A physician, non-physician medical practitioner, or other Provider of Service.
Prescription drugs must be ordered by a doctor and obtained at a pharmacy. They are reviewed and approved through a formal process set by the U.S. Food and Drug Administration (FDA).
Prescription Drug List
A list of commonly prescribed drugs (also known as a drug formulary). Not all drugs listed in a plan's prescription drug list are automatically covered under that plan.
Preventive Care Services
Health care provided for prevention and early detection of disease, illness, injury or other health condition and, in the case of a full service plan includes but is not limited to all of the basic health care services.
Primary Care Physician (PCP)
The physician you choose to be your primary source for medical care. Your PCP coordinates all your medical care, including hospital admissions and referrals to specialists and serves as tyour “gatekeeper” for managed care plans. The PCP is a general practitioner, internist, pediatrician, family practitioner, or obstetrician/gynecologist (OB/GYN).
The process by which a plan member or their doctor gets approval before the member undergoes a course of care, such as a hospital admission or a complex diagnostic test. Also called preauthorization.
A licensed health care facility, program, agency, doctor or health professional that delivers health care services.