Glossary of Terms

C

Care Manager

Your Care Manager will most likely be your main Point of Contact for the In Touch Care (ITC) Enhanced Condition Management program. He or she will be available to assist both you and your family member(s) with acute or chronic conditions. However, your Care Manager could also be a member of the Behavioral Health, Beginning Right Maternity Management, or National Medical Excellence (NME) Transplant team, ensuring you are getting the care you need, when you need it.

Condition Management

Enhanced condition management is a program of one- on-one support, information and guidance to help participants manage a specific acute or chronic medical condition or disease, and enjoy better overall health.

Calendar Year

The period of time starting January 1 and ending December 31.

Chronic Condition; Chronic Disease

A medical condition or disease that is ongoing or lasts for a long time is referred to as “chronic.” Examples of chronic conditions are diabetes, asthma, chronic obstructive pulmonary disease and chronic kidney disease.

Claim

A claim is information sent to the LM HealthWorks Plan requesting payment for medical or prescription drug benefits that you or a covered family member received. If you use in-network providers, they will submit claims for you. If you use out-of-network providers, you must file your own claims.

Coinsurance

Coinsurance is your share of a covered expense, expressed as a percentage. For covered medical expenses, you pay the applicable coinsurance after you meet the annual deductible. For example, if the plan covers an expense at 85%, your coinsurance is 15%. Coinsurance varies whether you use in-network or out-of-network providers. When you have a prescription filled, you pay a percentage of the cost (called coinsurance). The amount depends on the type of drug used to fill the prescription and if you used a retail pharmacy in the plan or the plan’s mail-order service.

Copayment; Copay

A copayment is a fixed amount paid for a specific service under certain types of health plans. The LM HealthWorks Plan does not have copays.

Cost Estimator Tool

The Cost Estimator Tool is an online tool that lets you enter current information about how you use health care services and receive a summary showing your estimated out-of-pocket responsibility and the plan’s share of costs. This can help you anticipate and plan for your out-of-pocket health care costs for the coming year.

Cost Of Care Tools

The Cost of Care Tools, available at Aetna Navigator®, are online tools you can use to arrive at the average estimated costs of medical procedures, treatments and tests in your area. You may also use the Price-a-Medication Tool at Medco’s prescription drug web site to receive cost estimate information on the medication(s) you take, as well as lower cost alternatives, if available.

Covered Expense

A covered expense is the charge for a health care service or supply allowable under the plan.

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