Children's Health Insurance Program (CHIP) Glossary

A

  • Advance Directive

    Một quyết định về việc chăm sóc sức khỏe của quý vị mà quý vị thực hiện trước trong trường hợp quý vị không thể tự nói cho chính mình. This will let your family and your doctors know what decisions you would make if you were able to.

  • Kháng cáo

    A request for your managed care organization to review a denial or a grievance again.

  • ASC/SPU

    Ambulatory surgical center/short procedure unit.

  • Ủy quyền

     O.K. hoặc chấp thuận một dịch vụ.

B

  • Quyền lợi

    Services, procedures and medications that CHIP will cover for you.

C

  • Clinical Care Management

    One-on-one help by a nurse providing education and coordination of CHIP benefits, tailored to your needs.

  • Complaint

    A grievance that you communicate to your health insurer or plan.

  • Copayment

    A fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service.

D

  • Disenrollment

    To stop your membership in CHIP.

  • Durable Medical Equipment (DME)

    Equipment ordered by a health care provider for everyday or extended use. Coverage for DME may include but is not limited to: oxygen equipment, wheelchairs, crutches, or diabetic supplies.

E

  • Emergency

    When you reasonably believe that your health is in serious danger.

  • Emergency Medical Condition

    An illness, injury, symptom, or condition so serious that a reasonable person would seek care right away to avoid harm.

  • Emergency Medical Transportation

    Ground or air ambulance services for an emergency medical condition.

  • Emergency Room Care

    Emergency services you get in an emergency room.

  • Emergency Services

    Evaluation of an emergency medical condition and treatment to keep the condition from getting worse.

  • Excluded Services

    Health care services that your health insurance or plan doesn’t pay for or cover.

G

  • Khiếu nại

    A complaint to your health insurer or plan.

H

  • Habilitation Services and Devices

    Health care services such as physical or occupational therapy that help a person keep, learn, or improve skills and functioning for daily living.

  • Bảo Hiểm Y Tế

    A contract that requires your health insurer to pay your covered health care costs in exchange for a premium.

  • Home Health Agency

    A company hired by CHIP to provide care for you in your home.

  • Chăm Sóc Sức Khỏe Gia Đình

    Health care services a person receives in a home.

  • Dịch vụ bệnh viện cho người hấp hối

    Services to provide comfort and support for persons in the last stages of a terminal illness and their families.

  • Hospital Outpatient Care

    Care in a hospital that usually doesn’t require an overnight stay.

  • Nhập viện

    Care in a hospital that requires admission as an inpatient and usually requires an overnight stay.

I

  • ID Card

    Identification card – a card that says you are a CHIP member. Quý vị phải luôn đem theo thẻ này bên mình.

  • Informed Consent

    You agree to all medical treatments.

  • Nội trú

    Khi quý vị nhập viện trong thời gian dài.

M

  • Medical Necessity

    Your health care provider decides if a treatment, admission, procedure, medical supply, equipment, service or supply is medically necessary.

  • Medically Necessary

    Health care services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine.

  • Thành viên

    A person who is eligible for CHIP.

N

  • Mạng lưới

    The facilities, providers, and suppliers your health insurer or plan has contracted with to provide health care services.

  • Non-participating Provider

    A provider who doesn’t have a contract with your health insurer or plan to provide covered services to you. It may be more difficult to obtain authorization from your health insurer or plan to obtain services from a non-participating provider instead of a participating provider. In limited cases, such as when there are no other providers, your health insurer can contract to pay a non-participating provider.

O

  • Bệnh nhân Ngoại trú

    Khi quý vị được tiến hành thủ thuật nhưng không yêu cầu phải ở lại qua đêm tại bệnh viện.

P

  • Nhà cung cấp tham gia

    A Provider who has a contract with your health insurer or plan to provide covered services to you.

  • Physician Services

    Health-care services a licensed medical physician (M.D. -Medical Doctor or D.O. -Doctor of Osteopathic Medicine) provides or coordinates.

  • Chương trình

    A benefit, like Medicaid, which provides and pays for your health-care services.

  • Pre-authorization

    A decision by your health insurer or plan that a health-care service, treatment plan, prescription drug, or durable medical equipment that you or your provider has requested, is medically necessary. This decision or approval, sometimes called prior authorization, prior approval, or pre-certification, must be obtained prior to receiving the requested service. Pre-authorization isn’t a promise your health insurance or plan will cover the cost.

  • Phí bảo hiểm

    The amount that must be paid for your health insurance or plan.

  • Phạm vi bảo hiểm thuốc theo toa

    Health insurance or plan that helps pay for prescription drugs and medications.

  • Thuốc Theo Toa Bác Sĩ

    Drugs and medications that by law require a prescription.

  • Bác Sĩ Chăm Sóc Chính

    A physician (M.D. -Medical Doctor or D.O. -Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health-care services for a patient.

  • Người Chăm Sóc Chính

    A physician (M.D. -Medical Doctor or D.O. -Doctor of Osteopathic Medicine), nurse practitioner, clinical nurse specialist, or physician assistant, as allowed under state law, who provides, coordinates, or helps a patient access a range of health-care services.

  • Prior Authorization

    The process for any service that needs an O.K. from CHIP before it can take place.

  • Nhà cung cấp

    A physician (M.D. -Medical Doctor or D.O. -Doctor of Osteopathic Medicine), health- care professional, or health-care facility licensed, certified, or accredited as required by state law.

  • Danh Bạ Nhà Cung Cấp

    A list of providers who participate with CHIP to help take care of your healthcare needs.

R

  • Giới Thiệu

    When you and your primary care provider agree you need to see another doctor, your primary care provider will send you to a CHIP specialist.

  • Rehabilitation Services and Devices

    Health-care services such as physical or occupational therapy that help a person keep, get back or improve skills and functioning for daily living that have been lost or impaired because a person was sick, hurt or disabled.

S

  • Self-Referred Services

    Các dịch vụ mà quý vị không cần phải có sự giới thiệu từ nhà cung cấp dịch vụ chăm sóc chính của quý vị.

  • Skilled Nursing Care

    Services from licensed nurses in your own home or in a nursing home.

  • Special Needs Unit (SNU)

    A voluntary service offered by CHIP that can give you extra help in understanding and using your benefits if you have a disability or other special need.

  • Specialist

    A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions.

T

  • TANF

    Temporary Assistance for Needy Families.

  • Treatment

     The care that you may receive from doctors and facilities.

U

  • Chăm Sóc Khẩn Cấp

    Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.

W

  • WIC

    Women, Infants and Children program, a supplemental nutrition program that provides nutritious food, education support and health care referrals for women, infants and children.

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