As you learn more about us, you may see some terms that are unfamiliar to you. This glossary explains some frequently used terms. If you have any questions, just give us a call.
An Illinois Department of Healthcare and Family Services (HFS) insurance program that provides medical insurance for children ages birth to 18.
The process that a doctor or other health provider completes to work with UIC-Specialized Care for Children and enrolled families.
Authorization to Release Health Information (Release)
Special written permission from you to get or share your child’s medical information with those specific individuals you indicated.
The process by which your Care Coordination Team helps your family to identify and meet your child’s medical, social and educational needs.
A UIC-Specialized Care for Children staff person who is either a nurse, social worker, speech pathologist, or audiologist.
Care Coordination Team
The team includes you, your child, the UIC-Specialized Care for Children Care Coordinator and Program Coordinator Assistant. Your Care Coordination Team will provide assistance to you and your child, answer your questions and talk with you about your concerns.
A form that financially eligible UIC-Specialized Care for Children families can complete for help with some “out-of-pocket” expenses such as co-pays and deductibles.
The evaluation by an approved specialist that determines whether your child has a UIC-Specialized Care for Children medically eligible condition.
A letter that states your child’s medically eligible condition(s) and the time period during which UIC-Specialized Care for Children may help pay bills for services related to the eligible condition(s).
Explanation of Benefits (EOB)
A statement from your insurance company that explains what was paid on a specific bill and why the bill was processed in that way. UIC-Specialized Care for Children must have a copy of this paperwork in order to pay any cost for the service or equipment that was not covered by your insurance.
If you meet the financial eligibility criteria for UIC-Specialized Care for Children, a financial eligibility period is established. The period may be 1 or 2 years, depending on what documentation of income you provide. Your financial period will be indicated on your eligibility letter.
Health Insurance Portability and Accountability Act of 1996. This Federal law protects the privacy of health information that can be linked to an individual. The law ensures your right to access your personal health information and to determine how that information may be shared with others.
The card tells specialists that your child is eligible for UIC-Specialized Care for Children financial assistance for approved specialty care.
A formal request to your insurance company from your child’s primary care physician (PCP) for your child to see a specialist. Most insurance companies issue a referral number to the specialist to indicate the referral has been approved.
UIC-Specialized Care for Children requires that you maximize insurance benefits. When you follow all the rules of your insurance company, the insurance may pay for more services and at a higher rate. Following the rules is necessary in order for the insurance company to pay the maximum benefit on a claim.
An Illinois Department of Healthcare and Family Services (HFS) program that provides assistance with medical, dental and vision services for low income families.
Medically Eligible Condition
Medical eligibility is determined either through a diagnostic evaluation or through review of existing medical reports regarding your child’s condition.
The providers that have agreements with your insurance company are considered “in-network” providers for that insurance company. Using “out-of-network” providers usually results in a lower payment by your insurance company or a penalty that you have to pay.
Primary Care Physician (PCP)
The child’s regular pediatrician or family physician who gives routine child care. Many insurance companies require children to have a PCP.
A written approval that is required for some services.
Program Coordinator Assistant (PCA)
A PCA will most likely be your first contact with us. The PCA will take your referral, discuss your child’s needs and send the application to you. The PCA will determine your financial eligibility for UIC-Specialized Care for Children and will update that financial eligibility periodically. The PCA and the Care Coordinator will work together as a team to meet your child’s needs.
Illinois is divided into 102 counties. UIC-Specialized Care for Children has 11 regional offices that cover all counties in the state.
Service from a physician who treats children with certain diagnoses. UIC-Specialized Care for Children requires that care be provided by an approved specialist.
The process of preparing for adulthood and the changes that will bring in coordinating health care and other areas of your life.