Health Insurance Terms Covering Health Insurance Plans, Portability and More

Health Insurance Glossary Page 6

Continued from Previous Page

Outpatient Treatment for Mental Illness. Therapy sessions with a psychologist, psychiatrist, or other mental health professional to treat mental or emotional illnesses.

Parity. Equality of benefits in terms of coverage for the treatment of mental and physical illnesses or conditions.

Participating Provider. A doctor, hospital, or testing center that is part of a plan network.

Percentile. The level of an array of charges at which reimbursement will generally be provided by an insurer.

Plan Administrator. An insurance company or other agency that administers a self-funded plan; benefit-related decisions are generally made on the basis of rules set by the plan sponsor rather than by the insurer.

Plan Sponsor. A corporation, union, association, or state or municipal government agency that has established a self-funded plan.

Point-of-Service (POS) Option. An option in a managed care plan that provides reimbursement for non-network providers, though often at a lower level.

Portability and Accountability Act. A federal law passed in 1996 that allows consumers to transfer to a new health insurance plan without exclusions for pre-existing conditions under certain conditions, provides for the establishment of Medical Savings Accounts, and contains a series of provisions related to Medicare, Medicaid, and group health insurance plans.

PPO (Preferred Provider Organization). A managed care plan in which a participant may use either network providers or non-network providers; reimbursement is generally higher if network providers are used.

Pre-authorization. The requirement that a plan participant generally receive approval before entering a hospital or before arranging for expensive medical tests or services.

Predetermination of Benefits. A request that an insurer provide information prior to treatment about the amount of reimbursement that may be available for a particular procedure under the terms of the insurance policy.

Continued on Next Page