Health / Health Insurance Glossary

Plan Funding: The method that an employer or other payor or purchaser uses to pay medical benefit costs and administrative expenses.

Point-Of-Service (POS) Product: A healthcare option that allows members to choose at the time medical services are needed whether they will go to a provider within the plan's network or seek medical care outside the network.

Pooling: The practice of underwriting a number of small groups as if they constituted one large group.

Pre-Admission Certification: Also called pre-certification review, or pre-admission review. Approval by a case manager or insurance company representative (usually a nurse) for a person to be admitted to a hospital or i . . . View Full Definition

Pre-Admission Review: A review of an individual's health care status or condition, prior to an individual being admitted to an inpatient health care facility, such as a hospital. Pre-admission reviews are often c . . . View Full Definition

Pre-Existing Condition: In group health insurance, generally a condition for which an individual received medical care during the three months immediately prior to the effective date of coverage.

Pre-Existing Conditions: A medical condition that is excluded from coverage by an insurance company, because the condition was believed to exist prior to the individual obtaining a policy from the particular insuran . . . View Full Definition

Preadmission Testing: Medical tests that are completed for an individual prior to being admitted to a hospital or inpatient health care facility.

Preferred Provider Arrangement (PPA): As defined in state laws, a contract between a healthcare insurer and a healthcare provider or group of providers who agree to provide services to persons covered under the contract. Example . . . View Full Definition

Preferred Provider Organization (PPO): A healthcare benefit arrangement designed to supply services at a discounted cost by providing incentives for members to use designated healthcare providers (who contract with the PPO at a d . . . View Full Definition

Preferred Provider Organizations (Ppos): You or your employer receive discounted rates if you use doctors from a pre-selected group. If you use a physician outside the PPO plan, you must pay more for the medical care.

Premium: A prepaid payment or series of payments made to a health plan by purchasers, and often plan members, for medical benefits.

Premium Taxes: State income taxes levied on an insurer's premium income.

Prepaid Care: Healthcare services provided to an HMO member in exchange for a fixed, monthly premium paid in advance of the delivery of medical care.

Prepaid Group Practices: Term originally used to describe healthcare systems that later became known as health maintenance organizations.

Primary Care: General medical care that is provided directly to a patient without referral from another physician. It is focused on preventative care and the treatment of routine injuries and illnesses.

Primary Care Case Manager (PCCM): In states that have obtained a Section 1915(b) waiver, a primary care provider who contracts directly with the state to provide case management services, such as coordination and delivery of . . . View Full Definition

Primary Care Provider (PCP): A health care professional (usually a physician) who is responsible for monitoring an individual's overall health care needs. Typically, a PCP serves as a 'quarterback' for an individual's m . . . View Full Definition

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