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Resource LinksReference Library: Glossary of Terms
P
Paramedical Report
A report based on a physical examination and a medical history completed by a medical technician, a physician's assistant, or a nurse, rather than a physician. A paramedical report describes the health of a proposed insured and can serve as part of an insurance application.
Partial Disability
A disability that prevents an insured from engaging in some of the duties of his or her usual occupation or from engaging in the occupation on a full-time basis.
Partial Disability Benefit
A flat amount specified in a disability income insurance policy that is payable when the insured suffers a partial disability. Usually the partial disability benefit is half the full disability benefit.
Payroll Deduction Plan
(1) See salary-reduction plan. (2) A premium payment method for individual insurance under which an individual's employer deducts the employee's premium amount from his or her paycheck and sends the premium to the insurer.
Per-Cause Deductible
A deductible which must be satisfied for each separate accident or illness before major medical benefits will be paid. Also known as a per-disability deductible.
Percentage Contribution
The amount of the premium that a group member pays in a contributory group insurance plan. Also known as employee contribution or member contribution.
Percentage Participation
See coinsurance.
Point-of-Service (POS) Plan
A type of managed care plan combining features of health maintenance organizations (HMOs) and preferred provider organizations (PPOs), in which individuals decide whether to go to a network provider and pay a flat dollar co-payment (say $10 for a doctor's visit), or to an out-of-network provider and pay a deductible and/or a coinsurance charge.
Policy Provisions
The statements, following the face page of an insurance policy, that describe the operation of the insurance contract.
Portability
The ability of an individual to transfer from one health insurer to another health insurer without regard to preexisting conditions or other risk factors.
Pre-Admission Review
A component of a utilization review program that requires an insured person, or that person's physician, to obtain prior authorization from an insurer before any non-emergency hospitalization.
Pre-Authorization
A cost containment feature of many group medical policies whereby the insured must contact the insurer prior to a hospitalization or surgery and receive authorization for the service.
Predetermination of Benefits Provision
A provision often included in dental policies which specifies that when dental treatments are expected to exceed a stated level, such as $100, $150, or $200, the dentist should submit to the insurer the proposed treatment plan for the patient so that the insurer can determine the amount payable by the dental plan. Also known as a preauthorization of benefits provision, precertification of benefits provision, or pretreatment review provision.
Pre-Existing Condition
A health problem that existed before the date your insurance became effective. Many insurance plans will not cover preexisting conditions. Some will cover them only after a waiting period.
Pre-existing Conditions Provision
A provision in most medical expense insurance policies stating that until the insured has been covered under the policy for a certain period, the insurer will not pay benefits for any preexisting condition.
Preferred Provider Organization (PPO)
A network of health-care providers with which a health insurer has negotiated contracts for its insured population to receive health services at discounted costs. Health-caredecisions generally remain with the patient as he or she selects providers and determines his or her own need for services. Patients have financial incentives to select providers within the PPO network.
Premium
The monthly amount you or your employer pays in exchange for insurance coverage.
Primary Beneficiary
The party or parties who have first rights to receive policy benefits when the benefits of an insurance policy become payable.
Primary Care Physician
Usually your first contact for health care under a health maintenance organization (HMO) or point-of-service (POS) plan. This is often a family physician, internist, or pediatrician. A primary care physician monitors your health, treats most health problems, and authorizes referrals to specialists, if necessary.