| A | B |
|---|
| Maximum out of Pocket | maximum copay/coinsurance per policy year |
| Deductible | upfront amount paid by insured prior to benefit payment |
| Diagnosis | description of a medical condition |
| Pre-existing | condition treated 6 mos. prior to effective date |
| Timely filing | an acceptable time limit a provider has to bill a claim from the DOS |
| Medicare Supplement | secondary coverage to Medicare for members age 65 and older |
| ICD-10 | description of a medical condition |
| Speech therapy | payable for restorative only |
| Pharmacy provider | Express Scripts |
| COB | two insurance companies coordinating benefits |
| Dual coverage | two PEHP policies |
| scopy | words ending in this are considered surgery |
| Copay | set $ amount a member has to pay for an office visit |
| CPT | medical procedure code |
| Orthodondics | braces |
| Pano | full-mouth x-ray |
| HIPAA | privacy of insurance information |
| Non covered mental health service | residential treatment |
| Orthotics | molded arch supports |
| Bruxism | teeth grinding |
