayment

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

D

  • Deductible

    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

  • Emergency

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

G

  • Grievance

    Your statement of dissatisfaction with any part of your care. A grievance can be filed over the phone or in writing, and must be filed directly with your plan.

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.

  • Member

    An eligible person enrolled in the UnitedHealthcare Health Plan.

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

  • Premium

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

  • Prescription

    A doctor's written instructions for medication or treatment.

  • Primary Care Provider (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.

  • Provider

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

R

  • Referral

    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.

  • Specialist

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

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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. Access to this service is subject to terms of use.

Star ratings disclaimer

Every year, Medicare evaluates plans based on a 5-Star rating system. The 5-Star rating applies to plan year 2026.

Formularies

The formulary, pharmacy network and provider network may change at any time. You will receive notice when necessary.

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.

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.