Patient Protection and Affordable Care Act (PPACA)
Also known as the Affordable Care Act, the PPACA is the health care reform law passed in March 2010 by the 111th Congress and signed by President Barack Obama. Beginning in 2010, the provisions of the PPACA have been and will continue to be gradually implemented through 2014. The core of the legislation is providing coverage to millions of Americans without insurance, improving the quality and lowering the cost of the health care system, and stop insurers from denying coverage to people with pre-existing conditions and giving recissions.
PCIP (Pre-existing Condition Insurance Plan)
A program set up by the ACA to give those with pre-existing conditions, and those who have been uninsured for a minimum of six months, an option for medical coverage if they have been denied by an insurer. PCIP offers coverage until 2014, when every adult with a pre-existing condition will be accepted for health insurance policies through state exchanges.
Overseeing the regular operation of a health plan, through actions like enrolling individuals in a plan, answering questions, billing and accepting premiums, and other duties to maintain the function of a health insurance policy.
Point of Service Plan (POS)
A type of health plan where the policy-holder is encouraged to see in-network providers (in order to receive lower costs), and similar to an HMO, they may need you to get a referral from your primary care physician before seeing a specialist. For more about POS plans, read this article.
A document granting prior approval from an insurance company, case manager, or nurse to admit an individual to an inpatient care facility or hospital. Before an individual can receive care, they must obtain the pre-admission certification, or pre-admission review. The purpose of this process is avoiding medically unnecessary services.
Prior to being admitted into an inpatient facility or hospital, an individual’s medical condition or status is reviewed by an insurance company or case manager. These reviews are performed with the consent of the patient, their primary care provider, and the facilities where they plan to get care.
Defined differently from state to state, a pre-existing condition is a medical condition for which an individual has received treatment prior to enrolling in a health plan. In certain states, you must have received care for this condition in the past 6 months, and others open it up to 7 years. There has been much discrimination against those with pre-existing conditions in the underwriting process, which will be eliminated by the Affordable Care Act in 2014, when all individuals with pre-existing conditions must be accepted for a health plan, and cannot be overcharged for them. For more on pre-existing conditions, refer to this article.
Preferred Provider Organization (PPO)
A type of health insurance plan that uses a network of contracted providers, such as doctors and hospitals, through which you may receive a lower fee for covered services. A PPO plan offers the flexibility of being able to see an out-of-network provider without a referral from your primary care doctor, and even the option of whether you have a primary care doctor at all. For further information about PPOs, read this article.
The monthly payment for health insurance coverage that a policy-holder pays to their insurance company. Premiums can be paid by employers, employees, individuals, unions, or divided among several payers, depending on the plan.
Regular medical care services that includes check-ups, screenings, and patient counseling for the prevention of disease, illness, or other types of health issues. These are usually covered by all health insurance plans in every state.
Primary Care Provider (PCP)
A professional in the medical field, usually a physician, who manages the totality of a person’s health care. PCPs can be doctors, nurses, nurse practitioners, and physicians assistants. In HMOs and other types of plans, the PCP is the “gatekeeper” for health care services, orchestrating the whole process. This means they are required by insurance to write referrals before you see any other type of provider or specialist.
Private Health Insurance
Insurance plans created by the private health insurance industry, as opposed to a public health plan, which is federally or state funded. Private insurance companies are more frequently used than any other type of health insurance, with about 2/3 of the non-elderly population insured through a private company. Group plans through employers and other organizations, as well as individual plans are thriving in the private market. For more about each company available through East Coast Health Insurance, refer to our Companies page.
Professionals of the medical field who offer services for health care. This can mean either a doctor or specialist, or a hospital or facility, as well as nurse practitioners, physical therapists, and other specialty health care professionals.
Part of the health care industry that offers preventive care and wellness programs to those who cannot afford health insurance coverage by working in communities that otherwise would not have access to health care services.
1. HealthInsurance.org, “Health insurance glossary”. http://www.healthinsurance.org/glossary/
2. HealthCare.gov, “Glossary – P”. http://www.healthcare.gov/glossary/p/index.html