AtlantiCare Benefits Book 2020

Glossary

TABLE OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 SERVICE CENTERS AND WEBSITES...................4 HOW TO ENROLL.......5 MEDICAL..............6-12 PRESCRIPTION DRUG. ................13-15 ADDITIONAL MEDICAL PLAN RESOURCES........16-18 DENTAL...............19-21 VISION.....................22 LIFECENTER..............23 LIFE INSURANCE. .....24 LONG TERM DISABILITY...............25 VOLUNTARY OFFERINGS. ........26-29 SPENDING ACCOUNTS. ............30 RETIREMENT BENEFITS..................31 WELLNESS. .........32-36 LEGAL NOTICES..37-39 CONTACTS.........40-41 GLOSSARY..........42-43 FAQs...................44-46 FORMS................47-56

Preventive Benefits – These are covered services that are focused on prevention and early detection of disease. This type of care is exemplified by routine examinations and immunizations. When using a network provider, these benefits are covered at 100% without deductibles, copays or coinsurance in all plans.

Primary Care Physician (PCP) – Your PCP is the physician you select to serve as your main healthcare provider. Usually a family practitioner, internist, pediatrician or OB/GYN, he/she may refer you to a specialist for additional care. You do not need a referral form to be seen by a specialist for any of the medical plans.

Qualifying Life Event (QLE) – A change in your situation (getting married, having a baby or losing/gaining other health coverage) that makes you eligible for a Special Enrollment Period, allowing you to enroll in health insurance outside the yearly Open Enrollment period, 30 days to report event.

Reasonable and Customary – A reasonable and customary charge is an amount that is in the normal range of payment for a specific health-related service or medical procedure within a given geographic area. If the charges you (or your doctor) submit to your health plan are higher than what the health plan considers reasonable and customary for the covered service, then your health plan may not allow the full amount charged to you and you will be responsible for the balance.

Specialist or Specialty Care Physician (SCP) – This is a physician who has special experience and/or expertise in a particular area (i.e., orthopedics, urology, podiatry). Their practice is limited to this branch of medicine.

Telehealth –The delivery of health related services and information via video conferencing.

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