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Explanation of Terms

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There are currently 8 terms in this directory beginning with the letter P.
Palliative Care
Treatment for the relief of pain in the final state of a terminal condition.

Participation Requirements
As stipulated by the insurer, the percentage of employees that must be enrolled in the group plan.

Dental treatment of gums.

Pre-determination of Benefits
A pre-determination will show whether or not a medical or dental treatment is covered by the plan, and at what cost to the plan member. A detailed treatment plan is submitted to the insurer prior to treatment. It is usually recommended that a plan member obtain a pre-determination for treatment likely to exceed $400.

Pre-existing Condition
A medical condition, for which a plan member sought and/or received treatment, that existed within a specified period of time before the effective date of coverage.

Prescribed Drug Plan
Drugs covered under this type of plan include over-the-counter medications that have been prescribed by a physician or dentist.

Prescription Drug Plan
This type of plan only covers drugs that legally require a prescription from a physician or dentist. This means that over-the-counter medications are not covered even if they have been prescribed.

Prospectively-rated Benefit
The premium for this type of benefit is calculated based in whole or in part on a group’s claims experience. Also called an experience-rated benefit.

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