Glossary: C

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Calculus (or Tartar) This is when plaque left untreated on your teeth begins to harden. It then becomes known as calculus or tartar.
Capitation This is a fixed amount of money doctors and hospitals get from health plans to serve plan members. They get this amount no matter how many patients they see.
Career counseling This is help people get to further their career. Job skills, abilities and work habits are reviewed. Education, experience and interests are looked at also. Results are compared and matched to other jobs. This gives people ideas on what moves to make next.
Caries This is a dental term that means cavities or tooth decay.
Case management This is the way health plans help people with complex care needs. Case managers help coordinate care to help people improve their health.
Centers for Medicare & Medicaid Services (CMS) This is a federal agency. It runs the Medicare program. It also works with states to run the Medicaid program.
Certificate of coverage This details the benefits provided by your health plan. It lists what is covered and what is not covered. You will get this document after you sign up for a plan.
Certification See “Precertification.”
Certification of a period of disability This is a way to decide if a worker is truly disabled. The terms of the policy are used to decide this.
Certified Financial Planner^TM (CFP^®) This is someone who helps people plan how to save and use their money. He or she has been qualified by the Certified Financial Planner Board of Standards, Inc. This means the person passed certain tests to get the CFP title. All CFPs have to take certain classes every two years to keep this title.
Chemotherapy This is a cancer treatment. It involves chemical or biological drugs. These drugs are usually given through a vein.
Chiropractic care This therapy is used to help treat the spine, joint pain and movement problems. A licensed chiropractor gives this care.
Claim This is a request to be paid by a health plan for health services given. An example would be the claim your doctor sends to your health plan for an office visit. It is also a request for payment under a disability or life insurance plan.
Closed formulary This is a type of pharmacy benefits plan. It only covers prescription drugs on the plan’s list. The list is called a “formulary”. Drugs not on this list need to be approved by the plan before they can be covered.
CMS See “Centers for Medicare & Medicaid Services.”
COBRA (Consolidated Omnibus Budget Reconciliation Act of 1986 This law allows you to continue your health plan coverage for a limited time. It is often used after people lose their job or become divorced. If you choose this option, you will pay the cost of coverage. Small employers with less than 20 workers are not subject to this law.
Coinsurance This is the percentage of health care expenses you pay after your deductible. Your health plan pays the rest up to any benefit or lifetime maximum.
COLA See “Cost of Living Adjustment.”
Combined life insurance maximum This is the highest amount of life insurance you can get. It means you can have both basic and supplemental plans, but only up to this amount.
Common-law marriage This is when two people live together for a certain amount of time. They think of themselves as married because of the time spent together. Some states agree and recognize them as married.
Complication of pregnancy This is a health problem that happens during pregnancy. It is something that would not happen in a normal pregnancy. It can affect the baby, the mother or both.
Composite This is a type of filling that matches your natural tooth color.
Congenitally missing teeth These are teeth that never existed in your mouth. This is a condition that existed at, or dates from, your birth.
Consumer-directed health plan This plan helps you control more of your health benefit dollars. It includes a fund or account that can be used to pay for your medical expenses. Most health funds allow unused dollars to be rolled over from year to year, for as long as you stay in the plan. Some plans allow the fund to go with you, even if you change jobs.
Consumerism This is a term for a new movement in health care. Its goal is to have everyone more involved in their own care. This means people will have more information to make better decisions about their health care. It includes knowing the real costs of health care and taking an active role in managing those costs.
Contract (also known as a “Benefit certificate” or “Policy”) This is a legal agreement. It is between a customer (an individual or group) and an insurance plan. It lists all details of the plan’s coverage.
Contract holder This is a legal term. It is a customer (an individual or group) who buys an insurance plan from an insurer.
Contributory This refers to a group health plan. It means costs are shared between an employer and its employees.
Conversion charge This is an amount charged to change policies. It must be paid when you change a group health plan to an individual policy.
Conversion option This means people can buy a policy on their own after they leave a group plan. It may be offered with certain health and life insurance plans. It is often another choice besides COBRA coverage for health plans.
Coordination of Benefits (COB) These rules are used to decide which plan pays first for people who have more than one plan. This helps coordinate coverage and allows claim information to be shared by the plans. This way, the plans can avoid duplicate payments.
Copay This is the dollar amount you pay for health care expenses. In most plans, you pay this after you meet your deductible limit. For example, you pay a set dollar amount to your doctor for an office visit. So, if your copay is $25, you pay that amount when you go to your doctor. Copays are also used for some hospital outpatient care services in the Original Medicare plan. In prescription drug plans, it is the amount you pay for covered drugs.
Copayment See “Copay.”
Cost of Living Adjustment (COLA) This is an optional benefit. It goes with some long-term disability plans. It raises the monthly benefit amount each year. The person on disability gets more money based on the cost of living. These raises are given only for a set time period.
Coverage gap This is also called the "donut hole." It is the part of the Medicare plan where the member pays for prescription drugs. The plan does not pay. The gap occurs after you reach your initial coverage limit. It lasts until the expenses you pay add up to a certain amount.
Covered services (also Covered benefits or Covered expenses) These are services or supplies your health plan covers. They are eligible to be paid by your plan.
Credentialing This is a process. It is used to be sure doctors and hospitals meet certain standards. It is also used for other health professionals and facilities.
Creditable coverage See “Prior creditable coverage.”
Creditable coverage—Medicare This applies to people who are eligible for Medicare. It is coverage that is at least as good as the Medicare drug plan. If you have such a prescription drug plan, you can stay in your plan. You will not be charged higher fees if you switch to Medicare later.
Crown lengthening This is a way to expose more of a tooth. The dentist removes gum tissue and bone. Dentists do this when patients do not have enough tooth above their gum line to support a crown or filling.
Custodial care This is care that helps people with the daily life activities. The person giving the care does not have to be trained in medicine. This care may help people with walking, bathing, dressing and eating.
Customary and Reasonable A limit on the amount your health plan will pay. Also called "usual, customary and reasonable (UCR)," "reasonable" or "prevailing” charge. The limit is based on data Aetna receives. The data is based on what doctors' charge for the health care service. We get this data from a subsidiary of another health insurer. In 2011, we will receive the data from an independent organization known as Fair Health.

Check your plan documents for more details: Your health plan documents will tell you how we pay for out-of-network care. Or call Member Services at the phone number listed on your Aetna ID card. Learn More.

Glossary: C

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Calculus (or Tartar)	This is when plaque left untreated on your teeth begins to harden. It then becomes known as calculus or tartar.
Capitation	This is a fixed amount of money doctors and hospitals get from health plans to serve plan members. They get this amount no matter how many patients they see.
Career counseling	This is help people get to further their career. Job skills, abilities and work habits are reviewed. Education, experience and interests are looked at also. Results are compared and matched to other jobs. This gives people ideas on what moves to make next.
Caries	This is a dental term that means cavities or tooth decay.
Case management	This is the way health plans help people with complex care needs. Case managers help coordinate care to help people improve their health.
Centers for Medicare & Medicaid Services (CMS)	This is a federal agency. It runs the Medicare program. It also works with states to run the Medicaid program.
Certificate of coverage	This details the benefits provided by your health plan. It lists what is covered and what is not covered. You will get this document after you sign up for a plan.
Certification	See “Precertification.”
Certification of a period of disability	This is a way to decide if a worker is truly disabled. The terms of the policy are used to decide this.
Certified Financial Planner^TM (CFP^®)	This is someone who helps people plan how to save and use their money. He or she has been qualified by the Certified Financial Planner Board of Standards, Inc. This means the person passed certain tests to get the CFP title. All CFPs have to take certain classes every two years to keep this title.
Chemotherapy	This is a cancer treatment. It involves chemical or biological drugs. These drugs are usually given through a vein.
Chiropractic care	This therapy is used to help treat the spine, joint pain and movement problems. A licensed chiropractor gives this care.
Claim	This is a request to be paid by a health plan for health services given. An example would be the claim your doctor sends to your health plan for an office visit. It is also a request for payment under a disability or life insurance plan.
Closed formulary	This is a type of pharmacy benefits plan. It only covers prescription drugs on the plan’s list. The list is called a “formulary”. Drugs not on this list need to be approved by the plan before they can be covered.
CMS	See “Centers for Medicare & Medicaid Services.”
COBRA (Consolidated Omnibus Budget Reconciliation Act of 1986	This law allows you to continue your health plan coverage for a limited time. It is often used after people lose their job or become divorced. If you choose this option, you will pay the cost of coverage. Small employers with less than 20 workers are not subject to this law.
Coinsurance	This is the percentage of health care expenses you pay after your deductible. Your health plan pays the rest up to any benefit or lifetime maximum.
COLA	See “Cost of Living Adjustment.”
Combined life insurance maximum	This is the highest amount of life insurance you can get. It means you can have both basic and supplemental plans, but only up to this amount.
Common-law marriage	This is when two people live together for a certain amount of time. They think of themselves as married because of the time spent together. Some states agree and recognize them as married.
Complication of pregnancy	This is a health problem that happens during pregnancy. It is something that would not happen in a normal pregnancy. It can affect the baby, the mother or both.
Composite	This is a type of filling that matches your natural tooth color.
Congenitally missing teeth	These are teeth that never existed in your mouth. This is a condition that existed at, or dates from, your birth.
Consumer-directed health plan	This plan helps you control more of your health benefit dollars. It includes a fund or account that can be used to pay for your medical expenses. Most health funds allow unused dollars to be rolled over from year to year, for as long as you stay in the plan. Some plans allow the fund to go with you, even if you change jobs.
Consumerism	This is a term for a new movement in health care. Its goal is to have everyone more involved in their own care. This means people will have more information to make better decisions about their health care. It includes knowing the real costs of health care and taking an active role in managing those costs.
Contract (also known as a “Benefit certificate” or “Policy”)	This is a legal agreement. It is between a customer (an individual or group) and an insurance plan. It lists all details of the plan’s coverage.
Contract holder	This is a legal term. It is a customer (an individual or group) who buys an insurance plan from an insurer.
Contributory	This refers to a group health plan. It means costs are shared between an employer and its employees.
Conversion charge	This is an amount charged to change policies. It must be paid when you change a group health plan to an individual policy.
Conversion option	This means people can buy a policy on their own after they leave a group plan. It may be offered with certain health and life insurance plans. It is often another choice besides COBRA coverage for health plans.
Coordination of Benefits (COB)	These rules are used to decide which plan pays first for people who have more than one plan. This helps coordinate coverage and allows claim information to be shared by the plans. This way, the plans can avoid duplicate payments.
Copay	This is the dollar amount you pay for health care expenses. In most plans, you pay this after you meet your deductible limit. For example, you pay a set dollar amount to your doctor for an office visit. So, if your copay is $25, you pay that amount when you go to your doctor. Copays are also used for some hospital outpatient care services in the Original Medicare plan. In prescription drug plans, it is the amount you pay for covered drugs.
Copayment	See “Copay.”
Cost of Living Adjustment (COLA)	This is an optional benefit. It goes with some long-term disability plans. It raises the monthly benefit amount each year. The person on disability gets more money based on the cost of living. These raises are given only for a set time period.
Coverage gap	This is also called the "donut hole." It is the part of the Medicare plan where the member pays for prescription drugs. The plan does not pay. The gap occurs after you reach your initial coverage limit. It lasts until the expenses you pay add up to a certain amount.
Covered services (also Covered benefits or Covered expenses)	These are services or supplies your health plan covers. They are eligible to be paid by your plan.
Credentialing	This is a process. It is used to be sure doctors and hospitals meet certain standards. It is also used for other health professionals and facilities.
Creditable coverage	See “Prior creditable coverage.”
Creditable coverage—Medicare	This applies to people who are eligible for Medicare. It is coverage that is at least as good as the Medicare drug plan. If you have such a prescription drug plan, you can stay in your plan. You will not be charged higher fees if you switch to Medicare later.
Crown lengthening	This is a way to expose more of a tooth. The dentist removes gum tissue and bone. Dentists do this when patients do not have enough tooth above their gum line to support a crown or filling.
Custodial care	This is care that helps people with the daily life activities. The person giving the care does not have to be trained in medicine. This care may help people with walking, bathing, dressing and eating.
Customary and Reasonable	A limit on the amount your health plan will pay. Also called "usual, customary and reasonable (UCR)," "reasonable" or "prevailing” charge. The limit is based on data Aetna receives. The data is based on what doctors' charge for the health care service. We get this data from a subsidiary of another health insurer. In 2011, we will receive the data from an independent organization known as Fair Health. Check your plan documents for more details: Your health plan documents will tell you how we pay for out-of-network care. Or call Member Services at the phone number listed on your Aetna ID card. Learn More.