Glossary: P

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Palliative careThis is care given for immediate pain relief. It is not a final treatment for a condition.
Partial day treatment This is a behavioral health program. It provides treatment for mental health or substance abuse issues. It is offered during the day or at night. No overnight stay is needed.
Partial disabilityThis is when a person has an illness or injury. It stops the person from doing one or more job tasks. This causes the person to earn 80 percent or less of income earned before he or she became disabled.
Participating pharmacy This is a Pharmacy that has a contract with a health plan. It fills covered prescriptions for plan members. Members might pay less for their prescriptions at this type of pharmacy.
Participating providerThis is a doctor, hospital or other health care provider. The provider signs a contract with a health plan. The provider is part of the plan’s network for covered services. People may pay less when they visit this type of provider.
Patient This is a person who gets medical care. The care is from a doctor, hospital or other health care provider.
PCP See Primary care physician.
PDPSee Medicare prescription drug plan.
Pediatric dentist This dentist treats children. Sometimes, this dentist is called a “pedodontist.”
Pending claimThis is a medical claim that has not yet been approved or denied.
Pension This is a retirement fund for employees. It is usually not taxed. An employer pays for or contributes to the fund as part of a benefits package.
PeriapicalThis is the area and tissue around the root of a tooth.
Periodontal disease This is a dental condition. It affects the gums and bones supporting the teeth. The disease is caused by bacteria that stick to teeth and teeth roots. If not treated, it can destroy the gums and supporting bone around the teeth. It is also called “periodontitis.”
PeriodontistThis is a type of dentist. This specialist prevents, finds and treats diseases of the gums and bones that support the teeth.
Permanent and total disability Sometimes, a person becomes disabled and can never return to work. This benefit provides that person with payment. It replaces some lost income. The payment can be made in one sum or in a series.
Permanent partial disabilityThis is an injury or disease that stops people from being able to do all their regular job functions. It causes the person to lose income. This benefit repays some of the income that is lost.
Personal health record This is a record of a person’s health information. It can include claims and other health history. It is stored online and viewed on a computer. A health plan can add to it. It might add medical claims received and doctor visit information. People can also add their own information to it. They might add information on family health or eating habits.
PharmacyA pharmacy is a drug store.
Pharmacy and therapeutics committee This is a group of health care professionals. Doctors, pharmacists and others are on it. The group advises a health plan company on safe and effective drug use. It also helps the plan create a formulary.
Pharmacy copayThis is a person’s share for covered prescription drugs. It is paid to a participating pharmacy. It is a set dollar amount.
Physical reaction This describes how the body reacts to something.
Physical therapyThis is care given to help improve part of the body. It helps ease pain and promote healing. It can also help prevent disability. It is used to limit the effects of disease. It is also used after illness, injury or surgery.
Physician This is a medical doctor.
PlaceboThis is a substance that has no medicine it. It is also called a “sugar pill.” It can be given to help people expect to feel better. It is usually used during tests to find out how potential new drugs and treatments will work.
Plan documents A plan sponsor gets important papers from a health plan. These are plan documents. They describe the details of coverage. They include the:
  • group agreement
  • group policy
  • certificate or evidence of coverage or certificate of insurance
  • summary of coverage or benefits.
Plan exclusions and limitationsThese are legal conditions. They apply to health plans. They list specifically what is and what is not covered by the plan.
Plan maximum This is a limit on the dollar amount of benefits a health plan will play.
Plan sponsorThis is a group that sets up and manages a health plan or group insurance plan. It can be an employer. It can also be a labor union, government agency or nonprofit group.
Plaque Plaque is a soft, sticky substance on the teeth. It comes from bits of food and bacteria in the mouth. It can be removed by brushing and flossing. If it is not removed, it can cause cavities and gum disease.
Point-of-service (POS)This is a type of health plan. It lets members see participating providers. They can also see nonparticipating providers. In many POS plans, members who use referrals and see a Primary care physician(PCP) get more coverage. They may pay less for care. Members can get care from a provider who is not a PCP. They might pay more for care.
Policy See “Contract.”
Policy holderThis is a person who has a contract with an insurance company.
Portability This is a legal right of an insured person. The person gets to keep group insurance. The person keeps it as an individual policy. The person does not need to prove he or she is in good health to keep the policy.
POSSee “Point-of-service.”
PPO See “ Preferred Provider Organization.”
Practice guidelinesThese are for doctors. They describe the best possible methods to diagnose and treat illness or injury. They are based on medical research. Some call them:
  • clinical practice guidelines
  • practice parameters
  • medical protocols.
Preauthorization See “Precertification.”
PrecertificationThis is an important process. It is approval a person gets for care before he or she receives the care. This helps people know if the care is covered by a health plan. People should check with their plan to see what kind of service needs this approval.
This can also be called:
  • precertification*
  • authorization
  • certification
  • prior authorization.
*In Texas, this approval is known as “pre-service utilization review” and is not “verification” as defined by Texas law.
Pre-disability earnings This is how much money a person earned before a disability. It can be a weekly or monthly rate.
Pre-existing conditionThis is a health condition. It was diagnosed or treated before the date a health plan’s coverage began.
Preferred care provider See “participating provider.”
Preferred drug listSee “Formulary.”
Preferred provider organization (PPO) This is a type of health benefits plan. Members can choose any doctor. They do not have to name a primary care physician. No referrals are needed. Members who go to network providers usually get more coverage. They may pay less for services.
PremenstrualThis is the time before a woman’s period starts.
Premium This is the amount paid to a health plan company for coverage. A person can pay it directly. Sometimes a person has a health plan with an employer. Then this cost might be shared between the person and the employer.
Premium waiverThis is a phrase in a contract. It means an insurer can keep up life insurance coverage for a disabled employee. The employee does not pay for the coverage.
Prescription A doctor's order for a drug is a prescription. It is usually written. If it is a verbal order, it must be put in writing by the pharmacy.
Prescription drugThis is a type of medicine. It must have a doctor’s prescriptions before it can be sold. It is different than an over-the-counter drug. This can be bought without a prescription.
Prevailing chargeA limit on the amount your health plan will pay.  Also called "usual, customary and reasonable (UCR)," "customary and reasonable" or "reasonable" charge.  The limit is based on data Aetna receives.  The data is based on what doctors' charge for the health care service.  We get this data from a subsidiary of another health insurer.  In 2011, we will receive the data from an independent organization known as Fair Health.

Check your plan documents for more details:  Your health plan documents will tell you how we pay for out-of-network care. Or call Member Services at the phone number listed on your Aetna ID card. Learn More 
Preventive care This type of care is often covered in a health plan. It includes programs or services that can help people prevent disease. It may include yearly exams, shots and tests for some diseases. The tests are sometimes called screenings.
Primary care physician (PCP)This is a doctor who is part of a health plan's network. He or she is a patient’s main contact for care. PCPs give referrals for other care. They coordinate care their patients get from specialists or other care facilities. In some health plans, a person must choose a PCP to coordinate care.
Prior creditable coverage This term means types of health coverage a person has had. People sometimes need to prove they have had this so they can be fully covered by a new plan.
Some examples of acceptable types are:
  • group or individual coverage
  • Medicare
  • Medicaid
  • health care for members of the uniformed services
  • a program of the Indian Health Service
  • a state health benefits risk pool
  • the Federal Employees’ Health Benefit Program 
  • a public health plan (any plan established by a state, the government of the United States, or any subdivision of a state or of the government of the United States, or a foreign country)
  • any health benefits plan under Section 5(e) of the Peace Corps Act
  • the State Children’s Health Insurance Program (S-CHIP).
Private fee-for-service planThis is a type of Medicare Advantage Plan. It is offered through a private health plan company. A person pays a premium for medical coverage. Then, the person can go to any doctor or hospital that:
  • is approved by Medicare
  • accepts the plan's payment and other terms.
Progressive In health care, this refers to an illness or condition that gets worse over time.
ProphylaxisThis is a routine health service. A doctor or dentist does this to preserve health and prevent the spread of disease.
Prosthetic device This is an artificial body part. It is used to replace a body part that is damaged, missing or not working properly. It can replace teeth, eyes, arms, legs and hands.
ProsthodontistThis is a type of dentist. This dentist restores or maintains dental health by replacing natural teeth. A person might see this specialist for dentures.
Provider This term is used often by health plans. It means a licensed person or place that delivers health care services. Some examples are doctors, dentists, hospitals and more.
Provider networkSee “network.”
Pulmonary embolism This is a blood clot in the lungs.

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