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Site Map Glossary Employee Book of Benefits OneCall: 1-877-861-2255 |
Home > Glossary
Annual Pension Benefits Return to previous pageAmount of pension benefit provided under the plan formula.Average Straight-Time Monthly Earnings Return to previous pageThe average of your highest earnings for three years during the last ten years just before you retire.Beneficiary Return to previous pageThe person, organization or trust that you name to receive any life, pension plan or savings program benefits if you die.Birthing Center Return to previous pageAn institution which is constituted, licensed and operated in accordance with the laws of legally authorized agencies to furnish room and board, services of qualified nurses and a certified nurse midwife to expectant mothers. One or more nurses must be on duty at all times. To qualify as a birthing center, an institution must:
Child Return to previous pageFor medical and dental coverageYour own child, your legally adopted child or any child of the person who is recognized under applicable law as your spouse and any other child for whose care you are responsible pursuant to the terms of a court order or an agreement with a state or other governmental agency for his or her custody and support. However, no individual shall be treated as a child under this definition unless you can claim the child as a dependent on your federal income tax return and can demonstrate that:
COBRA Return to previous pageConsolidated Omnibus Budget Reconciliation Act of 1985; this federal law allows you and your eligible dependents to continue health care coverages under certain circumstances when coverage would otherwise end.Coinsurance Return to previous pageThe percentage of the bill you are required to pay. For example, if you go out-of-network under the Point-of-Service Plans, you pay 20% or 30% of the bill as coinsurance for most medical services, after meeting the deductible.Company Return to previous pageUT-Battelle, LLCBWXT-Y12, LLC Conversion Privilege Return to previous pageYour right to convert a group medical or life insurance policy into an individual policy.Copayment Return to previous pageThe amount you pay when you go in-network for medical treatment under the Point-of-Service Plans. For example, you pay a $20 copayment when you visit a network physician.Crown Return to previous pageA restoration which replaces enamel, covering the entire crown of a tooth, usually made of porcelain or acrylic.Deductible Return to previous pageThe amount you and your enrolled dependents are required to pay each year for covered expenses before the out-of-network side of the Point-of-Service Plans or the Indemnity Plan pay benefits.Dependent Child Return to previous pageFor the pension planYour natural or adopted child, stepchild or foster child who is under age 23 and who qualifies as your dependent child for federal income tax purposes. Dependent Parent Return to previous pageFor the pension planYour natural parent or stepparent who qualifies as your dependent for federal income tax purposes. Durable Medical Equipment Return to previous pageAny equipment which can withstand repeated use and is medically essential to treat an injury or sickness.Early Retirement Return to previous pageRetirement prior to reaching age 65.Elective Surgery Return to previous pageA surgical procedure which is not considered emergency in nature and which may be avoided without undue risk to the patient.Eligible Dependents Return to previous pageFor medical and dental coverageYour eligible dependents are:
Emergency Return to previous pageA serious accident or sudden illness that is life-threatening or could result in a long-term medical problem, such as uncontrolled bleeding, seizure or chest pain.Emergency Admission Return to previous pageAny hospital admission for an inpatient stay for a condition which:
ERISA Return to previous pageThe Employee Retirement Income Security Act of 1974, as it may be amended from time to time.Fixed Bridgework Return to previous pagePermanently inserted artificial teeth joined to inlayed or crowned natural teeth on either side called abutments. A fixed bridgework for anterior teeth often requires two abutments on either side.Full Denture Return to previous pageUpper or lower; artificial teeth in replacement of all teeth in an arch.Home Health Aide Return to previous pageA person who is trained to assist a person with daily living in his or her home after surgery or injury and who reports to and is under the direct supervision of a home health care agency. A home health aide can assist with personal hygiene, changing dressings and mobility.Home Health Care Agency Return to previous pageA hospital or a non-profit or public agency which is constituted and licensed to provide home health care.Home Health Care Visit Return to previous pageFour hours of skilled nursing or services provided by a home health aide.Hospice Return to previous pageAn institution or part of one which primarily provides care for terminally ill patients and fulfills any licensing requirements of the state or locality in which it operates.Hospice Program Return to previous pageA coordinated, interdisciplinary program of care designed to meet the physical, psychological, spiritual, and social needs of dying persons and their families. A hospice program may also provide palliative and supportive medical, nursing and other health services through home or inpatient care during the terminal illness.Hospice Care Services Return to previous pageAny services provided by a hospital, skilled nursing facility, home health agency, hospice, or any other licensed facility or agency under a hospice program.Hospital Return to previous pageA hospital is an institution constituted, licensed and operated in accordance with the laws pertaining to hospitals, which maintains on its premises all the facilities needed to diagnose and treat injury and sickness. It is an institution which qualifies as a hospital, a psychiatric hospital or a tuberculosis hospital as a provider of services under Medicare and is accredited by the Joint Commission on the Accreditation of Hospitals.A hospital can specialize in treatment of mental illness, alcoholism, drug addiction, or other related illness. It can also provide residential treatment programs, but only if it is constituted, licensed and operated in accordance with the laws of legally authorized agencies responsible for medical institutions. It provides all treatment for a fee, by or under the supervision of physicians on an inpatient basis with continuous 24-hour nursing service by qualified nurses. Any institution which is, other than incidentally, a place for rest, a place for the aged or a nursing home, will not be considered a hospital. Hospital Precertification Return to previous pageApproval of a hospital stay or special procedure by CIGNA Member Services if you are covered under the Point-of-Service Plans and Intracorp if you are covered under the Indemnity Plan.Hour of Work Return to previous pageEach hour of work for the Company for which you are paid, including straight-time, overtime, holidays, and jury duty. However, vacations, personal leave and time off for union business are not included in calculating your hours of work.Indemnity Plan Return to previous pageA medical plan in which you can use any provider you choose and in which benefits are paid after a deductible is satisfied.Informal Caregiver Return to previous pageFor long term careA person providing custodial (personal) care, who is not a nurse or therapist or whose services are not provided and supervised by a home health care agency, nursing home, assisted living facility, hospice, or adult day care center or care management organization. Members of the covered person's immediate family may qualify as informal caregivers. In-Network Benefits Return to previous pageThe level of coverage you receive under the Point-of-Service Plans for care provided or coordinated by your primary care physician.Lifetime Maximum Return to previous pageThe maximum amount of benefits a plan will pay for an individual during his or her lifetime.Limb Return to previous pageAn arm or a leg.Major Medical Medicare Supplement Plan Return to previous pageA medical plan available to retirees who are age 65 or over and enrolled in Medicare Part A and Part B. The plan is designed to supplement your Medicare Part A coverage and to provide coverage for certain expenses for which no Medicare benefits or limited Medicare benefits are payable.Member Services Return to previous pageThe network manager's customer service unit. You can call Member Services any time you have a question about the Point-of-Service Plans.Mental Health Provider Return to previous pageThe company responsible for authorizing mental health and alcohol/drug abuse treatment for Point-of-Service Plans participants.Myofunctional Therapy Return to previous pageCorrecting and/or retraining of the muscles in order to correct an orthodontic disorder.Necessary Services and Supplies Return to previous pageAny services or supplies, other than bed and board, that are necessary for your treatment and are administered during hospital confinement. Necessary services and supplies will also include professional ambulance service to or from the nearest hospital where the necessary medical treatment can be provided, and any charges for the administration of anesthetics during hospital confinement. Necessary services do not include special nursing, dental or medical services.Network Return to previous pageA group of health care providers who have agreed to provide care for prenegotiated rates, as well as to comply with quality assurance procedures and patient service standards.Network Manager Return to previous pageThe health plan that sets up and manages a network of providers and administers out-of-network benefits, too. The Point-of-Service Plans' network manager is CIGNA HealthCare.Network Pharmacy Return to previous pageA pharmacy that has contracted with Merck-Medco to provide prescription drugs.Normal Retirement Return to previous pageRetirement at age 65.Nurse Return to previous pageA Registered Graduate Nurse, a Licensed Practical Nurse or a Licensed Vocational Nurse. A nurse is a professional who has the right to use the respective title and the respective abbreviation R.N., L.P.N. or L.V.N.Orthodontic Treatment Return to previous pageScience of the movement of teeth in the correction of malocclusion.Orthotics Return to previous pageA custom-molded rigid insert that, when placed in the shoe, distributes the patient's weight equally throughout the foot and leg and relieves the stress from any one particular area.Out-of-Network Benefits Return to previous pageIf you are enrolled in the Point-of-Service Plans, the level of coverage for care you receive when the care is not coordinated by your primary care physician.Out-of-Pocket Maximum Return to previous pageThe maximum you have to pay for eligible medical expenses in one plan year. Once you reach this amount, the medical plan pays 100% of eligible expenses for the rest of that plan year.All eligible medical expenses count toward the out-of-pocket maximum, except for expenses for prescription drugs, mental health/alcohol and drug abuse treatment, amounts above reasonable and customary and any penalties for failing to precertify your hospitalization. Paralysis Return to previous pageThe loss of all practical use of a limb as it relates to the ability to perform the normal functions and activities of everyday life without the use of a prosthesis or any other mechanical device(s).Partial Denture Return to previous pageAn appliance supporting artificial teeth less than the full number of teeth in one jaw.Periodontal Splinting Return to previous pageStabilizing or immobilization of periodontically involved teeth. Splinting may be accomplished with acrylic resin bit guards, orthodontic band splints, wire ligation, provisional splints and fixed prosthesis.Periodontics Return to previous pageThe treatment of disease of the gum and tissues surrounding the teeth.Personal Identification Number (PIN) Return to previous pageThe number that allows you to access savings program account information through the information line.Physician Return to previous pageA person who is licensed to prescribe and administer drugs or to perform surgery and who operates within the scope of his or her license.Point-of-Service Plan Return to previous pageA medical plan through which you may receive care coordinated by a primary care physician (at the highest level of benefits) or by any other physician (at a lower level of benefits).Prescription Drugs Return to previous pageMedication prescribed by a physician for the treatment of an illness or injury. There are two types of prescription drugs: brand-name and generic.Primary Care Physician Return to previous pageA physician — generally an internist, general/family practitioner or pediatrician — whom you select to coordinate all your medical care within the point-of-service network.Prosthodontic Services Return to previous pageThe making of artificial devices for replacement of missing teeth and structures in the mouth.Reasonable and Customary Charge Return to previous pageFor medical coverageA rate for medical services that is determined by the insurance company by taking into account:
Reasonable and customary charges apply to the Indemnity Plan and the out-of-network side of the Point-of-Service Plans. All in-network charges under the Point-of-Service Plans are within the reasonable and customary limit. For dental coverage A rate for dental services that is determined by the insurance company by taking into account:
Rollover Contributions Return to previous pageDistributions from another employer's qualified plan that you deposit into your savings program account.Retiree Return to previous pageA retiree is a former employee who at the time of termination of employment was eligible to receive a retirement benefit.Room and Board Return to previous pageAll charges commonly made by a hospital for rooms and meals and all general services and activities needed for the care of registered bed patients.Routine Return to previous pageA situation that does not require immediate attention, such as immunizations or annual exams.Skilled Nursing Facility Return to previous pageAn institution or part of an institution which is constituted and operated in accordance with the laws pertaining to skilled nursing facilities. It must be under the full-time supervision of a physician or a registered graduate nurse who is regularly on the premises at least 40 hours per week. Such a facility must provide, for a fee, room and board and 24-hour nursing service by trained nurses.The facility must:
Space Maintainers Return to previous pageAppliances to prevent adjacent teeth from moving into space left by a lost tooth.Terminally Ill Return to previous pageA medical prognosis of six months or less to live.Urgent Return to previous pageA situation that requires prompt medical attention, but is not life threatening, such as a severe sore throat, sprained ankle, high temperature or ear infection.Vesting Return to previous pageOwnership interest in your pension plan benefits and Company matching contributions under the savings program. You have an irrevocable right to a benefit when you are fully vested. | |||
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