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UnitedHealthcare Community Plan (Medicaid (MMA) and LTC) Glossary

Glossary

A

  • Advance Directive

    A decision about your health care that you make ahead of time in case you are ever unable to speak for yourself. This will let your family and your doctors know what decisions you would make if you were able to.

  • Appeal

    You can file an appeal if you are not happy with a decision we made ("denial"). A denial is when we say no to a service you or your doctor asked us to give you. It could also be when we don't give you as much of a service you wanted. For example, you can file an appeal if your doctor wanted a drug we do not allow. You can also file if we didn't approve a hospital stay. If you are not happy but it is not because we said no to what you asked for, you can file a grievance.

  • ASC/SPU

    Ambulatory surgical center/short procedure unit.

  • Authorization

    An approval for a service.

B

  • Benefits

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

C

  • Clinical Care Management

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

D

  • Disenrollment

    To stop your membership in UnitedHealthcare.

E

  • Emergency

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

F

  • Fraud

    An untruthful act (example: if someone other than you uses your member ID card and pretends to be you).

G

  • Grievance

    You can file a grievance when you are not happy. This can be when you are not happy with our plan, or our providers, or anything other than an "action". For example, you may file a grievance if you have a problem making an appointment with a provider or have trouble finding a provider. You can file if you think you are not getting good care. You can also file if a doctor is sending you bills for services you get with our Plan. You can file an appeal If you are not happy with a decision we made (an 'action') (see Appeal).

H

  • Home Health Agency

    A company contracted by UnitedHealthcare to provide care for you in your home.

I

  • ID Card

    Identification card – a card that says you are a UnitedHealthcare member. You should have this card with you at all times.

  • Informed Consent

    Doctors give you information about a particular treatment or test in order for you to decide whether or not you wish to have the treatment or test.

  • Inpatient

    When you are admitted into a hospital for a length of time.

M

  • Medical Necessity

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

  • Member

    A person who is eligible for UnitedHealthcare.

O

  • Outpatient

    When you have a procedure done that does not require a hospital stay overnight. In some cases, you may stay overnight in the hospital but not be admitted as an inpatient.

P

  • Primary Care Provider (PCP)

    A doctor you choose to be your family physician. They have their own private practices.

  • Prior Authorization

    The process for any service that needs an approval from UnitedHealthcare before it can take place.

  • Provider

    Any medical professional that UnitedHealthcare has contracted with to take care of you.

  • Provider Directory

    A list of providers who participate with UnitedHealthcare Community Plan to help take care of your healthcare needs.

R

  • Referral

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

S

  • Self-Referred Services

    Services for which you do not need to see your primary care provider for a referral.

  • Specialist

    A doctor that has specific, detailed training in one certain medical field.

U

  • Urgent Care

    When you need care, treatment or medical advice within a 24-hour time period.

W

  • WIC

    Supplemental Food Program for Women, Infants and Children which provides nutrition counseling, nutrition education, and nutritious foods to pregnant and postpartum women, infants and children up to the age of 2. Children deemed nutritionally deficient are covered up to age 5 if they are low income and are determined to be at nutritional risk.

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For more information on Florida Medicaid, download the Florida Medicaid Reference Guide.

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UnitedHealthcare Community Plan (Medicaid (MMA) and LTC)


State disclaimer

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*UnitedHealthcare Community Plan of Florida is a Managed Care Plan with a Florida Medicaid contract. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the Managed Care Plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or co-payments/coinsurance may change. UnitedHealthcare does not discriminate on the basis of race, color, national origin, sex, age or disability in health programs and activities.

MMA Non-Discrimination and Language Assistance Notice

LTC Non-Discrimination and Language Assistance Notice

UnitedHealthcare Community Plan is available in the following counties: Alachua, Baker, Bradford, Citrus, Clay, Columbia, Dixie, Duval, Flagler, Gilchrist, Hamilton, Hardee, Hernando, Highlands, Hillsborough, Lafayette, Lake, Levy, Manatee, Marion, Miami-Dade, Monroe, Nassau, Polk, Putnam, St. Johns, Sumter, Suwannee, Union, and Volusia.

Last Updated: 12.01.2025 at 12:17 PM CST

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.

Star ratings disclaimer

Every year, Medicare evaluates plans based on a 5-Star rating system. The 5-Star rating applies to plan year 2025.

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.