P
physical therapy
Not all plans cover physical therapy -- a program of special exercises that can help an injury heal without restricting movement or limiting function.
Physicians Office Visit
Any time you visit a doctor at his or her office for medical care.
point-of-service plan
An HMO plan that also incorporates an indemnity plan option allowing members to obtain medical care from providers outside of the HMO network at a reduced benefit and at greater out-of-pocket expense.
policy
A written document that contains the terms of the contractual agreement between an insurance company and the owner of policy.
policy year
The period of time that the policy is to remain in force.
policyowner
The person or business that owns an insurance policy.
portable coverage
Group insurance coverage that can be continued by an insured employee who leaves the covered group.
POS (point-of-service plan)
An HMO plan that also incorporates an indemnity plan option. You can decide whether to go to a network provider for lower out of pocket costs, or go to an out-of-network provider and higher out of pocket costs.
PPO (preferred provider organization)
An organization where providers are under contract to an insurance company or health plan to provide care at a discounted or negotiated rate. Typically, you can see any doctor in the PPO network without requiring special approval, and you usually do not need to choose a primary care physician. Most PPOs will also allow you to seek care outside of the PPO network; however, the benefits are usually reduced and the insured has a greater out-of-pocket expense.
pre-admission certification
A component of utilization review under which the utilization review organization determines whether an insured's proposed non-emergency hospital stay or some other type of care is most appropriate and what the length of an approved hospital stay may be.
pre-existing condition
(1) According to most individual health insurance policies, an injury that occurred or a sickness that first appeared or manifested itself before the policy was issued and that was not disclosed on the application for insurance. (2) According to most group health insurance policies, a condition for which an individual received medical care during the three months immediately prior to the effective date of his coverage.
pre-existing conditions provision
A health insurance policy provision stating that benefits will not be paid for any illness and/or condition that existed prior to one becoming an insured under the particular health plan in question, until the insured has been covered under the policy for a specified period.
premium
A specified amount of money that the insurer receives in exchange for its promise to provide health insurance to an individual or a group.
prescription drug coverage (Rx)
A type of specified expense coverage that provides benefits for the purchase of drugs and medicines prescribed by a physician and not available over-the-counter. Often a plan will provide a prescription drug card that allows the insured to obtain medications by simply paying a copay at a participating pharmacy.
primary care physician (PCP)
A general or family practitioner who serves as the insured's personal physician and first contact with a managed care system. The PCP will usually direct the course of your treatment and/or refer you to other doctors and/or specialists in the network.
probationary period
The length of time that a new group member must wait before becoming eligible to enroll in a group insurance plan.
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