What is a PPO? A Preferred Provider Organization (PPO) is an arrangement designed to supply healthcare services at a discounted cost by providing incentives for members to use designated healthcare providers (who contract with the PPO at a discount), but which also provides coverage for services rendered by healthcare providers who are not part of the PPO network.

What is an HMO? HMO stands for Health Maintenance Organization, a healthcare system that assumes or shares both the financial risks and the delivery risks associated with providing comprehensive medical services to a voluntarily enrolled population in a particular geographic area, usually in return for a fixed, prepaid fee.

What is a Primary Care Physician (PCP)? A physician or other medical professional who serves as a group member's first contact with a plan's healthcare system. Also known as a primary care provider, personal care physician, or personal care provider.

What is a Claim? An itemized statement of healthcare services and their costs provided by a hospital, physician's office, or other provider facility. Claims are submitted to the insurer or managed care plan by either the plan member or the provider for payment of the costs incurred.physician or other medical professional who serves as a group member's first contact with a plan's healthcare system. Also known as a primary care provider, personal care physician, or personal care provider.

What is Coinsurance? A method of cost-sharing in a health insurance policy that requires a group member to pay a stated percentage of all remaining eligible medical expenses after the deductible amount has been paid. incurred. physician or other medical professional who serves as a group member's first contact with a plan's healthcare system. Also known as a primary care provider, personal care physician, or personal care provider.

What is Copayment? A specified dollar amount that a member must pay out-of-pocket for a specified service at the time the service is rendered.

What is a Fee Schedule? The fee determined by an acceptable for a procedure or service, which the physician agrees to accept as payment in full. Also known as a fee allowance, fee maximum, or capped fee.

What is a Generic Substition? The dispensing of a drug that is the generic equivalent of a drug listed on a pharmacy benefit management plan's formulary. In most cases, generic substitution can be performed without physician approval.

What is Managed Care? The integration of both the financing and delivery of healthcare within a system that seeks to manage the accessibility, cost, and quality of that care.