Glossary

Here you can quickly access medical terms and definitions through an alphabetized listing.

P

Part B Premium

A monthly premium paid to Medicare (usually deducted from Member Social Security check) to cover Part B services. The member must continue to pay this premium to Medicare to receive Covered Services under SCAN.

Participating Physician/Provider or Supplier

A provider who has contracted with the health plan to provide healthcare services to the plan's members. The provider may be a hospital, pharmacy, home health provider, ancillary provider, other facility or a doctor.

Participating Provider Group

A group of doctors organized as a legal entity that has a contract with a health plan to provide healthcare services to the plan's members. Also referred to as Contracted Physician Group or Contracted Medical Group.

Pharmacy Benefit Manager

Companies that contract with Medicare Advantage Organizations to manage pharmacy services. ExpressScripts Inc is the Pharmacy Benefit Manager for SCAN members.

Physician Assistant

A person who has two or more years of advanced training and has passed a special exam. A physician's assistant works with a doctor and is able to perform some of the same functions.

Plan Rating

Medicare uses information from member satisfaction surveys, plans, and health care providers to give overall performance star ratings to Medicare health and prescription drug plans. These ratings help you compare plans based on quality and performance. A plan can get a rating from one to five stars. A 5-star rating is considered excellent. The overall plan rating gives you a single summary score that makes it easy for you to compare plans based on quality and performance.

Premium

The periodic payment to Medicare, an insurance company, or a healthcare plan for health or prescription drug coverage.

Prescription Drug Plan

A plan that covers drugs for Medicare Part D. SCAN is a Medicare Advantage Prescription Drug plan.

Preventive Care

Includes diagnostic preventive procedures, such as PAP smear screenings, pelvic examinations, clinical breast examinations, flu shots, and colorectal cancer screening.

Primary Care Physician

Your primary care provider is the doctor or other provider you see first for most health problems. He or she makes sure you get the care you need to keep you healthy. He or she also may talk with other doctors and health care providers about your care and refer you to them. In many Medicare health plans, you must see your primary care provider before you see any other health care provider.

Prior Authorization

Approval in advance to get services or certain drugs that may or may not be on our formulary. Some in network medical services are covered only if your doctor or other network provider gets “prior authorization” from our plan. Some drugs are covered only if your doctor or other network provider gets “prior authorization” from us. Covered drugs that need prior authorization are marked in the formulary.

Provider

A doctor, hospital, health care professional or health care facility licensed and/or certified by the State Medi-Cal or Medicare to deliver or furnish health care services.

Provider Network

Your health plan contracts with a group of doctors and facilities -- this is the plan's Provider Network. It's composed of the physicians, hospitals and other providers that offer healthcare services to the health plan's members. SCAN's Provider Network is listed in our Provider Directory.