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Glossary | print |
A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z
A localized inflammation due to a collection of pus in the bone or soft tissue, usually caused by an infection.
A tooth or implant used to support a prosthesis. A crown unit used as part of a fixed bridge.
Certification that an organization meets the reviewing organization's standards. Examples: accreditation of HMOs by the National Committee on Quality Assurance (NCQA) or accreditation of hospitals by the Joint Commission of Accreditation of Healthcare Organizations (JCAHO).
The administrative procedure used to process a claim for service according to the covered benefit.
An employee must work for the employer on a regular basis in the usual course of the employer's business to be considered an active, full-time employee and eligible for coverage. Usually, a minimum number of hours of regular work is specified.
An arrangement in which a licensed insurer provides administrative services to an employer's health benefits plan (such as processing claims), but doesn't insure the risk of paying benefits to enrollees. In an ASO arrangement, the employer pays for the health benefits. Non-HMO CIGNA HealthCare benefits plans may be administered by Connecticut General Life Insurance Company on an ASO basis.
The maximum fee that a health plan will reimburse a provider for a given service.
A facility offering a "non-traditional" ("not like a hospital") setting for giving birth. While alternative birthing centers can range from free-standing centers to special areas within hospitals, birthing centers are generally known for a more comfortable, home-like atmosphere, allow more participation by the father and have more procedural flexibility than commonly found in hospital births.
A dental filling material, composed of mercury and other minerals, used to fill decayed teeth.
A surgical procedure used to recontour the supporting bone structures in preparation of a complete or partial denture.
A general term for care that doesn't involve admission to an inpatient hospital bed. Visits to a doctor's office are a type of ambulatory care. Ambulatory Surgery
Surgical procedures performed that do not require an overnight hospital stay. Procedures can be performed in a hospital or a licensed surgical center. Also called Outpatient Surgery.
A professional association of dentists dedicated to serving the public and profession of dentistry.
A professional association of physicians dedicated to promoting the art and science of medicine and the betterment of public health.
Ancillary care: Diagnostic and/or supportive services such as radiology, physical therapy, pharmacy or laboratory work.
A class of drugs that eliminates or reduces pain. See local anesthetic.
The day after a coverage period ends under a health benefits plan. Usually, the month and day that a health benefits plan first goes into effect becomes its anniversary date each year.
The most a plan member will pay per year for covered health expenses before the plan pays 100% of covered health expenses for the rest of that year.
Refers to the teeth and tissues located towards the front of the mouth (upper or lower incisors and canines).
The tip or end of the root of the tooth.
The amputation of the apex of a tooth.
A process available to the patient, their family member, treating provider or authorized representative to request reconsideration of a previous adverse determination.
When a covered person authorizes his or her health benefits plan to directly pay a health care provider for covered services. Traditional health insurance pays benefits directly to the covered person.
See Precertification.
Assessment and therapeutic services used in the treatment of mental health and substance abuse problems.
A person who is eligible to receive benefits under a health benefits plan. Sometimes "beneficiary" is used for eligible dependents enrolled under a benefits plan; "beneficiary" can also be used to mean any person eligible for benefits, including both employees and eligible dependents.
The benefit is usually determined as a percentage of the employee's pre-disability income up to an overall maximum benefit amount.
The coverage period, usually 12 months long, which is used for administration of a health benefits plan.
The portion of the costs of covered services paid by a health plan. For example, if a plan pays the remainder of a doctor's bill after an office visit copayment has been made, the amount the plan pays is the "benefit." Or, if the plan pays 80% of the reasonable and customary cost of covered services, that 80% payment is the "benefit."
A term informally used to refer to the employer's benefits plan or to the benefits plan options from which the employee can choose. "Benefits package" highlights the fact a health benefits plan is a compilation of specific benefits.
A two-cusped tooth found between the molar and the cuspid also known as an eye tooth or canine tooth.
A process of removing tissue to determine the existence of pathology.
X-rays taken of the crowns of teeth to check for decay.
The technique of applying a chemical agent, usually hydrogen peroxide, to the teeth to whiten them.
Any physician who has completed medical school, internship and residency in his or her chosen specialty and has successfully completed an examination conducted by a group (or board) of peers.
A process to chemically etch the tooth's enamel to better attach (bond) composite filling material, veneers, or plastic/acrylic.
The breakdown and loss of the bone that supports the teeth, usually caused by infection or long-term occlusal (chewing areas of the teeth) stress.
A drug manufactured by a pharmaceutical company which has chosen to patent the drug's formula and register its brand name.
A nonremovable restoration that is used to replace missing teeth.
Brush biopsy is a painless procedure used to gather cells in the mouth. The dentist uses a small brush to take a tissue specimen, which is then sent to a laboratory for analysis to determine the presence of pre-cancerous or early stage cancerous cells. Laboratory results are used to determine the need for further procedures.
The involuntary clenching or grinding of the teeth.
The hard deposit of mineralized plaque that forms on the crown and/or root of the tooth. Also referred to as tartar.
The second tooth from the big front tooth, commonly called the eye tooth or cuspid.
Another term for crown; usually referring to a crown for a front tooth.
A program that offers members a comprehensive open access benefit plan with the protection they need wherever they need it - throughout the country. Members in these plans can access a broad provider network consisting of Tufts Health Plan-contracted providers in Massachusetts and Rhode Island and CIGNA HealthCare-contracted providers in all other states. Members also have freedom of choice that allows them to see any provider - in or out of the network - when out-of-network coverage is part of the plan.
A generic term which has been used in many different ways. Used by CIGNA, "Care Management" refers to a CIGNA HealthCare initiative that takes a global approach to medical care from prevention through treatment and recovery.
The correct technical term for decay which is the progressive breaking down or dissolving of tooth structure, caused by the acid produced when bacteria digest sugars.
A term historically used for licensed insurance companies, although now is sometimes used to include both licensed insurers and HMOs.
Coordination of services to help meet a patient's health care needs, usually when the patient has a condition which requires multiple services from multiple providers. This term is also used to refer to coordination of care during and after a hospital stay.
A layman's term for tooth decay. Also, the dental term for the hole that is left after decay has been removed.
A health care model in which the consumer (plan member) is made aware of the true costs and value of health care so that he/she can make informed decisions that balance choice with cost. Health plans that fall in this category may include FSA, HSA and HRA.
A special type of glue used to hold a crown in place. It also acts as an insulator to protect the tooth's nerve.
The very thin, bonelike structure that covers the root of the tooth.
See Precertification.
A feature of the CIGNA HealthCare provider directory allowing you to compare quality and cost for hospitals in your area. CIGNA HealthCare identifies hospitals as Centers of Excellence when they achieve the highest (three-star) scores for cost efficiency and effectiveness in treating selected procedures/conditions, based on publicly available patient data.
The amount billed by a provider for services rendered to a participant.
Treatment of malignant disease by chemical or biological antinoeplastic agents.
The name derived from Connecticut General Insurance and Insurance Company of North America when they merged in 1982.
Part of the CIGNA HealthCare division which offers Employee Assistance Programs (EAP), as well as mental health and substance abuse benefits management. CIGNA Behavioral Health, Inc. delivers services through a national contracted provider network, as well as its own professional practice sites across the country.
A network of specialists selected from CIGNA HealthCare’s broad network of participating providers. In certain specialties, CIGNA Care Network includes doctors who meet specific criteria in the areas of quality, number of CIGNA HealthCare members treated, efficiency and member access.
CIGNA's Health Reimbursement Arrangement and Health Savings Account programs
A family of dental plans including dental indemnity, preferred provider (PPO) and managed care dental benefits and services.
A type of health benefits plan underwritten by CIGNA HealthCare HMOs and Connecticut General Life Insurance Company which combines the comprehensive benefits of an HMO with traditional health insurance coverage. This benefits plan design allows employees and their covered family members to enjoy all the advantages of HMO membership while still providing limited benefits to participating individuals who go outside the HMO system to obtain covered services.
Through this program Health Advisor nurses offer personal assistance, expertise and guidance to members with managing their health and making the most of their benefits.
The health benefits plan which allows persons eligible for Medicare to receive their Medicare Part A and Part B coverages through a CIGNA HealthCare HMO.
A national organ transplant network, developed by CIGNA HealthCare, designed to give participants access to quality care for heart, heart/lung, liver, kidney/pancreas and bone marrow transplants.
The CIGNA HealthCare mail order prescription service that dispenses medications to covered persons at their home address for up to a 90-day supply.
A claim is a request for payment under the terms of a health benefits plan.
Claims are Paid, Pended, Denied, or Received-Not-Yet-Processed.
The forceful holding together of the upper and lower teeth, which places stress on the ligaments that hold the teeth to the jawbone and the lower jaw to the skull.
General procedures and suggestions about what constitutes an acceptable range of practices for particular diseases or conditions. These guidelines are usually developed by a consensus of doctors in a given field, such as radiology or cardiology.
Diagnostic services a doctor provides during delivery of medical services, consultations or care.
The portion of eligible expenses that plan members are responsible paying, most often after the deductible is met. (CIGNA Choice Fund offers an employer the opportunity to add coinsurance to the fund.) It's usually determined as a percentage of the total cost.
The extensive dental restoration involving 6 or more units of crown and/or bridge in the same treatment plan. Using full crowns and/or fixed bridges which are cemented in place, the your dentist will rebuild natural teeth, fill in spaces where teeth are missing and establish conditions which allow each tooth to function in harmony with the occlusion (bite). The extensive procedures involved in complex rehabilitation require an extraordinary amount of time, effort, skill and laboratory collaboration for a successful outcome.
A tooth-colored filling made of plastic resin or porcelain.
A federal statute that requires most employers to offer to covered employees and covered dependents who would otherwise lose health coverage for reasons specified in the statute, the opportunity to purchase the same health benefits coverage that the employer provides to its remaining employees. This continuation of coverage can only last for a maximum specified period of time (usually 18 months for employees and dependents who would otherwise lose coverage due to loss of employment or work hour reduction, or 36 months for dependents who would lose coverage for certain reasons other than employment loss by the employee).
A discussion with another health care professional when additional feedback is needed during diagnosis or treatment. Usually, a consultation is by referral from a primary care physician.
A legal agreement between an individual subscriber or an employer group and a health plan that describes the benefits and limitations of the coverage.
The option to purchase individual coverage by a person who will no longer have access to group health insurance.
A provision in a contract that applies when a person is covered under more than one group health benefits program. It requires that payment of benefits be coordinated by all programs to eliminate overinsurance or duplication of benefits.
Amount that a plan member must pay the provider at the time of service, usually after the deductible is met for eligible expenses. (CIGNA Choice Fund offers an employer the opportunity to add coinsurance to the fund.) It is usually a flat fee of $10 - $25.
Any dental treatment or repair that is solely rendered to improve the appearance of the teeth or mouth.
The benefits that are provided according to the terms of a participant's specific health benefits plan.
Coverage End Date displays the date that coverage ends for a participant. This field is blank, if the participant is considered covered as of the date of the inquiry.
Hospital, medical, and other health care services incurred by the enrollee that are entitled to a payment of benefits under a health benefit contract. The term defines the type and amount of expense that will be considered in the calculation of benefits.
A process that reviews a health care provider's credentials against the credentials required to participate in a managed care network. To participate in a CIGNA HealthCare network, physicians and facilities are thoroughly credentialed before being admitted and are recredentialed every two years. They must meet specific criteria for continued participation in a CIGNA HealthCare provider network.
The portion of a tooth that is covered by enamel. Also a dental restoration that covers the entire tooth and restores it to its original shape.
A surgical procedure exposing more tooth for restorative purposes.
A deep scaling of that portion of the tooth below the gum line. Purpose is to remove calculus and infected gum tissue.
See canine tooth.
The protruding portion(s) of a tooth's chewing surface.
Care that is provided primarily to meet the personal needs of a patient. The care is not meant to be curative or providing medical treatment.
The date the service was provided to the participant as specified on the claim.
An outpatient facility that is licensed to provide outpatient care and treatment, usually for mental or nervous disorders or substance abuse.
Doctor of Dental Surgery or DMD, Doctor of Dental Medicine. Degrees given to dental school graduates. Both degrees are the same particular dental schools identify at their discretion their graduates as DMD or DDS.
See caries.
See primary teeth.
The dollar amount that a plan member must pay for eligible health expenses before a traditional health plan kicks in with benefits.
One of the most important provisions in a disability contract is the definition of disability that will be used to determine an employee's eligibility for benefits.
One of the most important provisions in a disability contract is the definition of disability that will be used to determine an employee's eligibility for benefits.
Under this definition, an employee will be considered disabled only if s/he is unable to perform the duties of his or her occupation.
Under this definition, an employee will be considered disabled only if s/he is unable to work in any occupation for which s/he is qualified by education, training, or experience. This is closely related to the definition that the Social Security Administration uses in determining disability.
This definition of disability applies when an employee is able to return to work part-time or even full-time but with a loss of earnings. If the employee is working in this limited capacity and is earning less than a certain level of income, s/he will still be eligible for limited benefits under the plan. Not all disability carriers use this terminology to describe a "part-time" work situation, but most provide some type of benefit to encourage return to work.
Delegation is a formal process by which CIGNA HealthCare gives another entity the authority to perform the claims payment administration on behalf of CIGNA HealthCare.
Claims that are not issued a bank draft/remittance due to a specific reason code.
A thin, nylon string, waxed or untaxed, that is inserted between the teeth to remove food and plaque.
A dental professional specializing in cleaning the teeth by removing plaque, calculus, and diseased gum tissue. He/She acts as the patient's guide in establishing a proper oral hygiene program.
The part of the tooth that is under both the enamel which covers the crown and the cemented which covers the root
A removable appliance used to replace teeth. A complete denture replaces all of the upper teeth and/or all the lower teeth. See also partial denture
A person eligible for coverage under an employee benefits plan because of that person's relationship to an employee. Spouses, children and adopted children are often eligible for dependent coverage
Medical centers selected to provide an advanced level of care for a disease or delivery of a specific procedure. For example, CIGNA's >LIFESOURCE Organ Transplant Network® is composed of 13 nationally acclaimed hospitals including Johns Hopkins University Medical Center and the UCLA Medical Center
A CIGNA point-of-service product. Each member chooses a CIGNA-affiliated PCP, but has the added convenience of going outside the network for care at any time. The benefits for out-of-network care are reduced, as an incentive to stay in the network, and are subject to indemnity-style deductibles and coinsurance
Tests and procedures ordered by a physician to help diagnose or monitor a patient's condition or disease. Diagnostic tools include radiology, ultrasound, nuclear medicine, laboratory and pathology services or tests
The procedure in which the exposed pulp is covered with a dressing or cement that protects the pulp and promotes healing and repair
Identifying a patient's health care needs after discharge from inpatient care
Voluntarily terminating one's participation in a health benefits plan
See Formulary
A localized inflammation of the tooth socket following an extraction due to infection or loss of a blood clot
When a person has coverage for the same health services under more than one health benefits plan
Equipment that can withstand repeated use and is primarily and usually used to serve a medical purpose, is generally not useful to a person in the absence of illness or injury, and is appropriate for use in the home.
The date on which coverage under a health benefits plan begins.
Provisions contained in each health benefits plan that specify who qualifies for coverage under that plan.
This is the period of time between the date the disability begins and the beginning of the benefit payment period. It is the period during which an employee must be disabled before payment of benefits begins. It is sometimes referred to as the Qualifying Period.
An accident or sudden illness that a person with an average knowledge of medical science believes needs to be treated right away or it could result in loss of life, serious medical complications or permanent disability. Emergencies are covered by your CIGNA HealthCare plan 24 hours a day, seven days a week, no matter where you are. Whenever there's a serious accident or sudden illness, and symptoms are severe and they occur unexpectedly, seek medical help immediately. Examples of emergency situations include: uncontrolled bleeding, seizure or loss of consciousness, shortness of breath, chest pain or squeezing sensations in the chest, suspected overdose of medication or poisoning, sudden paralysis or slurred speech, severe burns, broken bones or severe pain.
An EAP is an assessment and referral program or a short-term counseling program that is pre-purchased by some employers and is available to their employees, their dependents and household members. Visits to the EAP are separate from your behavioral health care benefits plan with no copayment required.
Federal legislation that applies to retirement programs and to employee welfare benefit programs established or maintained by employers and unions.
The hard, calcified (mineralized) portion of the tooth which covers the crown. Enamel is the hardest substance in the body.
The dental specialty that deals with injuries to or diseases of the pulp, or nerve, of the tooth.
An individual who is enrolled and eligible for coverage under a health plan contract. Also called Member.
Group disability coverage is generally sold as "guaranteed issue," which means that evidence of insurability is not required.
Specific conditions or services that are not covered under the benefit agreement.
A specific type of CIGNA health plan with a national network of physicians. Plan members can visit specialists without a referral. Members don't need to choose a primary care physician for coverage. An annual deductible is required, and an out-of-pocket maximum applies. Coverage is not available for out-of-network service.
A type of CIGNA HealthCare benefits plan, offered by Connecticut General Life Insurance Company, in which covered persons select a PCP and receive covered services exclusively from the EPP provider network.
Experimental, investigational or unproven procedures and treatments.
The date indicated in an insurance contract as the date coverage expires.
A statement provided by the health benefits administrator that explains the benefits provided, the allowable reimbursement amounts, any deductibles, coinsurance or other adjustments taken and the net amount paid. A participant typically receives an explanation of benefits with a claim reimbursement check or as confirmation that a claim has been paid directly to the provider.
A medical care institution for patients who require long-term custodial or medical care, especially for chronic disease or a condition requiring prolonged rehabilitation therapy.
When a person's coverage is extended under certain conditions, such as disability, after their group health coverage would otherwise have ended.
Surgical removal of bone or tissue.
There are specific provisions included in group disability plans that preclude coverage in certain situations. Typically, a plan will not pay benefits for disabilities caused by war or a self-inflicted injury.
The overgrowth of normal bone.
Some policies require that employees be totally disabled before payments begin. Other policies pay out for partial disability for a limited time, but most often only if the partial disability follows a period of total disability for the same cause.
The outside of the crown of the tooth.
The removal of a tooth.
The outside of the mouth.
Material used to fill a cavity or replace part of a tooth.
Flexible benefits plan: A type of benefits program that offers employees a menu of benefit options, allowing them to create a benefits package which best suits their individual needs.
An account that reimburses the participant for qualified health costs or dependent care expenses through one pre-tax savings account. Employees or employers or both fund the account. At the end of each year, unused dollars are forfeited by the account holder.
See dental floss.
A chemical compound used to prevent dental decay, utilized in fluoridated water systems and/or applied directly to the teeth.
A list of preferred, commonly prescribed prescription drugs. These drugs are chosen by a team of doctors and pharmacists because of their clinical superiority, safety, ease of use and cost. Also referred to as The CIGNA HealthCare Drug List.
Muscle fibers covered by a mucous membrane that attaches the cheek, lips and or tongue to associated dental mucosa.
The removal of a frenum.
A primary care physician who provides a broad range of routine medical services and refers patients to specialists, hospitals and other providers as necessary. This traditional primary care physician role is called a "gatekeeper" function. Under some benefits plans, a referral by the primary care physician is required to obtain services from other providers.
A prescription drug that has the same active-ingredient formula as a brand-name drug. A generic drug is known only by its formula name and its formula is available to any pharmaceutical company. Generic drugs are rated by the Food and Drug Administration (FDA) to be as safe and as effective as brand-name drugs and are typically less costly.
The soft tissue that covers the jawbone. Also referred to as the gums.
The removal of gingiva (gum).
An inflammation or infection of the gingiva (gum tissue); the initial stage of gum disease.
A surgical procedure to reshape or repair the gingiva (gum).
A piece of tissue or synthetic material placed in contact with tissue to repair a defect or supplement a deficiency.
A health benefits plan that covers a group of people as permitted by state and federal law.
A CIGNA HealthCare benefits option that, under certain circumstances, can provide an in-network level of coverage to covered persons who are temporarily outside of their "home" network service area for 90 days or longer.
See gingiva.
See periodontal disease.
CIGNA HealthCare and Health Alliance Plan (HAP) are working together to provide quality care to CIGNA HealthCare members, whether at home or traveling in the U.S. In Southeast Michigan, CIGNA members have access to the HAP Preferred/PHP network of hospitals, doctors and other providers. In the balance of Michigan and all other states, members have access to the CIGNA HealthCare national network of providers.
The federal agency responsible for administering Medicare and federal participation in Medicaid.
An organization that arranges a wide spectrum of health care services which commonly include hospital care, physicians' services and many other kinds of health care services with an emphasis on preventive care.
Any health care service or program that helps maintain a person's good health. Health maintenance services include all standard preventive medical practices, such as immunizations and periodic examinations, as well as health education and special self-help programs.
A term that has different meanings depending upon the context. "Health plan" can be used to mean an HMO, a health benefits plan provided by an employer to its employees, or a health benefits plan offered to employers by an insurer or third party administrator.
An arrangement in which the participant is reimbursed for covered health expenses by his/her employer up to a predetermined amount. The CIGNA Choice Fund HRA gives the employer flexibility and choice in the way the account is structured and what is covered. It also includes optional incentives for members as well as decision-making tools. Unused amounts may be carried over to the next year, subject to limits set by the employer.
A reimbursement account in which the participant pays for health costs through a fully insured, tax-exempt savings account. Employees or employers or both fund the account. An HSA is subject to regulations mandated by the federal government that limit coverage to IRS section 213(d) medical coverage. All unused amounts carry over indefinitely during a participant's lifetime. The CIGNA Choice Fund HSA includes access to decision-making tools through our secure member portal, myCIGNA.com.
A core set of performance measures developed through the collaborative effort of the National Committee for Quality Assurance (NCQA), employer groups and health care purchasers.
HEDIS is a registered trademark of the National Committee for Quality Assurance.
See metals, classification of.
Health Insurance Portability and Accountability Act of 1996. The law has several parts: The first part addresses health insurance portability and is designed to protect health insurance coverage for workers and their families when they change or lose their jobs. Another part of the law is designed to reduce the administrative costs of providing and paying for healthcare through standardization. The law also includes requirements to protect the privacy of individuals' protected health information. Health plans, providers and other organizations with access to protected health information are covered by the requirements of HIPAA.
Health services rendered in the home to an individual who is confined to the home. Such services are provided to individuals who do not need institutional care, but who need nursing services or therapy, medical supplies and special outpatient services.
A health care facility that provides supportive care for the terminally ill.
An institution whose primary function is to provide diagnostic and therapeutic inpatient services, for a variety of surgical and non-surgical medical conditions. In addition, most hospitals provide outpatient services, including emergency care.
Identification cards are provided to all participants for proper identification under their group health plan. ID card information helps providers verify patient eligibility for coverage.
A denture constructed for immediate placement after removal of the remaining teeth.
An unerupted or partially erupted tooth that is positioned against another tooth, bone or soft tissue so that complete eruption is unlikely.
An alteration of health status, assessed by objective medical criteria. This is a medical finding.
An artificial device, usually made of a metal alloy or ceramic material, that is implanted within the jawbone as a means to attach an artificial crown, denture, or bridge.
The four front teeth referred to as central and lateral incisors, located in the upper and lower jaws and used to cut and tear food. The central incisors are the two large teeth in the middle of the mouth and the lateral incisors are next to the central incisor, one on each side.
A type of health benefits plan under which the covered person pays 100% of all covered charges up to an annual deductible. The health benefits plan then pays a percentage of covered charges up to an out-of-pocket maximum.
A procedure in which the nearly exposed pulp is covered with a protective dressing to protect the pulp from additional injury and to promote healing and repair via formation of secondary dentin.
A cast gold filling that is used to replace part of a tooth.
Any health care provider (physician, hospital, etc.) that belongs to a CIGNA network. Staying in-network gives members the advantage of significant discounts, helping to stretch their account dollars further.
An opportunity for a plan member to earn points toward prizes or extra dollars in the CIGNA Choice Fund HRA. Participating in a disease management program is one way to gain these awards. For others, visit mycigna.com. (Note that incentives apply only to the HRA plan option.)
Term used to describe a condition or the inability to conceive or an inability to carry a pregnancy to a live birth after a year or more of regular sexual relations without the use of contraception.
Treatment accomplished by placing therapeutic agents into the vein, including intravenous feeding. Such therapy also includes enteral nutrition, which is the delivery of nutrients into the gastrointestinal tract by tube.
Care given to a patient admitted to a hospital, extended care facility, nursing home or other facility.
The area between two adjacent teeth.
The area within the crown of a tooth.
A CIGNA subsidiary offering an array of utilization management (UM) and cost containment services. Intracorp is the oldest and largest UM firm in the country.
The inside of the mouth
The JCAHO is an independent, not-for-profit organization whose mission is to improve the quality of care provided to the public through the provision of health care accreditation and related services which support performance improvements in health care organizations. The Joint Commission evaluates and accredits hospitals and health care organizations which provide managed care (including health plans, preferred provider organizations and integrated delivery systems), home care, long-term care, behavioral health care, laboratory and ambulatory care services.
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The area pertaining to or around the lip.
There may be specific provisions included in group disability plans that limit coverage in certain situations. Often only limited benefits are payable for specific conditions or under specific circumstances (for example, mental illness and pre-existing conditions). See also "Mental Illness Limitations" and "Pre-Existing Limitations."
The area pertaining to or around the tongue.
The injection given in the mouth to numb the areas where a tooth or area needs a dental procedure. Often referred to as novocaine.
The range of services typically provided at skilled nursing, intermediate-care, personal care or elder-care facilities.
Medications that are prescribed for long-term treatment of chronic conditions, such as diabetes, high blood pressure or asthma. Maintenance medications are available through Tel-Drug Rx®, CIGNA's mail order service, for up to a 90-day supply and at participating network retail pharmacies for up to a 30-day supply.
The improper alignment of biting or chewing surfaces of upper and lower teeth.
A "mandatory" rehabilitation provision encourages disabled employees to participate in rehabilitation efforts whenever appropriate. Such a provision allows for termination of benefits if the employee refuses to cooperate or participate with a rehabilitation plan.
The lower jaw.
This is a program that covers your mental health and substance abuse care needs. In most cases, in-network benefits need to be pre-authorized by calling the Mental Health/Substance Abuse number on your CIGNA HealthCare ID card. The services that may be covered under the benefit plans are: individual therapy, family therapy, group therapy, psychiatric evaluation, psychiatric medication management, intensive outpatient services, inpatient and partial hospitalization. Benefits plans vary by employer (covered services and number of available outpatient visits and inpatient days each year).
A system of health care delivery that manages the cost of health care and access to health care providers.
The trade name that has become synonymous with any resin bonded fixed partial denture (bridge).
The act of chewing.
The upper jaw.
This is the maximum length of time for which benefits are payable under the plan as long as the employee remains continuously disabled.
This is the highest dollar amount an employee with a disability can receive on a monthly basis under the Long Term Disability plan.
Medical necessity is a term used to refer to a course of treatment seen as the most helpful for the specific health symptoms you are experiencing. The course of treatment is determined jointly by you, your health professional and CIGNA HealthCare. This course of treatment strives to provide you with the best care in the most appropriate setting.
Title XVIII of the Social Security Act that provides payment for medical and health services to the population aged 65 and over regardless of income, as well as certain disabled persons and persons with ESRD.
Hospital insurance provided by Medicare that can help pay for inpatient hospital care, medically necessary inpatient care in a skilled nursing facility, home health care, hospice care and end-stage renal disease treatment.
Medicare-administered medical insurance that helps pay for certain medically necessary practitioner services, outpatient hospital services and supplies not covered by Part A hospital insurance of Medicare coverage. Doctors' services are covered under Part B even if they're provided to a member in an inpatient setting. Part B can also pay for some home health services when the beneficiary doesn't qualify for Part A.
A prescription drug benefit for Medicare-eligible seniors and disabled persons. It was established as part of the Medicare Prescription Drug, Improvement and Modernization Act (MMA) that President Bush signed into law on December 8, 2003. It goes into effect January 1, 2006.
A term used to describe health benefits coverage that supplements Medicare coverage.
An individual or dependent who is enrolled in and covered by a managed health care plan. Also called Enrollee or Beneficiary.
When a disability is caused by a psychological/behavioral/emotional disorder, or by alcoholism or the non-medical use of drugs, benefits may be limited by the disability contract to a period of 12 or 24 months unless the employee is confined to a hospital.
The noble metal classification system has been adopted as a more precise method of reporting various alloys in dentistry commonly used in crowns, bridges and dentures. These alloys contain varying percentages of Gold, Palladium and/or Platinum. High noble contains more than 60% of Gold, Palladium, and/or Platinum (with at least 40% gold); noble contains more than 25% Gold, Palladium and/or Platinum; predominantly base contains less than 25% Gold, Palladium and/or Platinum.
There is usually a minimum amount paid as a monthly benefit after reductions for "Other Income Benefits".
The broad, multicusped back teeth, used for grinding food are considered the largest teeth in the mouth. In adults there are a total of twelve molars (including the four wisdom teeth, or third molars), three on each side of the upper and lower jaws.
An independent, nonprofit organization which assesses the quality of managed care plans, managed behavioral health care organizations and credentials verification organizations.
A group of health care providers under contract with a managed care company within a specific geographic area.
A controlled mixture of nitrogen and oxygen gases (N2O) that is inhaled by the patient in order to decrease sensitivity to pain. Also referred to as laughing gas.
A medical provider who has not contracted with a health plan.
A generic name for the many kinds of anesthetics used in the dental injection, such as Xylocaine, Lidocaine, or Novocaine. See local anesthetic.
An intraoral x-ray taken with the film held between the teeth in biting position.
The chewing surface of the back teeth.
Any contact between biting or chewing surfaces of upper and lower teeth.
Treatment to restore a physically disabled person's ability to perform activities such as walking, eating, drinking, dressing, toileting, and bathing.
A cast gold or porcelain filling that covers one or all of the tooth's cusps.
A period when eligible persons can enroll in a health benefits plan.
A general term used when some benefits are available for out-of-network covered services. Often coverage is less than the coverage available for in-network services, and the covered person has to pay for services up front and then file a claim for reimbursement. The details of such privileges, if they exist, will vary from plan to plan.
The removal of teeth and the repair and treatment of other oral problems, such as tumors and fractures.
A specialized branch of dentistry that corrects malocclusion and restores the teeth to proper alignment and function. There are several different types of appliances used in orthodontics, one of which is commonly referred to as braces.
While disabled, an employee may be eligible for benefits from other sources. Benefits payable under the Long Term Disability plan may be reduced by other sources of income such as Social Security and workers' compensation.
Benefits the health plan provides to covered persons for covered services obtained outside of the network service area. The details of such benefits will vary from plan to plan.
Any health care provider that does not belong to a CIGNA network. Members can use their benefits for out-of-network expenses, but miss out on in-network discounts.
Copayments, deductibles or fees paid by participants for health services or prescriptions.
The most a plan member will pay per year for covered health expenses before the plan pays 100% of covered health expenses for the rest of that year.
Any health care service provided to a patient who is not admitted to a facility. Outpatient care may be provided in a doctor's office, clinic, the patient's home or hospital outpatient department.
A condition in which the upper teeth excessively overlap the lower teeth when the jaw is closed. This condition can be corrected with orthodontics.
The exact amount issued on a bank draft to the provider of service.
The hard and soft tissues forming the roof of the mouth.
Treatment that relieves pain but is NOT curative.
An extraoral full-mouth X-ray that records the teeth and the upper and lower jaws on one film.
A program offered by appropriately-licensed facilities that includes either a day or evening treatment program, usually for mental health or substance abuse.
A removable appliance used to replace one or more lost teeth.
A person who is eligible to receive health benefits under a health benefits plan. This term may refer to the employee, spouse or other dependents.
The unique identifier associated with a participant.
A physician, hospital, pharmacy, laboratory or other appropriately licensed facility or provider of health care services or supplies that has entered into an agreement with a managed care entity to provide services or supplies to a patient enrolled in a health benefit plan.
The specialized branch of dentistry that deals solely with treating children's dental disease. Also referred to as pedodontics.
Claims that require additional information prior to completing the adjudication process due to a specific reason code.
The area that surrounds the root tip of a tooth.
An inflammation of the gum tissue around the crown of a tooth, usually the third molar.
Relating to the tissue and bone that supports the tooth (from peri, meaning "around," and odont, "tooth").
The inflammation and infection of gums, ligaments, bone, and other tissues surrounding the teeth. Gingivitis and periodontitis are the two main forms of periodontal disease. Also called gum disease or pyorrhea.
An abnormal deepening of the gingival crevice. It is caused when disease and infection destroy the ligament that attaches the gum to the tooth and the underlying bone.
A surgical procedure involving the gums and jawbone.
The dental speciality that deals with and treats the gum tissue and bone that supports the teeth.
Inflammation of the supporting structures of the tooth, including the gum, the periodontal ligament, and the jawbone.
The area which surrounds a portion of the root of the tooth.
The thirty-two adult teeth that replace the baby, or primary teeth. Also known as secondary teeth.
Rehabilitation concerned with restoration of function and prevention of physical disability following disease, injury or loss of body part.
A recessed area found on the surface of a tooth, usually where the grooves of the tooth meet.
A film of sticky material containing saliva, food particles, and bacteria that attaches to the tooth surface both above and below the gum line. When left on the tooth it can promote gum disease and tooth decay.
A health plan allowing the member to choose to receive a service from a participating or non-participating provider, with different benefits levels associated with the use of participating providers.
The group or individual to whom an insurance contract is issued.
An artificial tooth used in a bridge to replace a missing tooth.
The process through which the reviewer evaluates the attending physician's request for admission to an acute care hospital and length of stay. Medical necessity is determined using established criteria. If PAC/CSR is part of the health benefit plan, the admission or continued stay must be certified for full payment of a claim.
The process of obtaining certification from the health plan for routine hospital stays or outpatient procedures. The process involves reviewing criteria for benefit coverage determination.
This is the amount of an employee's wages or salary that was in effect and covered by the plan on the day before the disability began.
A health condition (other than a pregnancy) or medical problem that was diagnosed or treated before enrollment in a new health plan or insurance policy.
When an employee has a physical or mental condition that existed prior to the effective date of his or her insurance coverage, it is considered a pre-existing condition. Most plans exclude or decrease disability benefits for an illness or injury for which an employee received medical treatment or consultation within a specified time period before becoming covered under the plan. The limitation generally expires after coverage has been in effect for a specified period of time.
Another name for bicuspid.
An account in which contributions are subtracted from an employee's pay before withholding income tax and Social Security. This ultimately reduces the account-holder's tax liability, since taxes are based on income minus the account contribution.
A specific type of CIGNA health plan with a national network of physicians. Plan members can visit physicians both in and out of the network, and can visit specialists without a referral. Members don't need to choose a primary care physician for coverage. An annual deductible is required, and an out-of-pocket maximum applies.
A drug that has been approved by the Federal Food and Drug Administration which can only be dispensed according to physician's prescription order.
Medical and dental services aimed at early detection and intervention.
Education and treatment devoted to and concerned with preventing the development of dental disease.
Any action taken by the patient, assisted by the dentist, hygienist, and the office staff that serves to prevent dental or other disease. Sealants, cleanings and space maintainers are examples of preventive treatment.
The basic, comprehensive, routine level of health care typically provided by a person's general or family practitioner, internist or pediatrician.
A physician, usually a family or general practitioner, internist or pediatrician, who provides a broad range of routine medical services and refers patients to specialists, hospitals and other providers as necessary. Under some benefits plans, a referral by the primary care physician is required to obtain services from other providers. Each covered family member chooses his or her own PCP from the network's physicians.
The first set of teeth that humans get, lasting until the permanent teeth come in. Also referred to as deciduous teeth or baby teeth.
See Precertification
The scaling and polishing procedure performed to remove calculus, plaque, and stains from the crowns of the teeth.
A device that replaces all or a part of the human body because a part of the body is permanently damaged, is absent or is malfunctioning.
The dental specialty dealing with the replacement of missing teeth and other oral structures.
A licensed health care facility, program, agency, physician or health professional that delivers health care services.
Provider directories are listings of providers who have contracted with a managed care network to provide care to its participants. Participants may refer to the directory to select in-network providers. You can search the CIGNA HealthCare Provider Directory.
A panel of providers contracted by a health plan to deliver medical services to the enrollees.
The hollow chamber inside the crown of the tooth that contains its nerves and blood vessels.
Removal of the entire pulp from the canals in the root.
An often painful inflammation of the dental pulp or nerve.
The removal of a portion of the tooth's pulp.
The dental term for the division of the jaws into four parts, beginning at the midline of the arch and extending towards the last tooth in the back of the mouth. There are four quadrants in the mouth; each quadrant generally contains five to eight teeth.
The process of refitting a denture by replacing the base material.
A condition characterized by the abnormal loss of gum tissue due to infection or bone loss.
The recurrent disability provision is designed to protect an employee who tries to return to work but becomes disabled again from the same or a related cause. If this happens within a certain period of time, the employee will be considered disabled from the original disability, and will not be subject to a new elimination period. This encourages an employee to return to work without fear of losing benefits.
When a dental patient from one office is sent to another dentist, usually a specialist, for treatment or consultation.
Rehabilitation means the restoration of or improvement in an employee's health and ability to perform the functions of his or her job. It usually involves a program of clinical and vocational services with the goal of returning employees to a satisfying occupation if possible.
The process of resurfacing the tissue side of a denture with a base material.
The return of a tooth to its socket.
Residual benefits can help make up the difference in income if an employee is able to work, but limited in his/her responsibilities due to his/her disability.
The breakdown and assimilation of the bone that supports the tooth, i.e., bone loss.
Any material or devise used to replace lost tooth structure (filling, crown) or to replace a lost tooth or teeth (bridge, dentures, complete or partial).
A removable dental appliance, usually used in orthodontics, that maintains space between teeth or holds teeth in a fixed position until the bone solidifies around them.
A method of sealing the root canal by preparing and filling it from the root tip, generally done at the completion of an apicoectomy.
To encourage employees to return to work as soon as they become physically able, an additional incentive is usually provided for a certain period of time, and is called a return to work provision. Under this provision, the employee can receive up to 100 percent of pre-disability earnings based on a combination of disability benefits, other benefits, income and return-to-work earnings.
The part of the tooth below the crown, normally encased in the jawbone. It is made up of dentin, includes the root canal, and is covered by cementum.
The hollow part of the tooth's root. It runs from the tip of the root into the pulp.
The process of treating disease or inflammation of the pulp or root canal. This involves removing the pulp and root's nerve(s) and filling the canal(s) with an appropriate material to permanently seal it.
The process of scaling and planing exposed root surfaces to remove all calculus, plaque, and infected tissue.
A procedure used to remove plaque, calculus and stains from the teeth.
A composite material used to seal the decay-prone pits, fissures, and grooves of children's teeth to prevent decay.
A CIGNA HealthCare program an employer may purchase in connection with some CIGNA HealthCare benefits plans which can reduce the incidence of unnecessary surgery by providing participants with second opinions.
The geographical area covered by a network of health care providers.
The first permanent tooth to erupt, usually between the ages of five and six.
A licensed facility that provides nursing care and related services for patients who do not require hospitalization in an acute care setting.
The hole in the jawbone into which the tooth fits.
A dental appliance that fills the space of a lost tooth or teeth and prevents the other teeth from moving into the space. Used especially in orthodontic and pediatric treatment.
Providers whose practices are limited to treating a specific disease (e.g., oncologists), specific parts of the body (e.g., ear, nose and throat), a specific age group (e.g., pediatrician), or specific procedures (e.g., oral surgery).
Treatment to correct a speech impairment that resulted from birth or from disease, injury or prior medical treatment.
An HMO where doctors are employed by the health plan and provide care at a health care center facility.
A pre-made metal crown, shaped like a tooth, that is used to temporarily cover a seriously decayed or broken down tooth. Used most often on children's teeth.
A lifestyle event that may cause a person to modify their health benefits coverage category. Examples include, but are not limited to, the birth of a child, divorce or marriage.
The removal of calculus and plaque found on the tooth below the gum line.
The date the claim was submitted and/or received by CIGNA HealthCare.
The removal of calculus and plaque found on the tooth above the gum line.
Relating to the whole body.
See calculus.
See CIGNA Tel-Drug.
The connecting hinge mechanism between the upper jaw and the base of the skull.
The problems associated with TMJ, usually involving pain or discomfort in the joints and ligaments that attach the lower jaw to the skull or in the muscles used for chewing.
The last of the three molar teeth, also called wisdom teeth. There are four third molars, two in the lower jaw and two in the upper jaw, one on each side. Some people are born without third molars.
A bony elevation or protuberance of normal bone. Usually seen on the upper palate behind the front teeth or under the tongue inside the lower jaw.
When an employer changes insurance carriers, transition plans enable participants already in treatment to transition to an in-network health provider. It gives the patient and their current provider a specific number of days to contact CIGNA HealthCare in order to discuss the patient's treatment plan and obtain authorization to continue treatment at the in-network benefit level for a specified period of time, or to transition to a contracted professional.
A list of the work the dentist proposes to perform on a dental patient based on the results of the dentist's X rays, examination, and diagnosis. Often more than one treatment plan is presented.
A program that offers members a comprehensive open access benefit plan with the protection they need wherever they need it - throughout the country. Members in these plans can access a broad provider network consisting of Tufts Health Plan-contracted providers in Massachusetts and Rhode Island and CIGNA HealthCare-contracted providers in all other states. Members also have freedom of choice that allows them to see any provider - in or out of the network - when out-of-network coverage is part of the plan.
When prompt medical attention is needed in a non-emergency situation, that's called "urgent" care. Examples of urgent care needs include ear infections, sprains, high fevers, vomiting and urinary tract infections. Urgent situations are not considered to be emergencies.
The amount reimbursed to providers based on the prevailing fees in a specific area.
An artificial filling material, usually plastic, composite, or porcelain, that is used to provide an aesthetic covering over the visible surface of a tooth. Most often used on front teeth.
In order to become eligible for coverage under the policy, an employee must satisfy a certain number of continuous days of service as an active, full-time employee. This is known as the waiting period. In addition, a waiting period can also be the time period between when a disability occurs and when payments from the disability insurance policy begin.
When an individual becomes disabled and eligible for benefits, no further disability premium payments are required as long as benefits are being paid out.
See third molar.
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