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Today, corporations are going through significant changes and turmoil with what often appears to be continual restructuring, reengineering and downsizing. Corporations are learning to be competitive. I believe it is a time of crisis. But as the Chinese word for "crisis" is composed of two picturecharacters one meaning danger and the other meaning opportunity we can seize opportunity if we are willing to take some risks.
This article focuses on the steps an organization should take once it has identified its vision. Vision is defined as the concept or picture of what your organization can or should be; it requires that you fulfill the unmet needs of your customers. For an organizational unit to be successful, its vision needs to be placed in the context of the larger visions of the corporate organization, and those responsible for achieving the mission need to understand how it meshes with that of the larger organization.
How do you create the reality that your vision forecasts? What do you need to do? How do you get there from here? If you manage the risks and take advantage of opportunities, you will be able to turn your vision into reality.
Though the path to achieving your vision is usually not obvious, with the benefit of hindsight, one can often work back through the decisions that were made, the actions implemented and the resultant success and see a logical progression. As you proceed through the visioning process, you will often wonder what the next appropriate step is. Will it be successful? It won't always be. It is a risk. But, let me offer some general guidance that can help you achieve your vision.
Corporate cultures are different. The background, education and training of the individuals in your organization are different; and each person is in a different place regarding the development of his or her individual potential. As a result, how the challenges and opportunities will be met is likely to be different for each information services (IS) department.
Despite the variability of organizations, four general issues need to be addressed by all organizations:
Phase 1: Analyze Your Organization
The first phase requires a tactical approach and addresses the first issue, recognizing the capabilities of your current organization. This phase defines a current state and is largely descriptive. The traditional approach to defining the current state of IS involves enumerating a list of services such as:
Data Modeling. Conceptual data modeling is a technique used to represent, interpret and understand data important to a business or function. It helps you understand what information is needed to operate your function and identifies the commonality that exists within your organization or function. It provides a first step to understanding where redundant work is being performed and indicates potential business simplification or integration opportunities. Process models reflecting the current state can identify basic work flow and offer similar opportunities.
Core Competencies. Next, what knowledge, skills and abilities does your staff have? This provides the basis for defining your core competencies, those underlying capabilities that allow you to be effective information professionals. Information professionals enable better corporate business decisions by selecting, organizing, analyzing and retrieving the information needed in decisionmaking. It is critical that you understand your core competencies and distinguish them from core skills. Core competencies will remain relatively stable over time, while the core skills needed to implement them will change.
Value Adding Chain. Developing a valueadding chain can be useful in accomplishing the objectives of Phase 1. It captures the inputs or raw materials you need, reflects the fact that your organization or function transforms those inputs from various suppliers and produces products at several levels, and shows who your customers are. Do you serve research or development? Do you provide technical support to manufacturing or sales? Do you focus on business, legal or financial aspects? Understanding whom you intend to serve is critical. The valueadding chain is also a tool that corporate management readily recognizes and understands.
Next, determine which services provide the most value. This requires talking to your customers to understand their needs and values, which may differ for each organization. In our analysis, we found that our customers need and value the following things:
Phase 2: Develop Your Organization
Phase 2 evaluates how your organization measures up. The results of this analysis will help you recognize the decisions that need to be made and the changes that must occur. It requires a hard and honest look at your organization. This process is likely to be painful, but it is absolutely critical. For the results of Phase 2 to be successful, you must operate at a more strategic level, taking a broader view of the IS organization: what it does and how it fits into the larger picture within the corporation.
A clear mission statement and/or business definition is a necessary foundation to provide the context in which you will evaluate your organization. The conceptual data model and process models you created in Phase 1 will help you understand how your organization works from a functional, rather than an activitybased, position. It also lets you create a picture that reflects your future state.
Does your staff possess the necessary core competencies as you have defined them in Phase 1? If so, are they aware of it? If they do not possess them, what education or training do they need to develop the appropriate core competencies? If they already possess them, do they recognize that they possess them, and do they recognize the power that gives them and the organization? Do they understand how transferable that knowledge is to solving broad information problems?
How might you develop that recognition? Discussion and validation of the core competencies and models can help create that awareness. Have you shared your vision? Is it their vision too? Taking the opportunity to help individuals understand when they have applied their core competencies empowers you and your staff. Don't let your staff take themselves and their knowledge and capabilites for granted. Make sure that the information professionals recognize their role and responsibility to be the resource that enables improved corporate decision making.
Focusing on valueadded tasks that require your core competencies may require you to recognize and make hard decisions about outsourcing or eliminating certain work. It may require that you downsize in one area to increase capability in another. If people do not have the appropriate capabilities and will not or cannot develop them, you may need to replace them. It is difficult to get people to stop doing what they have always done. Focusing on and prioritizing the most critical valueadding tasks is necessary in developing a strategy that takes innovations and moves them to implementation.
Finally, is your organization accountable? Have you established the tools for capturing the work you do? Have you developed adequate ways to measure your contributions and successes? Accountability is critical to your credibility. Everyone in your corporation has to accomplish more with less. You need to be able to help members of the corporation understand the value of the dollars they spend with your organization. You need to recognize that they are your customers.
Phase 3: Value and Develop Your People
Although the process described in this article is laid out as a series of phases, some can be worked on concurrently. I encourage you to start Phase 3 as soon as possible. As the leader of an organization, you need to take every opportunity to understand what leadership really means and to develop leadership qualities. A vision can only be realized if you understand how important people are. Develop strong communication skills and recognize that you need to communicate at many levels. A firm belief in people and teamwork and a commitment to consensusbuilding will help you achieve your vision. Personal integrity and credibility are critical. In many cases, the opportunities your organization confronts will depend in part on the management's view of the organization's leader. Dedication, perseverance, patience, faith they will all help you get there.
Strive to be the type of leader who helps people so that eventually they don't need you. The best leader helps others learn what they need to do to develop their potential and improve performance and effectiveness. Your role is to help them discover what they want to do. Give them the freedom to believe in what they are doing and to enjoy their work. Unleash the tremendous power of accomplishment that each individual possesses.
Spend time sharing your vision with all the members of your organization until the vision becomes theirs. You need to spend the time developing a shared understanding of empowerment. Empowerment is critical to success, but the definition of empowerment must be understood or the result may be anarchy. My definition of empowerment is understanding and supporting the vision, mission and goals of an organization and using that knowledge to gain critical information, understand the potential impact of the decision on the larger organization and ultimately make a decision that can be supported and that moves the organization closer to its vision.
Communicate all that you can to members of your organization. Information is critical to successfully empowering yourself and your staff. Seek the information you need and share it openly with your organization. Make the time to give your staff all the attention they need. Value them and believe in them. Your primary function as the leader of the organization is to support your people. They are the ones who actually make it happen.
Develop accountability in your people. "Accountability is the recognition and acceptance that one is answerable for whatever happens within a given area of activity, regardless of the cause." (PRYOR REPORT, Clemson, S.C.: Pryor Resources, Inc., January, 1993.) Expect your people to be accountable and give them the authority they need.
As an information manager, your primary responsibility is to support your people, and your people need to understand that their primary responsibility is to serve their customers. This includes a broad understanding that customers include those who need or use the end products of the IS department, as well as their colleagues within the function.
You and your staff need to take the time to think about what you are trying to accomplish. Take the strategic view. Develop leadership in yourself and your staff, value your people, recognize that each member's role is critical to the success of the overall organization, empower them and make them accountable. Share your knowledge. Celebrate the small victories. Put 110% of your abilities into everything you do.
Phase 4: Maintain and Develop Your Sphere of Influence
You need resources. If you have demonstrated the value of the IS organization, if you have made the difficult decisions necessary for the effective evaluation and restructuring of IS, if you have demonstrated creativity and have sought to do the right thing, if your organization is prepared, if you have communicated frequently and well, then your organization will likely receive the resources, support and recognition you need. You must develop judgment to know when to fight and when to back off, and you must clearly recognize the sphere of your influence. Identify the decisionmakers in your corporation and be sure that you are talking to them. Make sure your users know about the quality and breadth of your services, but be absolutely sure that the decisionmakers know your organization is costeffective and that they understand the value you bring. Pursue the areas where you can be successful and have the greatest impact, and communicate, communicate, communicate up, down and sideways. It is not good enough to address the first three issues. It is not good enough to have answered the hard questions well. It is not good enough to have a crackerjack staff. Without communication your chance of success will be very limited.
Achieving Reality
So do your homework, understand your IS organization, make the needed changes, develop your own and your staff's leadership capabilities, empower your staff with knowledge and understanding, and communicate, communicate, communicate. Today your parent organization really needs you. The information function is critical to the success of corporations. It takes a great deal of energy and commitment, but the view is definitely worth the climb.


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- Accountable Care Organization (ACO)
- A group of doctors who work together to manage patient care. Health care reform law offers incentives for doctors to form Medicare ACOs starting in 2012.
- Accreditation
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).
- Active, full-time employee
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.
- Adjudication
The administrative procedure used to process a claim for service according to the coverage.
- Administrative Services Only (ASO)
An arrangement in which an employer contracts with a third party, typically a health care carrier, to administer the health care plan for the employer who assumes the benefit plan claim risk. In an ASO arrangement, the third party processes the claims on the employer's behalf and the funds to pay the claims come from the employer. This is also referred to as self funded.
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- Advanced radiological imaging
Highly technological radiology procedures performed in an office or hospital-like setting.
- Allowable charge
The health care professional's billed charge or primary carrier's negotiated fee.
- Alternative birthing center
An organization offering a "non-traditional" ("not like a hospital") setting for giving birth. 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. They allow the father to participate more. They're also more flexible than hospitals in allowing changes to the standard procedures followed during a birth.
- Amalgam
A dental filling material, composed of mercury and other minerals, used to fill decayed teeth.
- Ambulatory care
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.
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- Ambulatory surgery
Surgical procedures that do not require an overnight hospital stay. Procedures can be performed in a hospital or a licensed surgical center. Also called outpatient surgery.
- America's Health Insurance Plans (AHIP)
A national trade group that represents 1,300 health insurance companies. (Note: Cigna is a member.)
- American Dental Association (ADA)
A professional association of dentists dedicated to serving the public and the profession of dentistry.
- American Medical Association (AMA)
A professional association of physicians dedicated to promoting the art and science of medicine and the improvement of public health.
- Ancillary care
Diagnostic and/or supportive services such as radiology, physical therapy, pharmacy or laboratory work.
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- Anniversary date
The day after a plan year ends. Usually, the month and day that coverage first goes into effect becomes its anniversary date each year.
- Annual limits-health care reform
Under health care reform, annual limits on essential health benefits for plans that begin on or after September 23, 2010 must be at least $750,000. Beginning September 23, 2011, the limit is $1.25 million and for September 23, 2012, it is $2 million. Reform does not allow annual minimum dollar limits for most plans beginning starting in 2014.
- Annual limits waiver
Employers and insurance companies can request a waiver to continue offering health plans with annual dollar limits until 2014. Waivers are available if removing the limits would reduce access to benefits or increase premiums. Only plans in effect on September 23, 2010 are eligible. No annual limits are allowed in 2014.
- Annual out-of-pocket maximum
The most a customer will pay per plan year for covered health expenses before the plan pays 100 percent of covered health expenses for the rest of that plan year.
- Appeals
A patient's request that the health plan review or change a claim decision or grievance again.
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- Appeals and external review
All health plans must have a standard internal appeal process and an external review process for denied claims.
- Assignment of coverage
When a covered person requests that their claim payments are made directly to a health care professional for covered services. Traditional health insurance coverage pays claims directly to the dependent.
- A-testing
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).
- Authorization
See Precertification: Getting approval from the health plan before a routine hospital stay or outpatient procedure. In precertification, Cigna reviews medical criteria to determine coverage. Also referred to as prior authorization.
- Automatic enrollment
Employers with more than 200 full-time employees will be required to enroll new full-time employees in a health plan. Employees will be enrolled in the plan with the lowest employee premium unless they opt out or choose another plan. Plans can have a waiting period before benefits begin.
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- Behavioral care services
Assessment and therapeutic services used to treat mental health and substance abuse problems.
- Beneficiary
A person who is eligible to receive coverage. Sometimes "beneficiary" is used for eligible dependents enrolled under a coverage plan; "beneficiary" can also be used to mean any person eligible for coverage, including both employees and eligible dependents.
- Biopsy
A process of removing tissue to determine if it is healthy or not.
- Bitewing X-rays
X-rays taken of the crowns of teeth to check for decay.
- Board-certified
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.
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- Bonding
A process to chemically etch the tooth's enamel to better attach (or bond) composite filling material, veneers or plastic/acrylic.
- Brand-name drug
A drug manufactured by a pharmaceutical company that's chosen to patent the drug's formula and register its brand name.
- Bridge
A non-removable dental solution used to replace missing teeth.
- Brush biopsy
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.
- Cancellation of coverage (rescissions)
Health plans cannot retroactively cancel coverage. The only exceptions are for fraud or false statements. Thirty days advance notice must be given before coverage ends.
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- Cap/crown
The portion of a tooth covered by enamel. Also a dental solution that covers the entire tooth and restores it to its original shape. Cap usually refers to a crown for a front tooth.
- CareLink®
A program that offers customers access to a national network of health care professionals, hospitals and clinics. Customers in these plans can access a broad network consisting of Tufts Health Plan-contracted services in Massachusetts and Rhode Island and Cigna-contracted services in all other states. Customers can also choose to see any health care professional (in- or out-of-network) when out-of-network coverage is part of the plan.
- Care management
Used by Cigna, "care management" refers to a Cigna initiative that takes a holistic approach to medical care from prevention through treatment and recovery.
- Carrier
A term historically used for licensed insurance companies. Today sometimes it is used to include both licensed insurers and health maintenance organization (HMOs).
- Case management
Coordination and ongoing review of services to help make sure care is appropriate and meets a customer's health care needs. Case management is usually done when the customer has a condition that involves multiple services from several health care professionals. This term is also used to refer to coordination of care during and after a hospital stay, including preparing a discharge plan and following up after higher risk procedures.
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- CDHP (consumer-driven health plan)
A health care model in which customers are made aware of the true costs and value of health care, so that they can make informed decisions that balance choice with cost. Health plans that fall in this category may include flexible spending accounts (FSA), health savings accounts (HSA) and health reimbursement accounts (HRA).
- Centers of Excellence
Cigna 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. Through our provider directory, you can compare hospitals in your area for cost and quality.
- Certification
See Precertification
- Charge amount
The amount a health care professional bills for services to a customer.
- Chemotherapy
A cancer treatment that uses drugs (chemical or biological antineoplastic agents) to help control or stop the growth and spread of cancerous cells.
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The name derived from Connecticut General Corporation and Insurance Company of North America when they combined their operations in 1982. This is a service mark used by one or more of the Cigna group of operating subsidiaries.
- Cigna Behavioral Health, Inc. (formerly MCC Behavioral Care)
Part of the Cigna division which offers Employee Assistance Programs (EAP), as well as mental health and substance abuse coverage management. Cigna Behavioral Health, Inc. provides access to services through a national contracted network, as well as a dedicated team of internal health care professionals.
- Cigna Care Network®
A network of specialists selected from Cigna's broad network of participating health care professionals. In certain specialties, Cigna Care Network includes doctors who meet specific criteria in the areas of quality, number of Cigna customers treated, efficiency and customer access.
- Cigna Choice Fund®
A product name used to describe Cigna's Preferred Provider Organization (PPO), Open Access Plus (OAP), LocalPlus, Exclusive Provider Organization (EPO) or Indemnity health plans when they are combined with a compatible Health Reimbursement Account (HRA), Health Savings Account (HAS) or Flexible Spending Account (FSA).
- Cigna Dental
A division of Cigna that offers dental plans including dental indemnity, preferred (PPO) and managed care (DHMO) dental coverage and services.
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- Cigna Health Access
A type of health coverage plan underwritten by Cigna Health Maintenance Organizations (HMOs) and Connecticut General Life Insurance Company, which combines the coverage of an HMO with traditional health insurance coverage. This coverage plan design allows employees and their covered dependents to enjoy all the advantages of an HMO, while still providing limited coverage to participating individuals who go outside the HMO network to receive health care services.
- Cigna Health Advisor®
Through Cigna Health Advisor®, nurses offer customers personal assistance, expertise and guidance related to wellness and prevention to help customers achieve their health-related goals and make the most of their health benefit plans.
- Cigna Home Delivery Pharmacy
The Cigna mail order prescription service that provides customers with up to a 90-day supply of their prescription drugs.
- Cigna LIFESOURCE Transplant Network®
A national organ transplant network, developed by Cigna, designed to give participants access to quality care for heart, heart/lung, liver, kidney/pancreas and bone marrow transplants.
- Claim
A payment request to the health plan for covered services provided to an individual enrolled in the health plan. A claim can be submitted by the patient, the patient's representative or by the health care professional who provided the service.
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- Claim status
A term used to describe where the claim is during the claim payment process. The claim could be paid, not paid, in-progress or waiting for action (for example, the doctor must provide more information before the claim can be processed).
- Clenching
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.
- Clinical practice guidelines
These are general guidelines that are made by a team of doctors in a medical field, such as radiology or cardiology. Clinical practice guidelines help other doctors determine acceptable treatments for certain diseases or conditions.
- Cognitive service
Diagnostic services a doctor provides during delivery of medical services, consultations or care.
- Coinsurance
The percentage a covered person must pay (for example, 20 percent) of the allowed amount for covered health services after the health plan begins to pay, usually once the plan deductible has been met. This may also refer to the percentage of covered expenses paid by a health benefit plan.
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- Comparative effectiveness research fee (2012)
A tax on health plans to fund research. The tax is currently $1 per enrollee. For plan years that start after October 1, 2012, it will be $2. The fee increases each year. It will not be collected after 2019.
- Complex rehabilitation
This is the extensive dental repair of six or more units of crown and/or bridge within the same treatment plan. Using full crowns and/or fixed bridges that are cemented in place, the dentist rebuilds natural teeth, fills in spaces where teeth are missing and helps each tooth function along with the occlusion (bite). This procedure involves a large amount of time, effort and skill.
- Composite
A tooth-colored filling made of plastic resin or porcelain
- Congressional Budget Office (CBO)
A federal agency that gives Congress impartial data to help make decisions about the federal budget.
- Consolidated Omnibus Budget Reconciliation Act (COBRA)
A federal law that allows people to continue benefits for a period of time after group health coverage ends. COBRA applies after a job loss, reduction in hours, death or divorce. The person usually pays the entire premium plus two percent.
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- Consultation
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.
- Consumer-Driven Health Plan (CDHP)
A health plan that educates people about costs so they can make informed decisions. CDHPs usually offer a compatible Health Reimbursement Account or a tax-advantaged Health Savings Account with a qualified high deductible health plan.
- Contract
An agreement that sets out the rights and obligations, including the financial obligations, agreed to between the contracting parties.
- Conversion option
The option to purchase individual coverage offered to a person who will no longer be eligible for coverage through an employer-sponsored group health plan.
- Coordination of benefits
When a person is covered under more than one insurance or health plan. It requires that carriers coordinate with one another to correctly consider benefits for all services payable.
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- Copay
The amount a customer pays towards a doctor's visit. The amount can vary based on the health plan coverage terms and the type of covered health service received.
- Cosmetic dentistry
Any dental treatment or repair that is done solely to improve the appearance of the teeth or mouth.
- Cost-sharing reduction
Cost-sharing reductions help lower your out-of-pocket costs for deductible and coinsurance for specific medical expenses like prescriptions and doctor's visits.
- Coverage
When a person signs up for a health plan, the plan provides protection ("coverage") for medical expenses the person or any dependents may incur during the plan year.
- Coverage end date
The day a plan's features and provisions end.
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- Coverage package
A term informally used to refer to the employer's coverage plan or to the coverage plan options from which the employee can choose.
- Coverage percentage
Typically used when referring to disability plans, this amount is usually determined as a percentage of the employee's pre-disability income up to an overall maximum amount.
- Coverage year
See Plan Year: Generally, any 12-consecutive-month period determined by the plan under which coverage is provided per the plan documents.
- Covered services
The services the health plan will pay for according to the agreement between the health care carrier and either the employer group or the individual.
- Credentialing
A process that reviews a health care professional's credentials against the credentials required to participate in a managed care network. To participate in a Cigna network, doctors and health care organizations are thoroughly credentialed before being admitted and are recredentialed. They must meet specific criteria for continued participation in a Cigna health care professional network.
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- Custodial care
Care provided primarily to meet the personal needs of a patient. The care is not meant to improve health or provide medical treatment.
- Customer
A person who is covered by a health plan. This term may refer to the person who enrolled in the plan, his or her spouse/partner or any other dependents who are eligible to enroll in the plan.
- Customer ID
The unique identifier associated with a customer.
- Date of service
The date the customer received the service.
- Day treatment center
An outpatient hospital or clinic licensed to provide care and treatment without the customer staying overnight. These centers usually treat people who suffer from mental or nervous disorders or substance abuse.
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Doctor of Dental Surgery or DMD, Doctor of Dental Medicine. These are educational degrees given to dental school graduates. Some dental schools identify their graduates as DMDs, while other schools confer a DDS. The degrees are the same.
- Deductible
An individual deductible is the amount a covered person needs to pay each plan year before the plan starts paying for covered services. A family deductible is the total amount the enrollee and their covered dependents need to pay each plan year before the plan starts paying for covered services.
- Delegation
Delegation is a formal process by which Cigna gives another firm the authority to perform the claims payment administration on behalf of Cigna.
- Denied claim
When services aren't covered under the customer's plan, the claim is denied. Cigna doesn't pay the claim but explains why the claim wasn't paid on the Explanation of Benefits (EOB).
- Dental floss
A thin, nylon string, waxed or unwaxed, that is inserted between teeth to remove food and plaque.
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- Dental hygienist
A dental professional specializing in cleaning teeth by removing plaque, calculus and diseased gum tissue. The dental hygienist acts as the patient's guide in establishing a proper oral hygiene program.
- Denture
A removable appliance used to replace teeth. A complete denture replaces all of the upper teeth and/or all the lower teeth.
- Dependent
A person, usually a spouse, partner, children or adopted children, who depends on another person for health coverage and who may be eligible for coverage under a health plan because of his or her relationship to the person enrolled in a health plan.
- Dependent coverage to age 26
Health plans that cover dependents must offer coverage up to age 26. Coverage is available regardless of marital or student status, residency or financial dependence on a parent.
- Designated centers for specialized care
Medical centers selected to provide an advanced level of care for a disease or delivery of a specific procedure. For example, Cigna LIFESOURCE Transplant Network® is made up of 13 nationally acclaimed hospitals, including Johns Hopkins University Medical Center and the UCLA Medical Center.
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- Designated Provider Program (DPP)
A Cigna point-of-service product. Each customer chooses a Cigna-affiliated primary care physician (PCP), but has the added convenience of going outside the network for care at any time. The coverage for out-of-network care is reduced, as an incentive to stay in the network, and is subject to deductibles and coinsurance.
- Diagnostic tests or tools
Tests and procedures ordered by a doctor to help diagnose or monitor a patient's condition or disease. Diagnostic tools include radiology, ultrasound, nuclear medicine, laboratory and pathology services or tests.
- Disability
The definition of this term varies greatly by coverage plan. It's one of the most important provisions in a disability contract because it determines an employee's eligibility for coverage. Here are a couple common types of disability:
Total disability: Any occupation (any occur). Under this definition, an employee is considered disabled only if unable to work in any occupation for which she or he is qualified by education, training or experience. This is closely related to the definition that the Social Security Administration uses in determining disability.
Partial/residual 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, she or he will still be eligible for limited coverage under the plan. Not all disability carriers use this terminology to describe a "part-time" work situation, but most provide some type of coverage to encourage return to work.
- Discharge planning
Identifying a patient's health care needs after discharge from inpatient (hospital or other health care clinic) care.
- Disenrollment
Voluntarily ending one's participation in a health coverage plan.
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- Doctor Choice (2010)
Adults can name any network doctor as their primary care physician (PCP). Children can name a pediatrician as their PCP.
- Dollar Limits: Annual and Lifetime (2010)
- Health plans cannot have lifetime limits on essential health benefits.
- Health plans can have annual limits on essential health benefits until 2014. These limits are allowed for plan years that begin on or after these dates:
- September 23, 2010-$750,000
- September 23, 2011-$1.25 million
- September 23, 2012-$2 million
- 2014-No annual dollar limits allowed
- Plans can request a waiver to have a lower annual limit until 2014.
- Drug formulary
See Formulary: A list of preferred, commonly prescribed prescription drugs. These drugs are chosen by a team of doctors and pharmacists because of the drugs' clinical superiority, safety, ease of use and cost. Also referred to as the Cigna Drug List and the Cigna Prescription Drug List.
- Duplicate coverage
When a person has coverage for the same health services under more than one coverage plan.
- Durable medical equipment
Equipment that can withstand repeated use, 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 as prescribed by a doctor.
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- Early Retiree Reinsurance Program (ERRP)
To encourage employers to offer health insurance to early retirees, companies can be paid for some of the cost. Early retirees are between the ages of 55 and 64. As of May 5, 2011, companies can no longer apply for the ERRP.
- Effective date
The date on which coverage under a plan begins (also called start date).
- Eligibility
Details contained in each health coverage plan that specify who qualifies for coverage under that plan.
- Eliminating the Medicare Part D coverage gap (Donut Hole)
The Medicare Part D coverage gap is when people reach the limit of their prescription drug benefit and must pay 100 percent of drug costs. Once they reach Medicare's catastrophic coverage level, they would again have prescription drug benefits. Before 2010, retirees paid 100 percent of their drug costs in the gap. In 2011, retirees pay 50 percent of the cost of brand-name drugs and 93 percent of the cost of generic drugs. The gap closes each year. By 2020, the percent retirees pay for generic drugs will be 25 percent.
- Elimination period
This is the period of time between the date the disability begins and the beginning of the coverage payment period. It's the period during which an employee must be disabled before payment begins. It is sometimes called the qualifying period.
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- Emergency care
This is the acute care of patients who have not had a prior appointment for their condition. Emergency care must be covered at the in-network level, even if care is received out-of-network.
- Employee assistance program (EAP)
An EAP is an assessment and referral program or a short-term counseling program that is pre-purchased by some employers and is typically available to their employees, their dependents and household members. EAPs are separate from behavioral health care coverage plans and are typically available to employees at no additional cost whether or not they are enrolled in their employer-sponsored health plan.
- Employee Retirement Income Security Act (ERISA)
Federal legislation that applies to retirement programs and to employee welfare coverage programs established or maintained by employers and unions.
- Employer mandate
- This applies to employers with 50 or more full-time employees.
- If an employer does not offer health coverage to full-time (30+ hours) employees and any full-time employee receiving premium assistance from the federal government, the employer must pay $2,000 for each full-time employee minus 30.
- If an employer offers coverage, and any full-time employee receives federal premium assistance, the employer must pay the lesser of:
- $3,000 for each employee receiving federal premium assistance, or
- $2,000 per employee for each full-time employee minus 30.
- Enamel
The hard, calcified (mineralized) portion of the tooth that covers the crown. Enamel is the hardest substance in the body.
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- Enrollee
An individual who is offered health coverage by his or her employer. At Cigna, this person is also called a primary customer or subscriber.
- Essential health benefits
These are benefits that health care reform requires plans to cover:
- ambulatory patient care
- emergency care
- hospitalization
- laboratory services
- maternity and newborn care
- mental health and substance abuse
- pediatric services, including oral and vision care
- prescription drugs
- preventive and wellness care and chronic disease management
- rehabilitative and habilitative care and devices
- Evidence of insurability
Documentation that proves a person is physically eligible for coverage.
- Excepted benefits
These are benefits offered separately or that are not part of a health plan. Excepted benefits might be dental, vision, long-term care or disability income.
- Exchange
Health care reform says that by 2014 states must either:
- operate health care exchanges where individuals and small employers can buy health insurance, or
- offer an exchange through the federal government
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- Excise "Cadillac" Tax
A tax on health plans that cost more than $10,200 per year for single coverage or $27,500 for family coverage. This 40 percent excise tax begins in 2018.
- Exclusions
Specific conditions or services that are not covered under the coverage agreement.
- Exclusive provider organization (EPO)
A specific type of Cigna health plan with a national network of physicians. Customers can visit specialists without a referral. Customers don't need to choose a primary care physician (PCP). An annual deductible is required and an out-of-pocket maximum applies. Coverage is not available for out-of-network care.
- Exclusive provider program (EPP)
A type of Cigna coverage plan in which covered persons select a primary care physician (PCP) and receive covered services exclusively from the EPP network.
- Experimental procedures
Unproven or investigational treatments that are not in line with generally accepted standards of care
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- Expiration date
The date stated in an insurance contract on which coverage ends (also called end date).
- Explanation of benefits (EOB)
Statement sent by the health plan explaining what medical treatments and/or services were paid.
- Extended care facility (ECF)
A medical care institution for people who need long-term custodial or medical care, especially for chronic disease or a condition needing prolonged rehabilitation therapy.
- Extension of coverage
When coverage is extended under certain conditions, such as disability, after an individuals group health coverage would otherwise have ended.
- Extent of disability
Refers to the severity of the condition. Some policies require that employees be totally disabled before payments begin. Other policies pay for partial disability for a limited time. Most often, policies only pay for partial disability if that condition follows a period of total disability for the same cause.
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- Federal mental health and substance abuse parity law
The Mental Health Parity and Addiction Equity Act of 2008 is a law that makes benefits under Mental Health and Substance Use Disorder coverage the same as benefit limitations under a person's medical/surgical coverage.
- Federal Premium Assistance Tax Credit
Beginning in 2014, a Federal Premium Assistance Tax Credit is available to eligible people to help pay their insurance premiums through a state exchange. To be eligible, the person's income must be between 100 and 400 percent of the Federal Poverty Level and meet certain criteria. About 19 million people who buy health insurance through a state exchange may be eligible for the tax credit.
- Filling
Material used to fill a cavity or replace part of a tooth.
- Flexible coverage plan
A type of program that offers employees a menu of coverage options, allowing them to create a coverage package that best suits their individual needs.
- Flexible spending account (FSA)
An account that allows employees to set aside pre-tax dollars to pay for certain health care or dependent care costs during a specific time period (usually one year). Employees deposit funds in the accounts each pay period. Depending on your plan, you may be able to carry up to $500 into next year. In 2013, the maximum health care FSA contribution will be $2,500. That amount will increase based on inflation.
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- Fluoride
A chemical compound used to prevent dental decay, used in fluoridated water systems and/or applied directly to the teeth.
- Formulary
A list of preferred, commonly prescribed prescription drugs. These drugs are chosen by a team of doctors and pharmacists because of the drugs' clinical superiority, safety, ease of use and cost. Also referred to as the Cigna Drug List and the Cigna Prescription Drug List.
- Fully insured
A health plan where an employer group contracts with a health care carrier to provide health insurance coverage to its employees and their dependents. The carrier underwrites and administers the health plan, and also pays the covered claims.
- Gatekeeper
A primary care physician (PCP) who provides a broad range of routine medical services and refers patients to specialists, hospitals and other health care professionals, as necessary. Under some coverage plans, a referral is required from the primary care physician to obtain coverage for services from other health care professionals.
- Generic drug
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. Usually, generics cost less.
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- Gingivitis
An inflammation or infection of the gingiva (gum tissue); the initial stage of gum disease
- Grandfathered status
Health plans that existed on March 23, 2010 may be "grandfathered". These plans do not have to comply with all Patient Protection and Affordable Care Act (PPACA) provisions. Plans can make routine changes without losing grandfathered status. Plans can lose their status if they reduce benefits or increase employee costs too much. Employers can switch insurance companies and change from administrative services only (ASO) to fully-insured without losing grandfathered status.
- Group health coverage
A health coverage plan that covers a group of people as permitted by state and federal law.
- Guest privileges
This is a Cigna coverage option. With this type of coverage, in some situations, people can pay for in-network services when they temporarily live outside of their home network area for 90 days or longer.
- Gum disease
See Periodontal disease: 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.
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- Health Alliance Plan (HAP)
A managed care health plan with a large service area in Michigan. Cigna and Health Alliance Plan (HAP) are working together to provide quality care to Cigna customers, whether at home or traveling in the United States. Cigna customers in southeast Michigan have access to the HAP Preferred/PHP network of hospitals, doctors and other health care professionals. In the rest of Michigan and all other states, customers have access to the Cigna national network of health care professionals.
- Health and Human Services (HHS)
The department of the federal government that issues regulations for most of the provisions under health care reform, or the Patient Protection and Affordable Care Act (PPACA).
- Health insurance fee
A new $8 billion annual tax on health insurance companies starting in 2014. The tax will grow to $14.3 billion a year by 2018 and rise with inflation after that. The tax will be based on each company's market share.
- Health Insurance Portability and Accountability Act (HIPAA)
A federal law that protects the privacy of health information. HIPAA applies to health plans, health care clearinghouses and health care professionals.
- Health maintenance organization (HMO)
A type of medical plan that offers coverage for a wide variety of health care services usually through the use of a primary care physician (PCP). These services usually include hospital care, physicians' services and many other kinds of health care services. HMOs emphasize preventive care.
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- Health maintenance services
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.
- Health plan
Health plan can be used to mean a health maintenance organization (HMO), a health coverage plan provided by an employer to its employees, or a health coverage plan offered to employers by an insurer or third party administrator.
- Health Reimbursement Arrangement (HRA)
An employer-funded account that employees use to pay health care costs. The HRA pays 100 percent of eligible expenses until it is used up. HRA dollars used to pay for eligible medical expenses can be applied to the employee's annual deductible. Some employers allow HRA dollars to roll over from year to year. An HRA is often combined with a high deductible health plan.
- Health Savings Account (HSA)
A tax-advantaged savings account used to pay for qualified health care costs. The account may be funded by the employee, the employer or both. A person must be covered by a qualified High Deductible Health Plan (HDHP) to contribute to an HSA. Unused funds in the account roll over.
- Health Savings Account tax penalty
The tax penalty for using Health Savings Account funds for ineligible expenses is 20 percent. Before January 1, 2011, the penalty was 10 percent. But health care reform law increased the tax.
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- Home health care
Health services given 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.
- Hospice
A service that provides supportive health care for the terminally ill.
- Hospital
An institution that provides 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.
- ID card
All group and individual health plan customers receive an identity document or identification (ID) card to help health care professionals verify their patients' eligibility for coverage
- Impacted tooth
An unerupted or partially erupted tooth that's positioned against another tooth, bone or soft tissue so that complete eruption (reaching its normal position) is unlikely.
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- Impairment
A change in health status documented by objective medical findings.
- Implant (dental)
An artificial device, usually made of a metal alloy or ceramic material, which is placed within the jawbone as a means to attach an artificial crown, denture or bridge.
- Incentive
An opportunity for a customer 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 other incentives, visit myCigna.com. Incentives apply only to Cigna's Health Reimbursement Account (HRA) plan option.
- Indemnity plan
A type of health plan under which a covered person must pay 100 percent of all covered charges up to the plan's annual deductible. Once the deductible is met, a percentage of the covered charges must be paid by the covered person, up to the plan's out-of-pocket maximum. Indemnity plans don't usually offer in- or out-of-network benefit restrictions, but out-of-pocket costs are usually less when services are received by in-network health care professionals.
- Individual mandate
All U.S. citizens and legal residents must have "minimum essential" health coverage in 2014 according to health care reform law. If they do not, they will pay a tax penalty.
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- Individual plan
A health insurance policy sold to an individual directly, not health coverage offered through an employer-sponsored plan. An individual plan can cover the individual and/or any family members.
- Infertility
The 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.
- Infusion therapy
Treatment accomplished by placing therapeutic agents into a vein. One example is intravenous feeding. Another is enteral nutrition (the delivery of nutrients into the gastrointestinal tract by tube).
- In-network
Cigna contracts with doctors, hospitals, labs, etc. to provide health services to its customers. This group of health care professionals forms a Cigna network. Customers usually pay less when they use these in-network health care professionals.
- In-network health care professional
Any physician, hospital, lab, etc. in a Cigna network. When customers receive care from an in-network health care professional, they usually pay less for services.
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- Inpatient care
Care given to a patient admitted to a hospital, extended care facility, nursing home or other similar health care institution.
- Institute of Medicine (IOM)
A nonprofit group that provides information to help the government make informed health decisions. The IOM is advising on essential health benefits.
- Interim final regulations (IFRs)
Regulations that are not final, but that are treated as final. Public comments are accepted during the interim period to help shape the final regulations.
- Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
An independent, nonprofit group working to improve the quality of health care. The JCAHO reviews health care organizations to make sure they meet quality standards.
- Large group plans
Health plans offered by employers with more than 100 employees. Until 2016, the Patient Protection and Affordable Care Act (PPACA), the health care reform law, allows states to define "large group" as more than 50 employees.
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- Lifetime maximum
The maximum amount a plan will pay over the lifetime of an individual's coverage. Health care reform law does not allow lifetime limits for most plans.
- Limitations
Limitations are specific provisions sometimes included in group health and disability plans that restrict coverage in certain situations. Often only limited coverage is payable for specific conditions or under specific circumstances. For example, a plan may have limitations on mental illness or pre-existing conditions.
- Limited medical plans
Plans that provide limited benefits to part-time and low-wage workers. In many cases, this is the only way they can afford health care. These plans are also called "mini med" plans.
- Local anesthetic
An injection given in the mouth to numb the areas where a tooth or area needs a dental procedure. Often referred to as Novocain.
- Long-term care
The range of services typically provided by skilled nursing, intermediate-care, personal care or elder-care organizations.
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- Maintenance medication
A medication prescribed for long-term treatment of a chronic condition, such as diabetes, high blood pressure or asthma. Maintenance medications are available through Cigna Home Delivery Pharmacy and at participating network retail pharmacies.
- Managed care
A system of health care delivery that manages the cost of health care and access to health care professionals.
- Maximum coverage period (coverage duration)
The maximum length of time for which coverage is payable under the plan, as long as the covered individual remains continuously disabled.
- Maximum monthly coverage
The highest dollar amount a disabled employee can receive on a monthly basis under the Long Term Disability plan.
- Maximum reimbursable charge
The maximum amount Cigna will pay an out-of-network health care professional for billed services. Customers may have to pay any amounts not covered under their plan, including any difference over the Maximum Reimbursable Charge, to the out-of-network doctor or hospital.
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- Medicaid
Health plan for low income and disabled people. More people will be eligible for Medicaid under the Patient Protection and Affordable Care Act (PPACA), also known as the health care reform law.
- Medical device fee
A 2.9 percent national sales tax will be charged on medical devices sold after December 31, 2012. This is the medical device fee.
- Medical loss ratio (MLR)
The percent of premium an insurance company spends on claims. If the MLR is less than 80 to 85 percent of premiums, the company must provide rebates to customers.
- Medical necessity
Health care services or supplies needed to diagnose, prevent or treat your condition and that meet accepted standards of medical practice.
- Medicare
A health plan for people age 65 and older. Medicare also covers certain disabled people and people with end-stage renal disease (ESRD).
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- Medicare annual enrollment period
The period each year when a person may enroll in a Medicare plan. The period is October 15 to December 7.
- Medicare Part A
The part of Medicare that helps pay for hospital care. It also covers nursing home, home health and hospice care.
- Medicare Part B
The part of Medicare that helps pay for doctors and outpatient care.
- Medicare Part D
The part of Medicare that helps pay for prescription drugs. Insurance companies must be approved sponsors before they can offer Medicare Part D Prescription Drug plans.
- Medigap
A term used to describe health coverage that supplements Medicare coverage.
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- Minimum essential coverage
All U.S. citizens and legal residents must follow health care reform's rule called the individual mandate. This rule requires people to maintain health coverage that offers essential health benefits. People that do not buy this coverage beginning in 2014 will pay a tax penalty.
- Minimum monthly coverage
In a disability coverage plan, there is usually a minimum amount paid as a monthly coverage after reductions for "Other Income Coverage".
- Minimum value
Under health care reform, a health plan provides minimum value if it pays at least 60 percent of the allowed cost of services.
- Molars
The broad, multicusped back teeth, used for grinding food. Molars are the largest teeth in the mouth. In adults there are 12 molars (including the four wisdom teeth, or third molars), three on each side of the upper and lower jaws.
- National Association of Insurance Commissioners (NAIC)
The organization of state insurance regulators for all 50 states, Washington, D.C. and the U.S. territories.
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- National Committee on Quality Assurance (NCQA)
An independent, nonprofit group that reviews the quality of managed care plans.
- Network
The hospitals, health care professionals and labs that have contracted with a health plan to provide health care services.
- Non-grandfathered status
A health plan that began after March 23, 2010. It may also be a plan that has made major benefit cuts or cost increases since that date.
- Non-participating health care professional
A medical professional who has not contracted with a health plan.
- Occupational therapy
Treatment to restore a physically disabled person's ability to perform tasks of daily living, such as walking, eating, drinking, dressing, toileting and bathing.
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- Open enrollment
A period when employees can enroll in a health plan or make changes. Most employers offer an open enrollment period each year.
- Opt-out privilege
A general term used when a plan offers some coverage for out-of-network covered services. Often this coverage is less than the coverage available for in-network services. Usually the customer has to pay for services up front and then file a claim for reimbursement. The details of such privileges vary from plan to plan.
- Oral surgery
The removal of teeth and the repair and treatment of other oral problems, such as tumors and fractures.
- Orthodontics
A specialized branch of dentistry that corrects the misalignment of teeth 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.
- Other income coverage
While disabled, a covered employee may qualify for funds from sources-like Social Security and workers' compensation-beyond the disability plan. The insurer may reduce the coverage payable under a Long Term Disability plan because of these additional income sources.
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- Out-of-area coverage
Payments the health plan provides for covered services received from health care professionals outside of the network service area. Coverage details vary from plan to plan.
- Out-of-network (outside the network)
Health care professionals, hospitals, clinics and labs that do not belong to the Cigna network. Some plans provide coverage for services received from out-of-network health care professionals, but customers will typically pay more and might have to file a separate claim for payment.
- Out-of-network health care professional
A health care professional who does not belong to a Cigna network. Customers can receive out-of-network services, but they typically pay more than when using in-network health care professionals.
- Out-of-pocket
Costs not covered by the health plan such as copays, coinsurance, deductibles and fees that the covered person pays personally for health services or prescriptions.
- Out-of-pocket maximum
The most a customer will pay for covered services during a plan year before the health plan begins to pay at 100 percent of covered charges. This limit does not include premiums, balance-billed charges or health care services not covered under the health plan. Some health plans don't include all copays, deductibles, co-insurance payments, out-of-network payments or other expenses towards this limit.
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- Outpatient care
Any health care service provided to a patient who is not admitted to a hospital. You may receive outpatient care in a doctor's office, clinic, your home or a hospital outpatient department.
- Overbite
A condition in which the upper teeth excessively overlap the lower teeth when the jaw is closed. Dentists can correct overbites with orthodontics.
- Over-the-counter drugs
Drugs that can be bought without a prescription. Examples are drugs for pain, heartburn and allergies. Starting January 1, 2011, over-the-counter drugs cannot be paid from health reimbursement accounts, health savings accounts or flexible spending accounts without a prescription. A prescription is not needed for insulin or diabetic supplies.
- Paid amount
The exact amount issued on a bank draft for services provided by a health care professional.
- Panorex
An extraoral full-mouth X-ray that records the teeth and the upper and lower jaws on one film.
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- Partial day treatment
A program offered by appropriately-licensed hospitals and clinics that includes either a day or evening treatment program, usually for mental health or substance abuse.
- Participating health care professional
Any doctor, hospital, clinic or lab in a Cigna network. When customers receive care from a participating health care professional, they usually pay less for services.
- Patient Protection and Affordable Care Act (PPACA)
The name of the health care reform law President Barack Obama signed on March 23, 2010.
- Pay or play
As of 2014, an employer must provide health benefits for employees or pay a penalty.
- Pediatric dentistry
The specialized branch of dentistry that deals solely with treating children's dental disease. Also referred to as pedodontics.
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- Pended claim
A claim that requires more information before Cigna can process it. A pended claim always has a specific reason code to clearly show what's missing.
- Periodontal disease
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.
- Pharmaceutical fee
A $2.5 billion tax on the drug industry starting in 2011.
- Physical therapy
Rehabilitation to restore function and prevention of physical disability following disease, injury or loss of a body part.
- Plan features
An overview that outlines the coverage and financial terms of a health plan.
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- Plan year
Generally, any 12-consecutive-month period determined by the plan under which coverage is provided per the plan documents.
- Plaque
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, plaque can promote gum disease and tooth decay.
- Point-of-service (POS) plan
A health plan allowing the customer to choose to receive services from a participating (in-network) or non-participating (out-of-network) health care professional. The customer may be required to select a primary care physician (PCP) and can usually save more by using a participating health care professional.
- Pre-admission certification/continued stay review (PAC/CSR)
The process through which Cigna evaluates a doctor's request for a customer's admission to an acute care hospital and length of stay. To determine coverage, Cigna reviews the medical necessity for the admission and stay. If PAC/CSR is part of the health coverage plan, the admission or continued stay must be certified for full payment of a claim.
- Precertification
Getting approval from the health plan before a routine hospital stay or outpatient procedure. In precertification, Cigna reviews medical criteria to determine coverage.
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- Pre-disability earnings
The amount of an employee's wages or salary in effect and covered by the plan on the day before a disability began.
- Pre-existing condition
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. Although employer-sponsored group health plans provide coverage for pregnancy, Cigna's individual and family plans do not provide coverage for pregnancy-related medical costs.
- Pre-existing condition exclusion or limitation
A limitation or exclusion of health benefits for a condition that existed prior to the date a person enrolled in a new health plan or insurance policy. As a result of health care reform law, or the Patient Protection and Affordable Care Act (PPACA), a person under age 19 cannot have benefits limited based on a pre-existing condition. Pre-existing means the condition (other than pregnancy) was diagnosed before enrollment in a health plan. The rule expands to all ages in 2014. Although employer-sponsored group health plans provide coverage for pregnancy, Cigna's individual and family plans do not provide coverage for pregnancy-related medical costs.
- Preferred provider organization (PPO) plan
A specific type of Cigna health plan with a national network of physicians. Customers can visit physicians both in- and out-of-network, and can visit specialists without a referral. Customers don't need to choose a primary care physician (PCP) for coverage. An annual deductible is usually required and an out-of-pocket maximum applies.
- Premium
A periodic payment by the customer or plan participant required to keep the insurance coverage in effect.
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- Premium tax credit
If you are eligible, your premiums will be reduced immediately when you begin coverage under a qualified plan.
- Prescription drug
A drug approved by the Federal Food and Drug Administration that you can only get with a prescription from your doctor.
- Pre-tax account
An account in which contributions are taken from an employee's pay before withholding income tax and Social Security.
- Preventive care
Medical and dental services aimed at keeping you healthy and detecting and treating any health problems early. Examples include immunizations, teeth cleaning and routine physical exams.
- Preventive services/immunizations without cost share
Health care reform law requires preventive care and immunizations to be covered without any cost sharing. Cost sharing is any cost when care is received. Dollar limits are not allowed. Does not apply to grandfathered plans under health care reform law.
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- Preventive treatment
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.
- Primary care
The basic, comprehensive, routine level of health care typically provided by a person's general or family practitioner, internist or pediatrician.
- Primary care physician (PCP)
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 health care professionals, as necessary. Under some coverage plans, a referral by the PCP is required to obtain services from other health care professionals. Each covered family member chooses his or her own PCP from the network's physicians.
- Prior authorization
See Precertification: Getting approval from the health plan before a routine hospital stay or outpatient procedure. In precertification, Cigna reviews medical criteria to determine coverage.
- Prohibition in favor of highly compensated individuals
Insured plans cannot provide greater benefits to highly-compensated employees. Previously, this rule applied only to self-insured plans. Employers who break this rule will pay penalties under health care reform law. Does not apply to grandfathered plans under the law.
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- Prosthetic devices
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. An artificial leg is a prosthetic device.
- Provider
A person or hospital that provides health care services. Cigna prefers the term "health care professional."
- Provider directory
A listing of health care professionals who have contracted with a health care carrier to provide care to its customers.
- Provider network
A group of health care professionals contracted by a health care carrier to deliver medical services to its customers.
- Quadrant
The dental term for the division of the jaws into four parts, beginning at the midline of the arch and extending toward the last tooth in the back of the mouth. There are four quadrants in the mouth. Each quadrant generally contains five to eight teeth.
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- Qualified health benefits plan
A health plan that is certified by an exchange. To be certified, a plan must provide essential health benefits and meet other health care reform rules.
- Receded gums
A condition characterized by the abnormal loss of gum tissue due to infection or bone loss.
- Recurrent disability provision
A plan's 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 is considered disabled from the original disability. That means disability payments will continue without a break. This provision helps protect people. It encourages an employee to return to work without fear of losing coverage.
- Referral
When a patient from one office is sent to another health care professional, usually a specialist, for treatment or consultation.
- Rehabilitation
Restoration of or improvement in an employee's health and ability to perform the functions of his or her job. Rehabilitation usually involves a program of clinical and vocational services, with the goal of returning employees to a satisfying occupation whenever possible.
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- Residual coverage
Disability coverage that pays for a portion of a covered person's salary when they are able to work, but limited in their abilities because of the covered disability. For example, residual coverage may pay if a covered person is diagnosed with multiple sclerosis and can only work part time because of their condition.
- Retainer
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.
- Return to work provision
This plan provision helps encourage injured or disabled employees to return to work as soon as safely possible. Under the provision, the employee can receive up to 100 percent of pre-disability earnings based on a combination of disability coverage, other coverage, income and return-to-work earnings.
- Root canal
The hollow part of the tooth's root. It runs from the tip of the root into the pulp.
- Root planing
The process of scaling and planing exposed root surfaces to remove all calculus, plaque and infected tissue.
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- Sealant
A composite material used to seal the decay-prone pits, fissures and grooves of children's teeth to prevent decay.
- Second surgical opinion
A Cigna program that encourages or requires individuals to obtain the opinion of a second doctor after the first doctor has recommended non-emergency or elective surgery be performed.
- Service area
The geographical locations covered by a network of health care professionals.
- Short-term rehabilitation
May include physical, occupational, hearing, speech, pulmonary, cognitive therapies and chiropractic services following an injury or illness. Covered short-term rehabilitation services will vary by plan.
- Skilled nursing facility (SNF)
A licensed organization that provides nursing care and related services for patients who do not require hospitalization in an acute care setting.
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- Small business health options program (SHOP)
A program to increase health insurance options for small businesses and individuals. SHOP offers money to states to improve their insurance markets.
- Small employers-health care reform
Prior to plan years beginning on or after January 1, 2016, states may define small employers as having one to 50 full-time employees. For plan years beginning on or after January 1, 2016, health care reform defines small employers as having one to 100 employees. Only small businesses and individuals can buy health insurance through a state insurance exchange starting in 2014.
- Small group plan
Health plans offered by employers with 100 or fewer employees. Until 2016, the Patient Protection and Affordable Care Act allowed states to define small group as one to 50 employees.
- Specialists
Health care professionals, whose practices focus on a single disease, part of the body, age group or procedure. For example, oncologists treat only cancer patients. Otolaryngologists or ENTs specialize in ear, nose and throat problems. Pediatricians are doctors who only serve children. And a cardiac surgeon only performs surgeries involving the heart and great blood vessels.
- Speech therapy
Treatment to correct a speech impairment that resulted from birth or from disease, injury or prior medical treatment.
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- Staff model health maintenance organization (HMO)
An HMO where doctors are employed by the health plan and provide care at a health care center.
- Status change
A lifestyle event that may cause or allow a person to modify their health coverage category. Birth of a child, divorce or marriage are examples of status changes.
- Submission date
The date a claim was submitted and/or received by Cigna.
- Subscriber
The person who first signed up for the Cigna plan. Cigna prefers using the term "primary customer" or simply "customer" or "individual."
- Systemic
Relating to the whole body.
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- Temporary high-risk pools
A health plan that covers people with pre-existing conditions. They must have been uninsured for six months. Pools will be available until state exchanges begin in 2014. Insurance companies and employers may not encourage people to leave their current plan to join a high-risk pool.
- Temporomandibular joint (TMJ)
The connecting hinge mechanism between the upper jaw and the base of the skull.
- Temporomandibular joint (TMJ) syndrome
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 Health Plan Employer Data and Information Set (HEDIS®)
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.
- Transitional coverage/plans
When an employer changes insurance carriers, transition plans allow participants already in treatment to transition to an in-network health care professional. It gives the patient and their current health care professional a specific number of days to contact Cigna to discuss the patient's treatment plan and obtain approval to continue treatment at the in-network coverage level for a specified period of time, or to transition to a Cigna contracted professional.
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- Treatment plan
In dentistry, a list of the work the dentist proposes to perform on a patient based on the results of the dentist's X-rays, examination and diagnosis. Dentists often present more than one treatment plan to give the patient options.
- Tufts Health Plan (THP) CareLink®
A program that offers customers enrolled in an open access coverage plan with access to a broad health care professional network, including Tufts-contracted professionals in Massachusetts and Rhode Island, and Cigna-contracted health care professionals in all other states.
- U.S. Preventive Services Task Force
A panel of doctors who review scientific evidence and suggest what preventive care services health plans should cover.
- Urgent care
Care for an illness, injury or condition that requires prompt care, but not serious enough to require emergency room care. Examples of urgent care needs include ear infections, sprains, high fevers, vomiting and urinary tract infections.
- Usual, customary or reasonable (UCR)
The amount paid to a health care professional for a service based on the typical charges for that service within a specific geographical area.
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- Veneer
An artificial filling material, usually plastic, composite or porcelain, used to provide an aesthetic covering over the visible surface of a tooth. Most often used on front teeth.
- W-2 reporting
Employers must report the value of employer health coverage on each employee's W-2. Employee contributions to flexible spending accounts and health savings accounts are excluded.
- Waiting period
To be eligible for coverage under a group insurance policy, an employee must have worked a certain number of continuous days as an active, full-time employee. Employees without the required days of employment are in the waiting period. Another type of waiting period is the time between when a disability occurs and when payments from the disability insurance policy begin.
- Waiver of premium
When a covered person becomes disabled and eligible for coverage, they no longer have to pay for the coverage. Paying the plan's cost (premium) is stopped (waived). And they pay no disability premium payments as long as they are receiving payments from the plan.
- Wisdom teeth
The last of the three molar teeth, also called third molars. 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.
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Michael Been, a singer, songwriter, guitarist and founding member of the Northern California modern rock band the Call, which broke out with the 1983 MTV hit "The Walls Came Down," has died. He was 60.
Been (pronounced Bean) died Thursday after suffering a heart attack at the Pukkelpop festival in Hasselt, Belgium, where he had been serving as a sound engineer for his son Robert's band Black Rebel Motorcycle Club. His death was announced in a statement from Black Rebel Motorcycle Club's publicist, Juliana Plotkin.
Formed in Santa Cruz as the '80s were dawning, the Call gained a reputation for epic anthems showcasing a ringing guitar sound and socially conscious, spiritually aware lyrics written by Been and sung in his earnest, emotive style.
The band, based in the Bay Area, featured Been on lead vocals and at various times guitar and bass, Scott Musick on drums, Tom Ferrier on guitar and Greg Freeman on bass (replaced later by Jim Goodwin on keyboards). The Call's self-titled debut album in 1982 was followed a year later by "Modern Romans," which yielded the hit song "The Walls Came Down."
Critics gave the band generally positive reviews, and the quartet released a series of albums: "Scene Beyond Dreams," "Reconciled," "Into the Woods," "Let the Day Begin" and "Red Moon."
Been and the Call had famous fans in both the rock world — Peter Gabriel once labeled the band the "future of American music" — as well as in the realm of movies — director Martin Scorsese cast Been as the apostle John in his 1988 film adaptation of Nikos Kazantzakis' novel "The Last Temptation of Christ."
Then Al Gore chose the band's 1989 anthem "Let the Day Begin" as a theme song for his 2000 presidential campaign, closing the Democratic National Convention at Staples Center with the rousing, optimistic celebration of working-class citizens.
"Here's to the babies in the brand new world,
"Here's to the beauty of the stars,
"Here's to the travelers on the open road,
"Here's to dreamers in the bars … "
Although the band wasn't consulted in advance about the selection — Been found out when he returned home late to find congratulatory messages on his answering machine. He was philosophical about it.
"It might be one of those things where you just have to donate it to the country," Been said at the time.
A native of Oklahoma City, Been was born March 17, 1950, and began playing guitar as a boy.
"I took guitar lessons and sang in church, but then I saw Elvis Presley on 'The Ed Sullivan Show.' ... I was never the same," Been told the Daily Oklahoman in 1989.
By age 7 he was performing at fairgrounds and on a TV variety show called "Big Red Shindig." He moved with his family to Chicago as an adolescent, then after a year of college moved to California to pursue a music career.
Been began making music and touring in the late '80s with actor Harry Dean Stanton, whom he met on the set of "The Last Temptation of Christ"; released a solo album, "On the Verge of a Nervous Breakthrough" (1994); then put out the Call's last studio album, "Heaven and Back" (1997). In recent years he had worked in a support role with Black Rebel Motorcycle Club.
Been, who had been living in the Los Angeles area, is survived by his son, Robert Levon Been, and a sister, Linda Southwell.


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Meals 20-25 served with Hashbrown Sticks and Choice of 16 oz Coffee, 20 oz drink or 8 oz Milk.
Meat + biscuit = delicious.
A ground pork sausage patty on one of our flaky buttermilk biscuits - a simple and delicious combination for only 500 calories. Add a small or medium coffee for just 5 calories more.
Biscuit with Sausage
Meat + biscuit = delicious.
Biscuit with Sausage
Ingredients: Biscuit: Enriched Bleached Wheat Flour (Wheat Flour, Malted Barley Flour, Niacin, Reduced Iron, Thiamine Mononitrate, Riboflavin, Folic Acid), Buttermilk (Cultured Low Fat Milk, Food Starch, Salt, Sodium Citrate, Carob Bean Gum, Carrageenan, Vitamin A Palmitate, Vitamin D3), Palm Oil, Biscuit Concentrate (Leavening [Sodium Bicarbonate, Sodium Acid Pyrophosphate, Sodium Aluminum Phosphate], Salt, Sugar, Dextrose, Bleached Enriched Flour [Wheat Flour, Niacin, Iron, Thiamine Mononitrate, Riboflavin, Folic Acid], Calcium Propionate, Calcium Sulfate, Soybean and /or Cottonseed Oil, Guar Gum), Soybean Oil, Artificial Butter Flavor, Potassium Sorbate, Ascorbic Acid. Liquid Margarine for Biscuit: Liquid and partially hydrogenated soybean oil, water, salt, vegetable mono & diglycerides, soy lecithin, sodium benzoate (a preservative), citric acid, natural and artificial flavor, calcium disodium EDTA added to protect flavor, beta carotene (color), vitamin A palmitate. Pork Sausage Patty: Pork, salt, natural spices, sugar, monosodium glutamate, spice extractives, BHA, BHT, and citric acid.
This Goes Great With
On The Side
Onion Rings
For Dessert
For Dessert


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Oscar Red Carpet Fashion Trends
From the stunning stars walking the red carpet to the hilarious hosts, the incredible array of movies honored to the thoughtful acceptance speeches, the Academy Awards this year was a night to remember. With Kathryn Bigelow's historic night as the first female to win the award for Best Director and the array of talented women honored in the Best Actress category, the ladies truly made a statement. Their amazing performances, directorial prowess, and all over impact were felt the entire night. However, as they arrived on the red carpet all eyes were tuned to what designers and trends would be worn. From Sandra Bullock's gorgeous metallic dress to Gabourey Sidebe's deep blue gown, one could see that the stars went all out for the evening and several hot trends became apparent.
The metallic trend was huge this year, seen on stars such as Cameron Diaz, Sandra Bullock, and Kate Winslet. Metallic dresses look great on the red carpet, as they ensure one will stand out and not get lost in the crowd. Both the gold and silver metallic look is stunning, with some designers even starting to blend gold and silver tones together. When wearing a statement metallic dress, it is important to keep the rest of your look simple. By wearing little to no jewelry with a simple hairdo, an elegant look is created. These actors got it just right!
One Shoulder
The one shoulder dress was popular on the red carpet, and for good reason. It creates a beautiful neckline, drawing the attention upwards, and provides plenty of bust support. Sigourney Weaver looked stunning in her red asymmetrical gown while Kate Beckinsale rocked the one shoulder look (in a metallic!) at an after party. For a modern yet comfortable look, the one shoulder dress is a great way to go.
Shades of nude were seen throughout the evening as stars arrived, with each dress looking equally as stunning as the one before it. Anna Kendrick looked beautiful in her pale pink draped gown and Demi Moore was flawless in a nude strapless ruffled dress. Shades of nude, whether a cocoa color or a light pink, are fashionable and gorgeous! By choosing a dress with some draping or ruffles, a beautiful silhouette is created. To really showcase a nude dress, pair it with neutral colored accessories, such as black or brown, so that the dress becomes the focal point.
Whether cut high or low, obvious or hidden, slit dresses were a popular trend at the Oscars. To showcase your legs in a sexy yet fashionable way, a slit dress is the way to go. From Meryl Streep's demure slit to Zoe Saldana's ruffled slit, a beautiful look is created. Slits are feminine and flirty and truly make a statement. If doing a high slit, make sure your dress does not have a low neckline. When showing more skin on the bottom you can be a bit more conservative on top, and vice versa.
Deep Blue
Gorgeous shades of jewel toned and deep blue were seen on the red carpet, taking the place of the usual go-to black dress. Kristin Stewart wore a beautiful midnight blue while Gabourey Sidebe had a lighter but equally rich blue gown, adorned with stunning jewels. These rich shades of blue look great on all skin tones and make a strong statement. Easily paired with gold or silver accessories, a deep blue is a great change if you want to switch up the black.
All of these trends are fun and pretty, and a great way to spice up your wardrobe. Even though the majority of us will not be walking the red carpet anytime soon, we can still wear these looks in our daily life. Whether it is a casual maternity maxi dress with a slit or a one shoulder strap cocktail dress (in a rich blue) there are many fun ways to apply these red carpet trends to your daily life.


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Diversity in Campus Life
Open to All
Bates is recognized for its inclusive social character: There are no fraternities or sororities, and student organizations are open to all. The College sponsors cultural, volunteer, athletic, social and religious opportunities that are open to all students, and it values participation in these activities.
Friendships flourish among very different types of people, both faculty and students, exemplifying the brightest facets of a Bates education.


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Download the latest version of Acer ALN101 Ethernet Adapter drivers according to your computer's operating system. All downloads available on this website have been scanned by the latest anti-virus software and are guaranteed to be virus and malware-free.
Browse the list of top matching drivers below to find the driver that meets your needs. To see more matches from our driver database, use our to customized driver search engine.
To download, select the best match for your device and then click the Download button. Need help? You can request the driver and we will find it for you.
Acer ALN101 Ethernet Adapter Driver Update UtilitySupported OS: Windows 10, Windows 8.1, Windows 7, Windows Vista, Windows XP
File Version: Version 184.108.40.206
File Size: 2.3 MB
File Name:
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ne2000 Driver
NovellSupported OS: Win 2003 Server, Win XP Home, Win XP Pro, Win 2000 Workstation, Win 2000 Server, Win NT 4.0
File Version: Version 5.00.2157.1
Release Date: 1999-10-19
File Size: 12.6 KB
File Name:
Download >>
5,468 DownloadsSubmitted Sep 15, 2001 by dyl (DG Member):
"This driver is actually the same as the one on the windows2000 cd, which works with my ne2000 compatible ISA card in windowsXP (nice of MS to remove support altogether, wasn't it?). Unzip both files to a folder, then use add hardware/manually/network adapters/have disk & point it at the inf file."
realtek / generic rtl8019 or ne2000 compatible Driver
MicrosoftSupported OS: Win XP Home, Win XP Pro
File Version: Version 5.00.2157.1
Release Date: 1999-10-19
File Size: 16.8 KB
File Name:
Download >>
7,269 DownloadsSubmitted Jan 20, 2004 by Dylan Davies (DG Member):
"This is basically the driver for an ISA NE2000 compatible network card taken from Windows 2000. MS no longer support ISA devices with XP, but I've got my old ISA Realtek RTL8019 NE2000 compatible network card working fine in XP with this driver. You can do without the .in_ file, that's just a compressed ..."
L10C Driver
DynalinkSupported OS: All Win 2000
File Version: Version 1.0
File Size: 30.2 KB
File Name:
Download >>
597 DownloadsSubmitted Aug 22, 2005 by Tuxxie (DG Member):
"Dynalink L10C (PCMCIA Ethernet) drivers for Windows 2000 [ds/10-02-2000]"


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Choosing internet providers can be a daunting task. There are so many offers, so many specials, and so much competition. It's important to know what you need, and check out the speeds available, contracts, and costs. How do you know what you need?
If you are looking for just basic internet, just email and a little web surfing, then basic DSL will probably do it for you. This is very inexpensive, and the major nationwide DSL providers AT&T and Verizon have great offers.
This is not a very high speed, but it is better than dial up, and does not tie up your phone. You will find with basic DSL that video speeds are often interrupted for buffering, and sound files may take time to load. If you plan on using the internet for video, downloading music, or secure banking and shopping, you will want to consider a higher speed.
That's why comparing plans in your area is a good idea. You'll find that Internet Business comes in several types of connections, DSL and fiber optic. Fiber optic connections are offered by cable companies, and both AT&T and Verizon have great ultra high speed fiber optic plans. Fiber optic connections travel on light, and so they have the least distortion. They are faster, and tend to be better choices for video, high memory, and heavy internet use. Ultra fast DSL will also be adequate for this purpose.
You will often find both fiber optic and DSL Best broadband Malaysia bundled with phone and television. This can really save you money and get you high speed internet at a very low price. Be sure to check out the terms of the contract, and the types of other services you receive. Are you getting phone as a landline, as VOIP (voice over internet protocol) or is your phone connected to your television and internet so that you can answer the phone with the television remote or program your TV through the internet? Is the television connection coming through cable, does it offer HDTV choices, or is it satellite? Which type of service is most dependable where you live? Which offers you the best variety of channels? Are you looking for different languages, programming from around the world? Make very sure that the bundle works for you before signing up for a two year contract.
The best way to research internet service providers is to go online. Look up the plans that are available in your city. To check availability you can enter your zip code on sites that feature major providers to see what they offer. There are blogs and websites that allow you to compare different companies and their plans. This makes it easy to compare your options side by side, and make a decision that is right for you. You will also find the best deals online. Many promotions are offered online only and are not available if you call the company to start service. Signing up online is easy, …


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16-night South America Expedition Cruise
Silversea Cruises — Silver Cloud Expedition
Destination: Buenos Aires/Ushuaia
Departure: 11/24/2019
Length: 16 Nights
Ports Buenos Aires Puerto Madryn New Island West Point Island Port Stanley Elephant Island Antarctic Sound Antarctic Peninsula Antarctic Peninsula ...
The Signature Collection – A Private Car & Driver Sailing
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