Access to Care

A member's ability to obtain medical or behavioral health care. It is determined by factors such as the availability of appointments, the location of offices and facilities, hours of operation, and accommodation of cultural and linguistic preferences.


Accreditation programs give an external opinion on quality in programs and services as reviewed against a set of industry-derived quality standards.


Behavioral Health

This is also called mental health. It describes a person's state of mind. Depression, eating disorders and substance abuse are conditions that fall under this term.

Benefit Limit

A predetermined amount of pharmacy benefit expenses that your plan sponsor will cover before you must pay for your medications at 100%. In most cases, the plan sponsor paid amount is tracked and, once your benefit limit is met, you are responsible for a 100% copayment amount.