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Here you will find helpful definitions that are commonly used when talking about Medicaid and WellCare of Nebraska.

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Advance Directive – A legal paper that tells your doctor and family how you wish to be cared for when you are ill and need care to prolong life. It goes into effect when you are so ill that you cannot make decisions for yourself.

Appeal – Requests you make when you do not agree with our decision to deny, cut back or end a service. Someone who represents you can also ask for an appeal.

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Benefits – Health care that’s covered by our health plan. (Same as Services.)

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Complaint – When you let us know that you’re not happy with our plan, a provider or a benefit/service. (Same as Grievance.)

Co-payment/Co-pay – This is how much you pay when getting care from a WellCare of Nebraska provider. Unlike coinsurance, it’s usually a fixed dollar amount.

Covered Medical Services - Services you need to get well and stay healthy.

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Department of Health and Human Services – State agency that renews your Medicaid coverage or changes information on your Medicaid file if you have a major life change. A major life change may be a new address, a change in family size, or a new job. 

Disenrollment – When you no longer wish to be a part of our health plan, and the steps to follow to leave WellCare of Nebraska (voluntary). When Nebraska Medicaid says you are no longer able to be part of our health plan (involuntary).

Nebraska Department of Medicaid and Long-Term Care (MLTC) – This division encompasses the Medicaid Program, Home and Community Services for Aging and Persons with Disabilities and the State Unit on Aging.

Dual-eligible – Someone eligible for both Medicare and Medicaid.

Durable Medical Equipment – Medical items such as wheelchairs and oxygen tanks.

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Emergency – A very serious, possibly life-threatening medical condition that must be treated right away.

Environmental Accessibility Adaptations – Changes to your home that are needed to help you get and stay healthy. And they help you function on your own at home safely.

EPSDT (Early and Periodic Screening, Diagnosis and Treatment) – Regular health exams for children. They are used to find and treat medical problems.

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Generic – A drug that has the same basic ingredients as a brand-name drug.

Grievance – When you call or write us to let us know that you’re not happy with our plan, a provider or a benefit/service. (Same as Complaint)

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Health Plan – A package of benefits that gives you access to health care providers and facilities to keep you and your family healthy.

HMO (Health Maintenance Organization) – A company like ours that offers health plans and works with health care providers and facilities to keep you and your family healthy. (Same as MCO and Managed Care Plan.)

Home Health Agency – A company that provides health care services in your home, such as nurse visits and therapy treatments.

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Identification (ID) Card – A card we give you that shows you’re a member of our health plan.

Immunizations – Shots that can help keep you and your children safe from many serious diseases. There are some shots your child has to get before he or she can start day care or school in Nebraska.

In-Network – A term we use when a provider is contracted with our health plan.

Inpatient – When you get admitted to a hospital or a medical or behavioral health facility and stay for a short or long period.

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Long-Term Care – For elderly or disabled members at home, in the community or in a facility or an institution.

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Managed Care Organization (MCO) – An HMO or insurer that has a contract with the Department of Health and Human Services. (Same as HMO and Managed Care Plan.)

Managed Care Plan – A health plan that works with providers and facilities, to keep you and your family healthy. (Same as MCO.)

Member – Someone who has joined our health plan.

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Out-of-Network – A term we use when a provider is not contracted with our health plan.

Outpatient – When you get treated at a medical or behavioral health facility but are not admitted as an inpatient.

Over-the-Counter (OTC) Supplies (Value Added Benefit) – Items we offer at no charge to you. They are mailed directly to your home each month. Examples of items covered by this benefit include vitamins, bandages and medicines that don't require a prescription.

Over-the-Counter (OTC) Benefit) - Items you can get at the pharmacy with prescription from your doctor. Some items include pain relievers, diabetic supplies and antacids.

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Pharmacy Network – A group of drug stores that members can use.

Post Stabilization – Follow-up care after you leave the hospital to make sure you get well and stay healthy.

Preferred Drug List (PDL) – A list of drugs that the plan covers for members. Doctors and pharmacists put the list together.

Prescription – A drug for which your doctor writes an order.

Primary Care Provider (PCP) – Your personal doctor or Advanced Practice Registered Nurse (APRN). He or she manages all your health care needs.

Prior Authorization (PA) – Plan approval before you get care or prescriptions.

Provider – Those who work with the health plan to perform covered services, like doctors, hospitals, pharmacies, labs and others.

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Referral – When your PCP sends you to see another health care provider.

Restricted Services - A program that helps to coordinate your drug and medical care.

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Services – Means health care, treatment, a procedure, supply, item or equipment..

Specialist – A doctor trained to practice in a specific field of medicine.

Supplemental Security Income (SSI) – A program that helps children, adults and seniors with disabilities.

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Treatment – The care you get from doctors and facilities.

TTY – A special number to call if you have trouble hearing or have a speech impairment.

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Women, Infants and Children (WIC) – A program that helps families get the food they need.

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Last Updated On: 12/4/2020