Glossary of Terms

Payment Bundling

A payment structure in which different health care providers who are treating you for the same or related conditions are paid an overall sum for taking care of your condition rather than being paid for each treatment, test, or procedure. This rewards providers for coordinating care, preventing complications and errors,…

Plan

Plans in Washington Healthplanfinder are available in 4 health plan categories – Bronze, Silver, Gold, or Platinum – based on the percentage the plan pays of the average overall cost of providing essential health benefits to members. The plan category you choose affects the total amount you’ll likely spend for…

Plan Year

A 12-month period of benefits coverage under an employer health plan. This 12-month period may not be the same as the calendar year. To find out when your plan year begins, you can check your plan documents or ask your employer. (Note: For individual health insurance policies, this 12-month period…

Platinum Health Plan

Plans in Washington Healthplanfinder are available in 4 categories – Bronze, Silver, Gold and Platinum. The category you choose impacts how much of the overall costs of services your insurer pays per year. On average, a Bronze plan pays 60% of the costs, a Silver plan pays 70%, a Gold…

Point of Service (POS) Plans

In these plans, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans also require you to get a referral from your primary care doctor in order to see a specialist.

Policy Year

A 12-month period of benefits coverage under an individual health insurance plan. This 12-month period may not be the same as the calendar year. To find out when your policy year begins, you can check your policy documents or contact your insurer. (Note: In employer health plans, this 12-month period…

Preauthorization

A decision by your health insurance plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval, or precertification. Your health insurance plan may require preauthorization for certain services before you receive them, except in an emergency. Preauthorization…

Preferred Provider

An in-network provider who has a contract with your health insurance plan to provide services to you at a discount. Check your policy to see if you can see all preferred providers. Some health insurance or plans have “tiered” networks, and you must pay extra to see some providers. Your…

Preferred Provider Organization (PPO)

A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost.

Pregnancy Medical (Program)

Pregnant women are eligible for Pregnancy Medical (or Pregnancy Medicaid) if they meet certain income guidelines. Undocumented pregnant women qualify regardless of legal status. All medical care, including prenatal care, delivery and post-pregnancy follow up are included. Coverage lasts for 2 months after the birth of the child.

Premium

The cost of your health insurance plan per month. You must pay this amount even when you do not get any medical care. Health plan premiums for individual and family customers must be paid directly to the insurance company.

Premium Tax Credit

A premium tax credit reduces premium costs. Tax credits can be used when you make your premium payment. This help is also known as a health insurance premium tax credit (HIPTC) or advanced premium tax credit (APTC). The Affordable Care Act provides a new tax credit to help you afford…

Prescription Drugs

Drugs and medications that, by law, require a prescription from a doctor.

Prevention

Activities to prevent illness, such as routine check-ups, immunizations, patient counseling, and screenings.

Preventive Services

Health care services, such as yearly health exams and flu shots, that are paid for by your health insurance plan at little or no cost to you. Some plans require the use of in-network providers for no-cost preventive services.

Primary Applicant

An individual who creates an account on Washington Healthplanfinder and initiates one of three application types: 1) for myself; 2) for myself and others (household members); or 3) for other household members (but not myself).

Primary Care

Health services that cover a range of prevention, wellness, and treatment services for common illnesses.

Primary Care Provider (PCP)

The main doctor or nurse whom you choose to visit as part of your health plan. Primary care providers include doctors, nurses, nurse practitioners, and physician assistants. They often maintain long-term relationships with you, give advice, and treat you on a range of health-related issues. They may also coordinate your…

Prior Authorization

Approval from a health plan that may be required before you get a service or fill a prescription in order for the service or prescription to be covered by your plan. It is important to ask if prior authorization is required before you have a service or fill a prescription.