||This means the same as stuffy nose.
|National AdvantageTM Program*
||This is an Aetna program. It offers contract rates for some claims. These claims would otherwise be paid at the cost the doctor billed. It applies to:
*Aetna does not credential, monitor or oversee those providers who participate through third-party contracts. Since there are a number of factors that determine whether a discount will be given, Aetna is unable to guarantee any level of discount under this program.
|National Committee for Quality Assurance (NCQA)
||This is an independent, nonprofit group. It is also known as the NCQA. The NCQA has an official recognition process. It measures how well a health plan:
- manages its care delivery system
- improves health care for members.
|National Medical Excellence Program®
||This is an Aetna program. It helps members get covered treatment for:
The services must be done by network facilities. They must have experience in these areas.
- solid organ transplants
- bone marrow transplants
- some other rare or complex conditions.
||This is a feeling of sickness in the stomach.
||See “National Committee for Quality Assurance.”
||Health plans usually pay only for care that is “necessary.” They decide this by using medical standards or research that states what care is most effective. Care can mean health services or supplies. This also is called “medically necessary,” “medically necessary services” or “medical necessity.”
||This means not taking care of something.
||A network is a group of health care providers. It includes doctors, dentists and hospitals. The health care providers in the network sign a contract with a health plan to provide services. Usually, the network provides services at a special rate. With some health plans, people get more coverage when they get care in the network.
||This is a medical condition. A person who has it gets up often during the night because he or she needs to urinate.
||This refers to something that is not cancerous.
||This is the cost of a group insurance plan that is paid by an employer. It can be part of the cost or can be the entire cost.
||This describes a disease not caused by a job or in any act related to a job.
||This is an injury not caused by a job or an act related to a job.
||This is a health care provider who does not have a contract with a health plan. People might pay more when they visit this kind of doctor, hospital or other health care professional. This may also be referred to as “out of network” or “nonpreferred.”
||This means a person can buy a drug without a doctor’s prescription.
||This is a substance that is good for the body. It is often used when talking about food.