Glossary
Health Insurance
P to Q

You will find an expanded list and definition of terms in this glossary health insurance A to B section.

Use it often, especially when you begin to review your health insurance policy and benefits.

P

per diem: Term that is applied to determining costs for one day of care. It is an average cost and does not reflect true cost for each patient.

pre-authorization: Previous approval required for a referral to a specialist or non-emergency health care services.

pre-certification: The approval an insurance company must give before hospitalization or surgical procedure. Notification allows the insurance company to authorize and to recommend alternate courses of action. The goal is to unnecessary non-emergency procedures.

pre-existing condition exclusion period: Time during which a health plan won't pay for covered care related to a pre-existing condition.

pre-existing condition clause: A clause in an insurance contract that specifies if benefits will or will not be paid for a pre-existing condition. Additionally, the clause may limit the benefit payable for treatment of pre-existing conditions until a certain time period of coverage has elapsed, usually six months to a year.

premiums: The periodic payments you make to the insurance company in exchange for health coverage.

premium tax: A state sales tax on insurance premiums.

prudent person rule: A rule that allows insurance companies to exclude as pre-existing any condition for which most people would have sought care or treatment prior to enrolling in an individual health plan.

preventive care: Any service that focuses on prevention such as mammograms, immunizations, shots, physical exams and diagnostic tests.

physical therapy: A program of special exercises that can help an injury heal without restricting movement or limiting function. Not all health plans cover physical therapy.

physicians office visit: Any time you visit a doctor at his or her office for medical care.

policy: The written contract between an individual or group policyholder and an insurance company. The policy outlines the duties, obligations, and responsibilities of both the policyholder and the insurance company.

A policy may include any application, endorsement, certificate, or any other document that can describe, limit, or exclude coverage benefits under the policy.

policy owner: The person or business that owns an insurance policy.

policy year: The period of time that your policy is to remain in force.

pooling: A method used by insurance companies to combine all premiums, claims and expenses in order to spread the risk of insurance coverage.

portability: Allows you to retain your policy after leaving your employer. COBRA provides a type of portability in that you can maintain your insurance for a limited period of time (typically 18 months) as long as you pay the premiums.

probationary period: The waiting time before you become eligible to enroll in a group insurance.

Q