|» PCP||» pre-certification|
|» PDP||» pre-existing condition|
|» PPO||» preferred brand drugs|
|» Part D (Medicare Part D)||» premium|
|» penalties||» primary care provider|
|» pharmacy network||» prior authorization or prior approval|
|» policyholder||» provider|
|A primary care physician you choose from a plan network to provide your routine and preventive care. HMOs require you to select a PCP, while PPOs don't. However, if you select a PCP with your PPO plan, you'll have a lower copay for office visits.
|Stand-alone Medicare Part D Prescription Drug Plans (PDPs) provide reduced-cost prescription drug coverage to Medicare recipients. Medicare Part D plans work together with Medicare Part A and Part B, as well as Medicare Supplements and Medicare Advantage (MA) plans that do not provide prescription drug coverage. Annual Enrollment periods for PDPs run from Nov 15 through Dec. 31, with January 1 as the plan starting date.
|A Preferred Provider Organization that provides access to a network of doctors and hospitals that coordinate your care. This allows you to get more benefits than the Original Medicare Plan and many Medicare supplement plans. PPOs also allow you to use any doctor or hospital outside of the network for a higher copay or coinsurance.
|Part D (Medicare Part D)|
|Part D is the new prescription drug program that became available to all Medicare beneficiaries on January 1, 2006. The Medicare Part D prescription drug program is insurance offered by the federal government and sold through private companies that helps pay for prescription drugs.
|Medicare beneficiaries without creditable coverage who were eligible to enroll but waited until after May 15, 2006, may pay the standard monthly premium plus a 1-percent penalty of the base beneficiary premium per month - or 12 percent a year - and won't be able to enroll until the next annual election period (November 15, 2006, through December 31, 2006). This higher premium will stay with them for as long as they are enrolled in the program. People who turn 65 between annual enrollment periods can join a Medicare prescription drug plan as soon as they sign up for Medicare. They can enroll at any time three months before or three months after their Medicare eligibility date without penalty. The effective date of prescription drug coverage will begin on their Medicare eligibility date. If they don't join a plan within three months after their Medicare eligibility date, don't have creditable coverage and decide to join later, they'll pay the same 1-percent penalty.
|This is the group of pharmacies who have contracted with the PDP to save you money on prescriptions.
|The person or party who owns an individual insurance policy. This the person may be the insured, a relative, the beneficiary, a corporation, or another person.
|HIPAA requires that workers with pre-existing medical conditions must receive credit for time in a previous health plan if they join an employer plan.
|A requirement to notify the insurance company for its approval before you check into a hospital, have elective surgery, visit specialists, have testing done. Pre-certification does not guarantee the insurance company will pay the medical bills. Also called pre-admission.
|Particular health conditions that occurred prior to applying for insurance and for which you received medical advice, diagnosis, care or treatment. Policies can exclude coverage of any medical condition for a period of time.
|preferred brand drugs|
|Among brand drugs, these are the ones the plan prefers, so they are less costly. These brand drugs generally have lower co-pays than non-preferred brand drugs.
|The payment required annually, semi-annually or monthly to be part of an insurance plan. In a Part D plan, this is usually a monthly fee.
|primary care provider|
|A health care professional (usually a physician) who is responsible for monitoring an individual's overall health care needs. Typically, a PCP refers the individual to more specialized physicians for specialist care.
|prior authorization or prior approval|
|Some benefit plans require you to receive authorization or approval before they will cover a particular prescription. The reasons vary and can include the medication itself, the quantity prescribed or the frequency of its administration. Prior authorization means that you or your doctor will need to get approval from the plan before you fill your prescriptions. If you don't get approval, your drug may not be covered by the plan. Please note that prior authorizations can take up to 72 hours to process. Drugs with this condition are designated 'PA' in the formulary.
|doctors, hospitals, radiation departments, pharmacies and others that provide medical health care service.|