Peer review - The evaluation of the clinical practice activities as well as the clinical outcomes of one health care professional by others of the same specialty and geographic region.

Per member per month (PMPM) - The method by which most managed care organizations account for revenue and expenses.

Physiatrist - A physician who is board-certified in physical medicine and rehabilitation.

Physical capacity - The capability of an employee to perform work activities and job tasks.

Physical medicine and rehabilitation - The medical practice of diagnosing, treating, preventing, and rehabilitating conditions that result in physical impairments and disabilities. Also known as physiatry.

Policyholder - The Employer to whom the policy is issued.

Pre-disability earnings - The amount of an employee's wage or salary covered by a plan on the date disability began; usually excludes overtime pay, bonuses, commissions, and any other extra pay. In STD plans, also called basic weekly earnings. In LTD plans, also called basic monthly earnings or covered earnings. After the first year of disability, the covered earnings may be increased by an annual percentage (indexed) to keep pace with inflation.

Preexisting condition - Illness or injury for which an employee has received medical treatment or consultation before the effective date of coverage under a disability plan.

Preexisting condition limitation Plan provision that excludes or reduces Disability benefits for any illness or injury for which an employee received medical treatment or consultation within a specified time period before being covered under a disability plan.

Premium - The periodic payment (e.g., monthly, quarterly) required to keep an insurance policy in force.

premium, annualized - The price of coverage for one year; the premium for one period multiplied by the number of periods in the policy year.  

premium, earned - That part of a premium applicable to the elapsed portion of the policy term (the period of time for which the insurer has already provided coverage).

premium, initial - Premium deposit paid when applying for a policy; applied against the first period's premium when it is determined.

Primary care physician - A physician trained in one or more of the following areas: family medicine, general practice, general internal medicine, and pediatric medicine. Some health plans include obstetrics-gynecology as one of the types of primary care physicians.

Primary integration - The LTD benefit is reduced, dollar for dollar, by social security benefits paid or payable to the insured because of the worker's disability. This does not include benefits payable to the eligible spouse and/or children.

Progression of disability benefits (PODB) - The predictable and progressive movement of individuals with disabilities through a system of income replacement benefits (STD, LTD, WC) resulting in their movement into the Social Security disability system (SSDI or SSI).

Providers - A broad term referring to the licensed or certified health care professionals and organizations that provide care to HMO members. Providers can be independent professionals in private practice or they can be members of an organized group, such as multi-specialty medical group. Common providers in managed care include hospitals, medical groups, home care companies, skilled nursing facilities, medical equipment companies, primary care physicians, and specialty physicians.

Puerto Rico Disability benefits (PRDB) Law - Mandates a non-occupational, short-term disability plan funded through a tax-supported state fund; in effect since 1969. Employers may substitute a private, insured or self-insured plan equaling or exceeding state benefits; additional cost is funded by employer, employees, or both.