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BadgerCare Plus 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.

  • ASC/SPU

    Ambulatory surgical center/short procedure unit.

  • Authorization

    An O.K. or approval for a service.

B

  • Benefits

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

C

  • Clinical Care Management

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

D

  • Disenrollment

     To stop your membership in UnitedHealthcare BadgerCare Plus.

E

  • Emergency

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

F

  • Federal Poverty Level (FPL)

    Poverty income thresholds by family size that are annually updated by the Census Bureau for inflation.

  • Fraud

    An untruthful act – an example is someone other than you using your UnitedHealthcare BadgerCare Plus member ID card and pretending to be you.

H

  • Home Health Agency

    A company hired by UnitedHealthcare BadgerCare Plus to provide care for you in your home.

I

  • ID Card

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

  • Informed Consent

    You agree to all medical treatments.

  • 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 BadgerCare Plus.

O

  • Outpatient

    A nonhospitalized patient receiving covered services away from a hospital, such as in a physician's office or the patient’s own home, or in a hospital outpatient or hospital emergency department or surgical center.

P

  • Primary Care Physician (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 O.K. from UnitedHealthcare BadgerCare Plus before it can take place.

  • Provider

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

  • Provider Directory

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

R

  • Referral

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

S

  • Self-Referred Services

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

  • Special Needs Unit (SNU)

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

  • Specialist

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

T

  • TANF

    Temporary Assistance for Needy Families.

  • Treatment

     The care that you may receive from doctors and facilities.

U

  • Urgent Care

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

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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Individual & Family ACA Marketplace Plans Disclaimer

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The benefits described may not be offered in all plans or in all states. Some plans may require copayments, deductibles and/or coinsurance for these benefits. This policy has exclusions, limitations, reductions of benefits, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, review your plan documents, call or write your insurance agent or the company, whichever is applicable. Plan specifics and benefits vary by coverage area and by plan category. Please review plan details to learn more.

UnitedHealthcare Individual & Family plans medical plan coverage offered by: UnitedHealthcare of Arizona, Inc.; Rocky Mountain Health Maintenance Organization Incorporated in CO; UnitedHealthcare of Florida, Inc.; UnitedHealthcare of Georgia, Inc; UnitedHealthcare of Illinois, Inc.; UnitedHealthcare Insurance Company in AL, KS, LA, MO, NJ, and TN; Optimum Choice, Inc. in MD and VA; UnitedHealthcare Community Plan, Inc. in MI; UnitedHealthcare of Mississippi, Inc.; UnitedHealthcare of New Mexico, Inc.; UnitedHealthcare of North Carolina, Inc.; UnitedHealthcare of Ohio, Inc.; UnitedHealthcare of Oklahoma, Inc.; UnitedHealthcare of South Carolina, Inc.; UnitedHealthcare of Texas, Inc.; UnitedHealthcare of Oregon, Inc. in WA; and UnitedHealthcare of Wisconsin, Inc.  Administrative services provided by United HealthCare Services, Inc. or its affiliates.

This policy has exclusions, limitations, reduction of benefits, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, call or write your insurance agent or the company, whichever is applicable. By responding to this offer, you agree that a representative may contact you.

*To qualify for a $0 monthly premium, you must meet household income requirements for Advanced Premium Tax Credits.

**$0 cost-share for network periodic oral evaluation 2 times per consecutive 12 months. Adult dental benefit coverage is limited to a $1,000 benefit maximum per plan year. Coverage for routine vision exam and eyewear is limited to once every 12 months. If you opt to receive vision care services or vision care materials that are not covered benefits under this plan, a participating vision care provider may charge you their normal fee for such services or materials. Coverage may not be available on all plans or in all states. For costs and complete details of coverage, contact your insurance agent or the company, as applicable.

Last Updated: 04.21.2025 at 10:57 AM CDT

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.