Basics of the Plan
The LM HealthWorks Plan provides you and your family comprehensive coverage and protection from unexpected health care costs. The plan gives you the freedom to receive care from any licensed provider and the opportunity to save when you use the plan’s in-network providers. And that’s just the beginning. The plan also provides coverage for prescription drugs, at both participating retail pharmacies and through a convenient mail-order service. There’s a host of best-in-class resources available to you as well, from health coaching to help with chronic conditions to online health references to a 24-hour nurse advice line and an e-newsletter tailored to your health interests and concerns.
Here are the key features of the plan:
In-network and out-of-network benefits.
You receive benefits from the plan regardless of who provides your care. However, when you use in-network providers, the plan pays a larger share of your expenses. You also save as a result of special rates that in-network providers have negotiated with Aetna. If you choose out-of-network providers, the plan pays less and you pay more.
The Benefits Summary shows how the plan's in-network and out-of-network benefits are covered.
100% coverage for preventive care.
The plan typically pays 100% of the cost of covered preventive care services. Preventive care includes services such as routine exams, well-child care, cancer screenings and immunizations. It's care to help you and your family stay healthy and identify potential problems early.
The Benefits Summary shows the guidelines and plan limits that apply to preventive care.
Learn more about preventive care and how it helps you Stay Well.
Sharing the cost.
The deductible is the amount of the covered expenses you pay each year before the plan's benefits become effective. How much you pay depends on the type of coverage you select and whether you get care from an in-network or out-of-network provider. Remember, preventive care and prescription drug expenses are not subject to the deductible. The plan's benefits for these expenses start immediately.
Learn more about how the deductible works »
See how the plan will step in and protect you from high, unexpected health care costs »
Prescription drug benefits.
The LM HealthWorks Plan also provides prescription drug benefits through Express Scripts. You can get short-term prescriptions (this generally means up to a 30-day supply), such as those for antibiotics, filled at participating retail pharmacies. And you can use the mail-order service to fill prescriptions for medications you use on a continuing basis, such as those used to treat high blood pressure or high cholesterol. You can typically order up to a 90-day supply and have it delivered right to your home.
There's no deductible to meet before the plan pays benefits for prescription drugs. When you fill a prescription, you pay a percentage of the cost — called coinsurance. There are three levels of coinsurance depending on whether your doctor prescribes a generic drug, a preferred brand drug (one listed on the plan's formulary) or a non-preferred brand drug (one that is not on the plan's formulary).
Learn more about the plan's prescription drug benefits »
You can manage your health and your health care with tools, resources, programs and coaching from leading health and wellness organizations. From help with making lifestyle changes to better ways to manage chronic health conditions to a full suite of online health references and resources, it's all here. What's more, you get help in finding and using what's most meaningful and useful to you.
Learn more about the best-in-class resources »
Coverage Under More Than One Plan (Coordination of Benefits).
When someone is covered under more than one health plan, we have guidelines to make sure you get maximum coverage without overpayment. Thus, we must “coordinate the benefits” by determining which plan is the primary insurer and which is the secondary insurer.
Learn more about how this works »