This section is a user guide to your LM HealthWorks Plan that takes you step by step through the process of seeking care and using your benefits.

How to Seek Care

  • Use the Glossary to understand plan terminology.

Know what to do, what to expect and what your responsibility will be when you or a family member needs health care.

Using in-network providers

When you need care, you have a choice. You may visit doctors and other care providers who belong to the network, or you may seek care outside the network. Remember, in-network doctors have negotiated special rates with Aetna. This, in addition to a higher level of benefits paid for in-network care, means you’ll pay less for your care when you visit in-network providers.

Follow these steps for in-network care »

Using out-of-network providers

If you seek care outside the network, the process is slightly different.

Follow these steps for out-of-network care »

When you have a prescription filled at a participating retail pharmacy

By entering a zip code and selecting “locate pharmacy” online, you can find participating retail pharmacies near you.

When you visit the participating retail pharmacy:

  1. Show your pharmacy ID card.
  2. Pay a percentage of the cost of the medication — called coinsurance. How much coinsurance depends on the type of drug used to fill the prescription. Remember, you pay the least when your doctor prescribes a generic drug, if one is available.
  3. Beginning January 1, 2015, you will not pay more than $2,000 (if you have individual coverage) or $4,000 (if you have family coverage) out-of-pocket for your covered prescription expenses. This is what’s called an “out-of-pocket maximum”.

The Benefits Summary shows coinsurance amounts for prescription drugs.

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