Health Insurance Terms You Should Know
These health insurance terms will help you feel more comfortable and confident the next time you visit a doctor or get a bill.
Related: 5 Key Insurance Terms
Participating (in-network) Provider
These are providers that participate on your network. For covered services, participating providers can’t bill you for charges that exceed the allowed amount (a discounted amount negotiated by Select Health).
Nonparticipating (out-of-network) Provider
If a provider is nonparticipating, they do not participate on your network and may not accept our allowed amount. Your coverage may be reduced or denied depending on your plan.
Primary Care Provider (PCP)
The doctor you see most regularly for general medical care and preventive care.
Preauthorization
Some services require prior approval from Select Health. Participating providers will typically get it for you, but if you are seeing a nonparticipating provider, you need to get it yourself.
Flexible Spending Account (FSA)
Think of an FSA as a savings account that you can use for qualified medical expenses. Some examples include doctor’s visits, copays, dental care, and prescriptions. An FSA can be funded with pre-tax dollars, but funds do not roll over from year-to-year.
Secondary Care Provider (SCP)
These doctors are typically specialists such as cardiologists, neurologists, dermatologists, and more. Select Health considers any doctors who aren’t PCPs to be SCPs.
Rx
This is an abbreviation used for prescriptions.
Related: Confused By Insurance Terms?
