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1-800-356-2219
TTY
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Email
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Phone
505-923-5590
1-866-861-7444

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Understanding Health Insurance
Glossary

Healthcare Terms: What Do They Mean?

With health coverage, there are many terms that can be difficult to understand. Below are a list of words and meanings that you may come across as you enroll in your new health plan with Presbyterian.

  • A
  • B
  • C
  • D
  • E
  • F
  • G
  • H
  • I
  • J
  • K
  • L
  • M
  • N
  • O
  • P
  • Q
  • R
  • S
  • T
  • U
  • V
  • W
  • X
  • Y
  • Z

A

  • Annual Out-of-Pocket Maximum
  • Attending Physician
  • Accidental Injury
  • Acupuncture
  • Admission
  • Age Limitation (AG)
  • Ambulatory Surgical Facility
  • Application
  • Alcoholism
  • Ambulance Service

B

  • Birthing Center
  • Benefit Certification

C

  • Chiropractor
  • Calendar Year
  • Certified Nurse-Midwife
  • Copayment (or Copay)
  • Custodial Care
  • Coinsurance
  • Covered Services
  • Co-dependency
  • Cosmetic Surgery
  • Congenital Anomaly

D

  • Diagnostic Services
  • Dependent
  • Dentist
  • Durable Medical Equipment

E

  • Experimental/Investigational

F

  • Freestanding Dialysis Facility
  • Family Coverage

G

  • Grievance

H

  • Healthcare Services
  • Home Health Agency
  • Hospice
  • Hospital
  • Healthcare Professional

I

  • Inpatient
  • In-network Provider
  • Identification Card or ID Card
  • Independent Clinical Laboratory
  • Immunosuppressive Drugs

L

  • Licensed Acupuncturist
  • Licensed Practical Nurse (LPN)

M

  • Medical Care
  • Medical Drugs (MED)
  • Maternity
  • Medicaid
  • Medicare
  • Maintenance Therapy
  • Member
  • Medical Emergency
  • Medical Necessity or Medically Necessary
  • Medical Exception

N

  • Negotiated Fee-for-Service

O

  • Orthopedic Appliance
  • Other Provider
  • Out-of-Pocket Maximum
  • Orthotic Device
  • Out-of-Network Provider
  • Occupational Therapist
  • Outpatient

P

  • Podiatrist
  • Presbyterian Health Plan
  • Premiums
  • Physical Therapist
  • Primary Care Physician (PCP)
  • Provider
  • Physician
  • Prescription Drugs
  • Prosthesis, Prosthetic Device
  • Prior Authorization (PA)

Q

  • Quantity Limit (QL)

R

  • Reasonable Charge or Reasonable and Customary (R&C) Charge
  • Rehabilitation Hospital
  • Respiratory Therapist
  • Referral
  • Registered Nurse (RN)

S

  • Summary Plan Description (SPD)
  • Specialist
  • Speech Therapist
  • Surgery
  • Special Enrollment
  • Skilled Nursing Facility
  • Specialty (SP)
  • Semi-private
  • Step Therapy (ST)
  • Special Care Unit
  • Skilled Nursing Care

T

  • Terminally Ill Patient
  • Two-Party Coverage
  • Tax Equity and Fiscal Responsibility Act (TEFRA)

U

  • Urgent Care

W

  • Well Child Care

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