Glossary of Terms
To make this site more helpful and easy to use, here is a list of terms
and their definitions. If you don't find a term here, or if you're still not
sure what something means, please don't hesitate to contact Community Health Plan's customer service representatives at
Chronic Condition
A sickness or health problem that lasts a long time or is permanent.
DSHS
The Washington State Department of Social and Health Services. DSHS runs the Healthy Options program, among others.
Explanation of Benefits (EOB)
After you receive health care under our plan, we'll mail you a written explanation of benefits, or EOB. It will explain what services we paid for and show any amount you are responsible for paying.
ID Card
This is the Community Health Plan ID card that was mailed to
you when you joined our plan. Every enrolled member of your family should
have a card. You'll need your card whenever you have a medical appointment
or fill a prescription. If you need an ID card, or if you lose yours, please
contact us at
Network
The clinics, health care providers, and pharmacies covered by Community Health Plan.
Prenatal Care
Health care given to a woman and her baby while she is pregnant.
Primary Care Provider (PCP)
Your primary care provider, or PCP, is your main health care provider. Your PCP works with you to coordinate all aspects of your care. As a member of our plan, you need to choose a PCP. If you do not choose a PCP, we'll choose one for you.
Prior Authorization
Certain treatments require prior authorization from Community Health Plan before they are covered; for instance, prior authorization is necessary before you receive treatment from specialists or follow-up treatment when you are out of state.
Second Opinion
Another doctor's opinion concerning a diagnosis or a treatment plan. You can get a second opinion at any time, as long as the doctor is part of our service network. Your PCP can refer you for a second opinion.
Specialist
A health care provider other than your primary care provider who focuses on one specific area of medicine--for instance, a surgeon, a physical therapist, or a mental health counselor. Your primary care provider must provide you with a written referral to a specialist for the care to be covered under your plan.
Standing Referral
If you have a complex or serious medical problem, you have the right to a specialist referral that continues for a long period of time. Your PCP will provide you with a standing referral if necessary.