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Glossary


Non-formulary
Describes prescription medications not covered by a health plan.

Non-gatekeeper, Open access
Health care program that does not require primary care physicians to approve all medical services.

Out-of-network
Term that describes providers or health care facilities that do not belong to a health plan’s network of providers. Insured individuals usually pay more when using out-of-network providers because no discounted service plan is in place.

Policy
An insurance contract, which describes the term, coverage, premiums and deductibles.

Policyholder
A person who pays a premium to an insurance company in exchange for the protection of an insurance contract.

POS
Point-of-Service Plan. A health plan that allows members to receive services from a participating or non-participating network provider, typically reducing benefits for out-of-network services.

PPO
Preferred Provider Organization. A health care organization in which member physicians, hospitals and other providers deliver health care services at a reduced fee.

Preauthorization
Previous approval for referral to a specialist or for non-emergency medical services.

Precertification
Advance approval required for hospital admission or a surgical procedure.

Preferred brand
Prescription drug protected by trademark registration for which no generic substitute is available.

Premium
Payment made on an insurance policy.

Procedure code
Standardized codes used in billing medical procedures and paying claims.

Property & casualty
A broad category of insurance that protects against loss of property, damage or other liabilities.

Second-to-die insurance
Insurance that pays a death benefit upon the death of the last surviving insured person.

Term
Time period covered by an insurance policy.

Term insurance
Life insurance policy that pays a pre-set amount if the insured dies during the period specified in the policy. Premiums typically increase as the policyholder gets older.

Travel insurance
Policy that protects against loss, damage, injury or expense that arise in connection with travel or intended travel by an insured person.

Umbrella policy
Insurance coverage that provides additional coverage when an insured exceeds the limits of an underlying policy.

Universal life insurance
A type of whole life insurance that has variable premiums, benefits and payment schedules, which are tied to market interest rates and the performance of the investment portfolio.

Usual and customary
A set rate established by an insurance company as the standard fee payable for a specific claim within a geographical area.

Vision
An insurance policy that helps pay for the services of eye care professionals.

Waiting period
A period of time that must pass before an insurance policy goes into effect.

Whole life insurance
Insurance policy that provides coverage for the entire life of the insured, who pays the same fixed premium throughout his or her life. The policy accumulates cash reserves that the policyholder can collect by surrendering the policy, partly or fully.



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