– a place with many doctors under one roof. This can mean PCPs and
specialists. It can also mean services, like lab, X-ray and optical.
– health care services or supplies needed to prevent, diagnose or treat an
illness, injury, disease or its symptoms and that meet accepted standards of medicine.
– the facilities, providers and suppliers your health insurer or plan has contracted with to
provide health care services.
– a medical partnership or individual doctor who does not have a contract
with HAP. Services received from non-affiliated providers are not covered, unless the care is an
Personal Care Physician (PCP)
– a doctor who directly provides or coordinates a range of health
care services for you.
– a decision by your 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 or plan may require preauthorization for certain
services before you receive them, except in an emergency. Preauthorization is not a promise that your
health insurance or plan will cover the cost.
– the amount that must be paid for your plan. You and/or your employer usually pay it
monthly, quarterly or yearly.
Prescription Drug Coverage
– plan that helps pay for prescription drugs and medications.
– drugs and medications that by law require a prescription.
– health care that stresses finding out early about problems and early care of
conditions, including routine doctor’s exams, vaccines and well-person care.
– to be sure certain medications or medical services are used correctly and only
when truly necessary, some plans may use a system where doctors or members need to get approval
from the plan before a medication or service is covered.
– a doctor, health care professional or health care facility licensed, certified or accredited as
required by state law.
– preapproval from a PCP for specialty care. Referrals are usually paperless and must follow