P

Partial Disability – A benefit sometimes found in disability income policies providing for the payment of reduced monthly income in the event the insured cannot work full time and/or is prevented from performing one or more important daily duties pertaining to his occupation.

Participating Provider – A hospital, physician, pharmacy or other provider to agrees to serve plan members under terms of a sponsoring network such as an HMO or PPO.

Pension Benefit Guaranty Corporation (PBGC) – The Federal body responsible for administering the plan termination insurance program under ERISA.

Pension Plan – A plan established and maintained by an employer, group of employers, union or any combination, primarily to provide for the payment of definitely determinable benefits to participants after retirement.

Point-of-Service Plans – Often known as open-ended HMOs or PPOs, these plans permit insureds to choose providers outside the plan yet are designed to encourage the use of network providers.

Policy – The printed legal document stating the terms of the insurance contract that is issued to the policyholder by the company.

Policy Term – That period for which an insurance policy provides coverage.

Policyholder – The person who owns a life insurance policy. This is usually the insured person, but it may also be a relative of the insured, a partnership or a corporation.

POS – Point of service plan. A health plan that allows members to choose to receive services from a participating or nonparticipating network provider, usually with a financial disincentive for going outside the network. More of a product than an organization, POS can be offered by HMOs, PPOs or self-insured employers.

PPO – Preferred Provider Organization. A managed health care plan in which a network of providers agrees to serve a group of employees in a fee-for-service arrangement, usually at discounted rates based on volume purchasing power.

Pre-Admission certification – Approval by a case manager or insurance company representative (usually a nurse) for a person to be admitted to a hospital or inpatient facility, granted prior to the admittance. Pre-admission certification often must be obtained by the individual. Sometimes, however, physicians will contact the appropriate individual. The goal of pre-admission certification is to ensure that individuals are not exposed to inappropriate health care services (services that are medically unnecessary).

Pre-Admissions Testing – Medical tests completed for an individual prior to being admitted to a hospital or inpatient health care facility.

Pre-Existing Condition – A medical condition excluded from coverage by an insurance company, because the condition was believed to exist prior to the individual obtaining a policy.

Primary Care Provider (PCP) – A health care professional (usually a physician) who is responsible for monitoring an individual’s overall health care needs, referring the individual for specialist care when necessary.

Private Insurance – Traditional health care coverage purchased from an insurance company. Gives you free choice of physicians, hospitals and other health care facilities.

Probate – The court supervised process of validating or establishing a distribution for assets of a deceased including the payment of outstanding obligations.

Probate Estate – That portion of the assets and liabilities whose distribution is supervised by the courts in the probate process.

Probationary Period – A period from the policy date to a specified time, usually 15 to 30 days, during which no sickness coverage is effective. It is designed to eliminate a sickness actually contracted before the policy went into effect.

Professional Review Organization (PRO) – An organization in which practicing physicians assume responsibility for reviewing the propriety and quality of health care services provided under Medicare and Medicaid.

Profit Sharing Plan – A defined contribution plan where contributions are allocated among participants’ accounts according to an established formula, with payment based on age, fixed number of years or occurrence of an event such as disability.

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