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Glossary of Terms
  • Affiliated Provider — Doctors, hospitals and other medical professionals that belong to our POS provider network.
  • Coinsurance — A fixed percentage of covered services you will pay, when applicable.
  • Copayments — A fixed or percent dollar amount that a member pays for covered services. The copayment is due at the time of service or when billed by the provider.
  • Deductible — A dollar amount you must pay each benefit year before services are covered under your health plan.
  • In-Network Benefits — Benefits that are covered when you receive care from a Preferred PPO Provider.
  • Non-Affiliated Provider — Doctors, hospitals and other medical professionals that are not in our POS provider network.
  • Non-Preferred Provider — Doctors, hospitals and other medical professionals that are not in our PPO provider network.
  • Out-of-Network Benefits — Benefits that are covered when you receive care from a Non-Preferred Provider which may involve higher out-of-pocket costs.
  • POS Plan — A health plan that allows members to choose between PCP directed care or a self-referral option each time they seek health care services. Members receive the highest level of coverage, Level 1 benefits, for services provided by or arranged through their PCP.
  • Preferred Provider — Doctors, hospitals and other medical professionals that belong to our PPO provider network.
  • Primary Care Physician (PCP) — An affiliated provider (Family Practitioner, Internal Medicine or Pediatrician) in our network, who coordinates the total health care of the member including routine medical care, preventive care, and provides referrals for specialists, procedures and hospitalizations.
  • Prior Authorization — Review and approval by a PPO plan representative of a requested service, prior to receiving.
  • Referral — An authorization initiated by your PCP to coordinate care with a specialist or other provider.