288 "All"
Allowed amount
The most Molina will pay for a service. This is a lower price that doctors in the Molina network agree to be paid.
Annual and lifetime maximums
The most money your plan will pay for your care in one year or over your whole life.
Appeal
A request to look again at a decision made by Molina when you do not agree with it. You or someone you choose may ask for an appeal.
Assignment of benefits
Letting Molina pay your doctor directly for your care.
Authorization (preauthorization or prior authorization)
Approval from Molina before you get some types of care. This helps show the care is needed.
Balance billing
When a doctor bills you for the amount Molina did not pay. This can happen if the doctor is not in the Molina network.
Behavioral health
Care for mental health, feelings and substance use concerns.
Benefits
Health care your plan helps pay for.
Care or case management
A team that helps you manage hard or long-term health needs. They may also help you get food, housing, or rides to care.
Claim
A request for payment that a doctor or provider sends to Molina after you get care.
Coinsurance
A share of the cost you pay for care. For example: if Molina pays 80%, you pay 20%.
Compliant
A grievance you report to Molina. Something that you did not think went right.
Copayment (copay)
Copayment (copay): A set dollar amount you pay when you get care, such as $20 for a doctor’s visit.
Coverage period
The time your plan is active and can help pay for your care.
Credentialing
Molina checks that a doctor is trained and qualified to join the Molina network.
Deductible
The amount you pay for care before Molina starts to help pay. For example: if your deductible is $1,000, you must pay that amount first.
Deductible
A family member, like a spouse or child, who is covered under your health plan.
Disenrollment
When someone’s health plan ends.
Drug tiers
Groups of medicines that cost different amounts. • Tier 1: Low-cost generic drugs • Tier 2: Brand-name drugs that cost more • Tier 3: Higher-cost brand-name drugs • Tier 4: Special drugs that are usually very expensive
Durable medical equipment (DME)
Medical equipment ordered for long or daily use, such as oxygen, wheelchairs, crutches or diabetic supplies.
Effective date
The day your health plan starts. Care before this date is not paid for.
Emergency medical transportation
An ambulance, by ground or air, that takes you to get help during a serious medical emergency.
Emergency room care
Fast care for serious health problems. It is usually covered even if the hospital is not in the Molina network.
Excluded services
Care your health plan does not pay for.
Explanation of Benefits
A paper that explains what Molina paid and what you may owe for care.
Family and Individual Plan (Marketplace)
Health coverage you can pick on a state or federal website, like HealthCare.gov. To keep your plan, you must pay a monthly premium. If you stop paying, your plan may end.
Formulary
A list of drugs that Molina covers.
Grievance
When you are not happy about something that happened that is not a coverage decision. You or someone you choose may ask Molina Member Services to file a complaint known as a grievance.
Habilitation services and devices
Care that helps you learn, keep or improve daily living skills, such as walking, talking or dressing.
Health Insurance Portability and Accountability Act (HIPAA)
A law that protects your private health information and how it is shared.
Health insurance
A plan you pay for that helps cover medical costs.
Health maintenance organization (HMO)
A health plan where you use certain doctors and may need a referral to see a specialist.
Health management
Programs that help you stay healthy or manage long-term conditions.
Health savings account (HSA)
A special account where you save money to pay for medical costs without paying taxes on the money.
Home health care
Health care you receive in your home.
Hospice services
Care that brings comfort near the end of life and supports families.
Hospital outpatient care
Care you get in a hospital that does not require an overnight stay.
Hospitalization
Care that requires staying in a hospital overnight.
Imaging services
Tests like MRIs or CT scans that help doctors see inside your body. Some tests may need approval first.
In network provider
A doctor or hospital in Molina’s network. Using in-network care usually costs less.
In network provider
Simple lab tests done in a doctor’s office.
Language services
Free help for people who need support with a language other than English.
Mail order prescription
A way to get your drugs delivered to your home, often for up to three months at a time.
Managed care
A system where Molina works with doctors and hospitals to help you get the right care at the right time.
Medicaid
Low- or no-cost health insurance from the government for people with low income.
Medical necessity
Care or supplies needed to prevent, find or treat an illness, injury or disease.
Medicare Advantage (Part C)
A private health plan that gives you Medicare benefits and may include extra care like dental or vision care.
Medicare Part A
Helps pay for hospital stays, nursing home care, hospice care and some home health care.
Medicare Part B
Helps pay for doctor visits, checkups, lab tests and some supplies. It also helps you get care to stay healthy.
Medicare Part D
Helps pay for the prescription drugs your doctor prescribes.
Member rights and responsibilities
What you can expect from Molina and what Molina expects from you.
Member services
The team that helps answer questions about your health plan.
National Provider Identifier (NPI)
A special number used to identify doctors, hospitals and other providers.
Network
The doctors, hospitals and other providers that work with your health plan.
Nonparticipating provider
A provider who does not have a contract with Molina. Care may cost more or may not be covered.
Out of network provider
A doctor or hospital that is not in the Molina network. Care may cost more or may not be covered.
Out of pocket maximum
The most you will pay in a year before your plan pays the rest.
Over the counter medications (OTC)
Medicines you can buy without a prescription.
Participating provider
A provider who has a contract with Molina to give you covered care.
Per diem rate
A daily amount paid to a hospital for your care.
Physician services
Medical care given by a doctor.
Preauthorization
Approval from Molina before you get some care, medicines or tests.
Preexisting condition
A health problem you had before your plan started.
Preferred provider organization (PPO)
A health plan where you can see any doctor, even outside the plan, though it may cost more.
Premium
The amount you pay each month for your health insurance.
Prescription drug coverage
Your plan helps pay for medicines.
Prescription drugs
Medicines you can only get with a prescription.
Preventive care
Care like checkups, screenings and vaccines that help keep you healthy.
Primary care provider (PCP)
Your main doctor who helps manage your care and gives referrals when needed.
Prior authorization (preauthorization)
Approval from Molina before you get some care, medicines or tests.
Provider
A doctor, nurse or health care facility that gives care.
Quality improvement
Programs that help make health care better.
Recredentialing
Molina checks a provider’s training and qualifications to stay in the network.
Referral
A note from your PCP that gives you approval to see a specialist.
Referral authorization form
A form your doctor fills out when sending you to a specialist.
Rehabilitation services and devices
Care like physical or occupational therapy that helps you regain skills lost because of sickness, injury or disability.
Skilled nursing care
Care from licensed nurses in your home or in a nursing home.
Special Enrollment Period
A time outside open enrollment when you can sign up for insurance because of a major life change.
Specialist
A doctor who treats a specific health problem, such as heart or skin issues.
Specialty pharmacy
A pharmacy that gives medicines for serious or long-term health problems.
Subrogation
When your insurance gets money back from someone else who caused your injury.
Summary of Benefits or Summary of Benefits and Coverage (SBC)
A paper that explains what your plan covers and what you may pay.
Treatment alternatives
Different ways to treat a health problem.
Urgent care
Quick care for problems that are not emergencies but should not wait.
Utilization management (UM)
Molina reviews if care is needed and the best way to provide it.
Allowed amount
The most Molina will pay for a service. This is a lower price that doctors in the Molina network agree to be paid.
Annual and lifetime maximums
The most money your plan will pay for your care in one year or over your whole life.
Appeal
A request to look again at a decision made by Molina when you do not agree with it. You or someone you choose may ask for an appeal.
Assignment of benefits
Letting Molina pay your doctor directly for your care.
Authorization (preauthorization or prior authorization)
Approval from Molina before you get some types of care. This helps show the care is needed.
Balance billing
When a doctor bills you for the amount Molina did not pay. This can happen if the doctor is not in the Molina network.
Behavioral health
Care for mental health, feelings and substance use concerns.
Benefits
Health care your plan helps pay for.
Care or case management
A team that helps you manage hard or long-term health needs. They may also help you get food, housing, or rides to care.
Claim
A request for payment that a doctor or provider sends to Molina after you get care.
Coinsurance
A share of the cost you pay for care. For example: if Molina pays 80%, you pay 20%.
Compliant
A grievance you report to Molina. Something that you did not think went right.
Copayment (copay)
Copayment (copay): A set dollar amount you pay when you get care, such as $20 for a doctor’s visit.
Coverage period
The time your plan is active and can help pay for your care.
Credentialing
Molina checks that a doctor is trained and qualified to join the Molina network.
Deductible
The amount you pay for care before Molina starts to help pay. For example: if your deductible is $1,000, you must pay that amount first.
Deductible
A family member, like a spouse or child, who is covered under your health plan.
Disenrollment
When someone’s health plan ends.
Drug tiers
Groups of medicines that cost different amounts. • Tier 1: Low-cost generic drugs • Tier 2: Brand-name drugs that cost more • Tier 3: Higher-cost brand-name drugs • Tier 4: Special drugs that are usually very expensive
Durable medical equipment (DME)
Medical equipment ordered for long or daily use, such as oxygen, wheelchairs, crutches or diabetic supplies.
Effective date
The day your health plan starts. Care before this date is not paid for.
Emergency medical transportation
An ambulance, by ground or air, that takes you to get help during a serious medical emergency.
Emergency room care
Fast care for serious health problems. It is usually covered even if the hospital is not in the Molina network.
Excluded services
Care your health plan does not pay for.
Explanation of Benefits
A paper that explains what Molina paid and what you may owe for care.
Family and Individual Plan (Marketplace)
Health coverage you can pick on a state or federal website, like HealthCare.gov. To keep your plan, you must pay a monthly premium. If you stop paying, your plan may end.
Formulary
A list of drugs that Molina covers.
Grievance
When you are not happy about something that happened that is not a coverage decision. You or someone you choose may ask Molina Member Services to file a complaint known as a grievance.
Habilitation services and devices
Care that helps you learn, keep or improve daily living skills, such as walking, talking or dressing.
Health Insurance Portability and Accountability Act (HIPAA)
A law that protects your private health information and how it is shared.
Health insurance
A plan you pay for that helps cover medical costs.
Health maintenance organization (HMO)
A health plan where you use certain doctors and may need a referral to see a specialist.
Health management
Programs that help you stay healthy or manage long-term conditions.
Health savings account (HSA)
A special account where you save money to pay for medical costs without paying taxes on the money.
Home health care
Health care you receive in your home.
Hospice services
Care that brings comfort near the end of life and supports families.
Hospital outpatient care
Care you get in a hospital that does not require an overnight stay.
Hospitalization
Care that requires staying in a hospital overnight.
Imaging services
Tests like MRIs or CT scans that help doctors see inside your body. Some tests may need approval first.
In network provider
A doctor or hospital in Molina’s network. Using in-network care usually costs less.
In network provider
Simple lab tests done in a doctor’s office.
Language services
Free help for people who need support with a language other than English.
Mail order prescription
A way to get your drugs delivered to your home, often for up to three months at a time.
Managed care
A system where Molina works with doctors and hospitals to help you get the right care at the right time.
Medicaid
Low- or no-cost health insurance from the government for people with low income.
Medical necessity
Care or supplies needed to prevent, find or treat an illness, injury or disease.
Medicare Advantage (Part C)
A private health plan that gives you Medicare benefits and may include extra care like dental or vision care.
Medicare Part A
Helps pay for hospital stays, nursing home care, hospice care and some home health care.
Medicare Part B
Helps pay for doctor visits, checkups, lab tests and some supplies. It also helps you get care to stay healthy.
Medicare Part D
Helps pay for the prescription drugs your doctor prescribes.
Member rights and responsibilities
What you can expect from Molina and what Molina expects from you.
Member services
The team that helps answer questions about your health plan.
National Provider Identifier (NPI)
A special number used to identify doctors, hospitals and other providers.
Network
The doctors, hospitals and other providers that work with your health plan.
Nonparticipating provider
A provider who does not have a contract with Molina. Care may cost more or may not be covered.
Out of network provider
A doctor or hospital that is not in the Molina network. Care may cost more or may not be covered.
Out of pocket maximum
The most you will pay in a year before your plan pays the rest.
Over the counter medications (OTC)
Medicines you can buy without a prescription.
Participating provider
A provider who has a contract with Molina to give you covered care.
Per diem rate
A daily amount paid to a hospital for your care.
Physician services
Medical care given by a doctor.
Preauthorization
Approval from Molina before you get some care, medicines or tests.
Preexisting condition
A health problem you had before your plan started.
Preferred provider organization (PPO)
A health plan where you can see any doctor, even outside the plan, though it may cost more.
Premium
The amount you pay each month for your health insurance.
Prescription drug coverage
Your plan helps pay for medicines.
Prescription drugs
Medicines you can only get with a prescription.
Preventive care
Care like checkups, screenings and vaccines that help keep you healthy.
Primary care provider (PCP)
Your main doctor who helps manage your care and gives referrals when needed.
Prior authorization (preauthorization)
Approval from Molina before you get some care, medicines or tests.
Provider
A doctor, nurse or health care facility that gives care.
Quality improvement
Programs that help make health care better.
Recredentialing
Molina checks a provider’s training and qualifications to stay in the network.
Referral
A note from your PCP that gives you approval to see a specialist.
Referral authorization form
A form your doctor fills out when sending you to a specialist.
Rehabilitation services and devices
Care like physical or occupational therapy that helps you regain skills lost because of sickness, injury or disability.
Skilled nursing care
Care from licensed nurses in your home or in a nursing home.
Special Enrollment Period
A time outside open enrollment when you can sign up for insurance because of a major life change.
Specialist
A doctor who treats a specific health problem, such as heart or skin issues.
Specialty pharmacy
A pharmacy that gives medicines for serious or long-term health problems.
Subrogation
When your insurance gets money back from someone else who caused your injury.
Summary of Benefits or Summary of Benefits and Coverage (SBC)
A paper that explains what your plan covers and what you may pay.
Treatment alternatives
Different ways to treat a health problem.
Urgent care
Quick care for problems that are not emergencies but should not wait.
Utilization management (UM)
Molina reviews if care is needed and the best way to provide it.
Allowed amount
The most Molina will pay for a service. This is a lower price that doctors in the Molina network agree to be paid.
Annual and lifetime maximums
The most money your plan will pay for your care in one year or over your whole life.
Appeal
A request to look again at a decision made by Molina when you do not agree with it. You or someone you choose may ask for an appeal.
Assignment of benefits
Letting Molina pay your doctor directly for your care.
Authorization (preauthorization or prior authorization)
Approval from Molina before you get some types of care. This helps show the care is needed.
Balance billing
When a doctor bills you for the amount Molina did not pay. This can happen if the doctor is not in the Molina network.
Behavioral health
Care for mental health, feelings and substance use concerns.
Benefits
Health care your plan helps pay for.
Care or case management
A team that helps you manage hard or long-term health needs. They may also help you get food, housing, or rides to care.
Claim
A request for payment that a doctor or provider sends to Molina after you get care.
Coinsurance
A share of the cost you pay for care. For example: if Molina pays 80%, you pay 20%.
Compliant
A grievance you report to Molina. Something that you did not think went right.
Copayment (copay)
Copayment (copay): A set dollar amount you pay when you get care, such as $20 for a doctor’s visit.
Coverage period
The time your plan is active and can help pay for your care.
Credentialing
Molina checks that a doctor is trained and qualified to join the Molina network.
Deductible
The amount you pay for care before Molina starts to help pay. For example: if your deductible is $1,000, you must pay that amount first.
Deductible
A family member, like a spouse or child, who is covered under your health plan.
Disenrollment
When someone’s health plan ends.
Drug tiers
Groups of medicines that cost different amounts. • Tier 1: Low-cost generic drugs • Tier 2: Brand-name drugs that cost more • Tier 3: Higher-cost brand-name drugs • Tier 4: Special drugs that are usually very expensive
Durable medical equipment (DME)
Medical equipment ordered for long or daily use, such as oxygen, wheelchairs, crutches or diabetic supplies.
Effective date
The day your health plan starts. Care before this date is not paid for.
Emergency medical transportation
An ambulance, by ground or air, that takes you to get help during a serious medical emergency.
Emergency room care
Fast care for serious health problems. It is usually covered even if the hospital is not in the Molina network.
Excluded services
Care your health plan does not pay for.
Explanation of Benefits
A paper that explains what Molina paid and what you may owe for care.
Family and Individual Plan (Marketplace)
Health coverage you can pick on a state or federal website, like HealthCare.gov. To keep your plan, you must pay a monthly premium. If you stop paying, your plan may end.
Formulary
A list of drugs that Molina covers.
Grievance
When you are not happy about something that happened that is not a coverage decision. You or someone you choose may ask Molina Member Services to file a complaint known as a grievance.
Habilitation services and devices
Care that helps you learn, keep or improve daily living skills, such as walking, talking or dressing.
Health Insurance Portability and Accountability Act (HIPAA)
A law that protects your private health information and how it is shared.
Health insurance
A plan you pay for that helps cover medical costs.
Health maintenance organization (HMO)
A health plan where you use certain doctors and may need a referral to see a specialist.
Health management
Programs that help you stay healthy or manage long-term conditions.
Health savings account (HSA)
A special account where you save money to pay for medical costs without paying taxes on the money.
Home health care
Health care you receive in your home.
Hospice services
Care that brings comfort near the end of life and supports families.
Hospital outpatient care
Care you get in a hospital that does not require an overnight stay.
Hospitalization
Care that requires staying in a hospital overnight.
Imaging services
Tests like MRIs or CT scans that help doctors see inside your body. Some tests may need approval first.
In network provider
A doctor or hospital in Molina’s network. Using in-network care usually costs less.
In network provider
Simple lab tests done in a doctor’s office.
Language services
Free help for people who need support with a language other than English.
Mail order prescription
A way to get your drugs delivered to your home, often for up to three months at a time.
Managed care
A system where Molina works with doctors and hospitals to help you get the right care at the right time.
Medicaid
Low- or no-cost health insurance from the government for people with low income.
Medical necessity
Care or supplies needed to prevent, find or treat an illness, injury or disease.
Medicare Advantage (Part C)
A private health plan that gives you Medicare benefits and may include extra care like dental or vision care.
Medicare Part A
Helps pay for hospital stays, nursing home care, hospice care and some home health care.
Medicare Part B
Helps pay for doctor visits, checkups, lab tests and some supplies. It also helps you get care to stay healthy.
Medicare Part D
Helps pay for the prescription drugs your doctor prescribes.
Member rights and responsibilities
What you can expect from Molina and what Molina expects from you.
Member services
The team that helps answer questions about your health plan.
National Provider Identifier (NPI)
A special number used to identify doctors, hospitals and other providers.
Network
The doctors, hospitals and other providers that work with your health plan.
Nonparticipating provider
A provider who does not have a contract with Molina. Care may cost more or may not be covered.
Out of network provider
A doctor or hospital that is not in the Molina network. Care may cost more or may not be covered.
Out of pocket maximum
The most you will pay in a year before your plan pays the rest.
Over the counter medications (OTC)
Medicines you can buy without a prescription.
Participating provider
A provider who has a contract with Molina to give you covered care.
Per diem rate
A daily amount paid to a hospital for your care.
Physician services
Medical care given by a doctor.
Preauthorization
Approval from Molina before you get some care, medicines or tests.
Preexisting condition
A health problem you had before your plan started.
Preferred provider organization (PPO)
A health plan where you can see any doctor, even outside the plan, though it may cost more.
Premium
The amount you pay each month for your health insurance.
Prescription drug coverage
Your plan helps pay for medicines.
Prescription drugs
Medicines you can only get with a prescription.
Preventive care
Care like checkups, screenings and vaccines that help keep you healthy.
Primary care provider (PCP)
Your main doctor who helps manage your care and gives referrals when needed.
Prior authorization (preauthorization)
Approval from Molina before you get some care, medicines or tests.
Provider
A doctor, nurse or health care facility that gives care.
Quality improvement
Programs that help make health care better.
Recredentialing
Molina checks a provider’s training and qualifications to stay in the network.
Referral
A note from your PCP that gives you approval to see a specialist.
Referral authorization form
A form your doctor fills out when sending you to a specialist.
Rehabilitation services and devices
Care like physical or occupational therapy that helps you regain skills lost because of sickness, injury or disability.
Skilled nursing care
Care from licensed nurses in your home or in a nursing home.
Special Enrollment Period
A time outside open enrollment when you can sign up for insurance because of a major life change.
Specialist
A doctor who treats a specific health problem, such as heart or skin issues.
Specialty pharmacy
A pharmacy that gives medicines for serious or long-term health problems.
Subrogation
When your insurance gets money back from someone else who caused your injury.
Summary of Benefits or Summary of Benefits and Coverage (SBC)
A paper that explains what your plan covers and what you may pay.
Treatment alternatives
Different ways to treat a health problem.
Urgent care
Quick care for problems that are not emergencies but should not wait.
Utilization management (UM)
Molina reviews if care is needed and the best way to provide it.
Appeal
A request for your managed care organization to review a denial or a grievance again.
Compliant
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.
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.
Emergency services
Evaluation of an emergency medical condition and treatment to keep the condition from getting worse
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.
Excluded services
Health care services that your health insurance or plan doesn’t pay for or cover.
Grievance
A complaint to your health insurer or plan.
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.
Health insurance
A contract that requires your health insurer to pay your covered health care costs in exchange for a premium.
Home health care
Health care services a person receives in a home.
Hospice services
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.
Hospitalization
Care in a hospital that requires admission as an inpatient and usually requires an overnight stay.
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.
Network
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.
Participating provider
A Provider who has a contract with your health insurer or plan to provide covered services to you.
Plan
A benefit, like Medicaid, which provides and pays for your health-care services.
Physician services
Health-care services a licensed medical physician (M.D. - Medical Doctor or D.O. - Doctor of Osteopathic Medicine) provides or coordinates.
Preauthorization
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.
Premium
The amount that must be paid for your health insurance or plan.
Prescription drug coverage
Health insurance or plan that helps pay for prescription drugs and medications.
Prescription drugs
Drugs and medications that by law require a prescription.
Primary care physician
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.
Primary care provider
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.
Provider
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.
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.
Skilled nursing care
Services from licensed nurses in your own home or in a nursing home.
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.
Urgent care
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.