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Glossary Of Terms |
Please Note: This information is a general reference tool. All terms, conditions and amounts may not be applicable to your benefit plan. Please refer to your Plan Document for a complete listing of terms, conditions, coverage and exclusions of your benefit plan.
Terms Beginning with the Letter "P"
Participant is any employee or dependent who is covered under this Plan.
Pharmacy means a licensed establishment where covered Prescription Drugs are filled and dispensed by a pharmacist licensed under the laws of the state where he or she practices.
Physician means a Doctor of Medicine (M.D.), Doctor of Osteopathy (D.O.), Doctor of Dental Surgery (D.D.S.), Doctor of Podiatry (D.P.M.), Doctor of Chiropractic (D.C.), Audiologist, Certified Nurse Anesthetist, Licensed Professional Counselor, Licensed Professional Physical Therapist, Master of Social Work (M.S.W.), Midwife, Occupational Therapist, Optometrist (O.D.), Physiotherapist, Psychiatrist, Psychologist (Ph.D.), Speech Language Pathologist and any other practitioner of the healing arts who is licensed and regulated by a state or federal agency and is acting within the scope of his or her license.
Plan Year is the 12‑month period beginning on either the effective date of the Plan or on the day following the end of the first plan year, which may be a short Plan Year.
Preferred Provider Organization (PPO): A managed care plan in which a network of providers contracts with an organization to give medical services at a discount to its members. With a PPO, you can choose one or more providers from a list of those who participate with the health plan.
Pre-Existing Condition is a condition for which medical advice, diagnosis, care or treatment was recommended or received within six months of the person’s Enrollment Date under this Plan. Genetic Information is not a condition. Treatment includes receiving services and supplies, consultations, diagnostic tests or prescribed medicines. In order to be taken into account, the medical advice, diagnosis, care or treatment must have been recommended by, or received from, a Physician.
Pregnancy is childbirth and conditions associated with pregnancy, including complications.
Prescription Drug means any of the following: a Food and Drug Administration-approved drug or medicine which, under federal law, is required to bear the legend: "Caution: federal law prohibits dispensing without prescription"; injectible insulin; hypodermic needles or syringes, but only when dispensed upon a written prescription of a licensed Physician. Such drug must be Medically Necessary in the treatment of a Sickness or Injury.
Prior Authorization is approval which is needed ahead of time from the health plan for certain services to be covered.
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