The Key Parts of LM Healthworks Plan
This section is a user guide to your LM HealthWorks Plan that takes you step by step through the process of seeking care and using your benefits.

How to Seek Care

Know what to do, what to expect and what your responsibility will be when you or a family member needs health care.

Using in-network providers

When you need care, you have a choice. You may visit doctors and other care providers who belong to the network, or you may seek care outside the network. Remember, in-network doctors have negotiated special rates with Aetna. This, in addition to a higher level of benefits paid for in-network care, means you’ll pay less for your care when you visit in-network providers.

Follow these steps for in-network care »

Using out-of-network providers

If you seek care outside the network, the process is slightly different.

Follow these steps for out-of-network care »

When you have a prescription filled at a participating retail pharmacy

By entering a zip code and selecting “locate pharmacy” online, you can find participating retail pharmacies near you.

When you visit the participating retail pharmacy:

  1. Show your pharmacy ID card.
  2. Pay a percentage of the cost of the medication — called coinsurance. How much coinsurance depends on the type of drug used to fill the prescription. Remember, you pay the least when your doctor prescribes a generic drug, if one is available.
  3. Beginning January 1, 2015, you will not pay more than $2,000 (if you have individual coverage) or $4,000 (if you have family coverage) out-of-pocket for your covered prescription expenses. This is what’s called an “out-of-pocket maximum”.

The Benefits Summary shows coinsurance amounts for prescription drugs.

Using an LM HealthWorks Wellness Center

LM HealthWorks Wellness Centers are another way to get the health services you need. The centers provide onsite care that includes routine physical exams, bloodwork, urgent and minor acute care, and much more – all free of charge.

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