Access for Infants and Mothers Program Banner

Glossary

appeal

Asking for reconsideration of an AIM program decision.

applicant

A pregnant woman 18 years of age or older who is applying on her own behalf, or a legal guardian or a natural parent, foster parent, or stepparent with whom the child resides, who applies for coverage under the program on behalf of a child.

"Applicant" also means a pregnant woman who is applying for coverage on her own behalf who is under 18 years of age, or who is an emancipated minor, or who is a minor not living in the home of a natural or adoptive parent, a legal guardian, foster parent or stepparent.

application date

The date an application is sent to the AIM Program as shown by the U.S. Postal postmark date on the application envelope, or documentation from other delivery services.

benefits

The health services the pregnant woman and infant receive under the AIM Program.

binding arbitration

Binding Arbitration is an agreement between some insurance plans and subscribers to have health care disputes reviewed by a neutral person. If you choose an insurance plan with arbitration, you give up the right to a jury or court trial to resolve disputes you may have with your insurance plan. The neutral person makes a decision after reviewing and hearing all the facts from both parties. Both parties agree to accept the decision.

Coordination of Benefits (COB)

Coordination of Benefits (COB) means that if you are covered by another health plan, that plan will pay frst and the AIM Health Plan will pay second for any services you receive under the AIM Program. The total of the two payments cannot be more than the total amount allowed by the AIM Health Plan. For more details on COB, please refer to your AIM plan’s Evidence of Coverage booklet.

coverage

The payment for benefits provided by a health plan participating in the AIM Program.

disenrollment

The end of enrollment in the AIM Program.

effective date of coverage

The date that health care coverage starts.

eligible

A pregnant woman who meets all the requirements to qualify for coverage in the AIM Program.

enroll

To accept an applicant as a subscriber by notifying a participating health plan to begin coverage.

exclusion

A service or medical condition not covered by an insurance plan under the AIM Program.

Exclusive Provider Organization (EPO)

A health plan whose members must seek care from a list of contracting providers. An EPO does not require you to choose a Primary Care Physician. Members also may self-refer to a specialist in the EPO contract network.

family member

The following persons living in the pregnant woman's home: The unborn child of the pregnant woman. Children under age 21 of married or unmarried parents living in the home. The married or unmarried parents of the child or sibling children. The stepparents of the sibling children. The separate children of either an unmarried parent or a married parent or stepparent. Children under the age of 21 of married or unmarried parents who are away at school and who are claimed as a dependent on your federal or state income tax return.

Family Planning Services

Family Planning Services are for counseling, surgical procedures for sterilization as permitted by state and federal law. This includes coverage for diaphragms and other approved devices pursuant to the prescription drug beneft, and voluntary termination of pregnancy.

Federal Income Guidelines (FIG)

Federal Income Guidelines are the amount of money the federal government says that a family needs to meet basic needs. The guidelines change every year on April 1st.

First Trimester

First trimester means the first 13 weeks starting with the first day of a pregnant woman’s last menstrual period and ending at the end of the 13th week, or the first one-third of a full-term pregnancy, including the first two weeks before conception, as document by a licensed health care professional.

Health Maintenance Organization (HMO)

An organized system that provides a set of health care services to plan subscribers in a geographic area.

Healthy Families Program

Low-cost medical, dental and vision coverage for California children and teens that do not have access to insurance and do not qualify for no-cost Medi-Cal coverage.

household income

The total income before taxes of all family members in a household.

infant

A subscriber's child born to a subscriber while enrolled in the program.

living in the home

Using the home as the primary place of residence.

resident

A person living in California who plans to stay except when absent for temporary purposes.

no-cost Medi-Cal

The State Medi-Cal program that pays for all services without requiring any payments or co-payments by the subscriber.

out-of-network

A service provided by a doctor, dentist, or other provider who does not have a contract with your insurance plan.

pre-existing condition

Any condition that was diagnosed before enrollment in the AIM Program where medical advice, diagnosis, care, or treatment, including use of prescription drugs, was recommended or received from a licensed health practitioner during that period.

primary care physician

The doctor, selected by the pregnant woman who will be in charge of her health care and who will refer her to specialists as needed.

share of cost Medi-Cal

A State Medi-Cal program that requires a subscriber to pay a certain amount of the medical expenses every month before it covers benefits. Share of Cost is based on monthly income.

subscriber

A pregnant woman who is eligible for and enrolled in the AIM Program.

subscriber contribution

The amount paid by the pregnant woman for health care services provided in the AIM Program.