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Is just another term for your family doctor, or the doctor you see for most of your healthcare needs
Primary Care Dpctor (PCP)
It's the specific time each year that you can buy a health insurance plan, renew the plan you already have, or switch to another plan
Annual Enrollment Period / Open Enrollment Period
Is a subsidy offered by the federal government to help offset the costs of individual and family health insurance plans.
Financial assistance
A person who has health care coverage
Member
Provider or hospital that does not participate in the Independence networks.
Out of Network (OON)
Is the process called when a policyholder or provider asks an insurance company to reconsider a denied claim or coverage decision
Appeal
is a program managed by the states and federal government that provided health insurance for individuals and family that are low income
Medicaid
To make it easier to compare plans, the federal government created four levels of coverage, which are:
Platinum, gold, silver and bronze
Its the plan that offers access to doctors and hospitals in a network. For the highest level of benefits, a primary care physician can refer in-network specialits
Point-of-Service (POS)
Electronic documentation from a Member's PCP authorizing care at a participating specialist/provider for covered services
Referral
It's the percentage a subscriber pays for some covered services
Out Of Pocket (OOP)
It's usually produced by a single manufacturer with a product name under which the drug is advertised and sold
Brand-name drugs
are Health care services or supplies needed to diagnose or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine
Medically necessary
Are the benefits in a members policy that the insurance company has agreed to pay fully or partially
Covered Services
They have same active ingredients as their counterparts but they usually cost less?
Generic Drugs
Its goal is to make health care more affordable and accessible for millions of Americans
Affordable Care Act
It means you may need extra approval from your health plan before you receive certain tests, procedures, or medications.
Precertification
Is Pennsylvania's state-based exchange and has replaced healthcare.gov for Pennsylvanians
Medication purchase without a prescription.
Over the counter (OTC)
Includes but is not limited to: hospital beds, crutches, canes, wheelchairs, walkers, peripheral circulatory aids.
Durable medical equipment