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This glossary is for non-commercial educational purposes only. The
definition of the
terminology below is only a brief description and should not be considered factual or
the only definition possible. This information is only to help better inform you
of information related to liquidations.
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| Participating Provider |
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A health care provider who participates through a contractual arrangement with a health care service contractor, HMO, PPO, IPA or other managed care organization. |
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| Policy |
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The legal document issued by the insurance company to the policyholder, which outlines the conditions and terms of the insurance; also called the policy contract or the contract. |
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| Policyholder |
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The person who owns an insurance policy. This is usually the insured person, but it may also be a relative of the insured, a partnership or a corporation. |
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| Preference |
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A transfer of any of the property of an insurer to or for the benefit of a creditor, for or on account of an antecedent debt, made or suffered by the insurer within one year before the filing of a successful complaint for liquidation under sections 3903.01 to 3903.59 of the Ohio Revised Code, the effect of which transfer may be to enable the creditor to obtain a greater percentage of his debt than another creditor of the same class would receive. If a liquidation order is entered while the insurer is already subject to a rehabilitation order, then such transfer shall be deemed preferences if made or suffered within one year before the filing of the successful complaint for rehabilitation, or within two year before the filing of the successful complaint for liquidation, whichever time is shorter. |
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| Preferred Provider Organization (PPO) |
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An arrangement whereby a third-party payer contracts with a group of medical care providers who furnish medical services at lower than usual fees in return for prompt payment and a certain volume of patients. |
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| Premium |
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The sum that is required to be paid by a policyholder to keep their insurance policy in force. |
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| Primary Care Provider or Primary Care Physician (PCP) |
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The physician responsible for overseeing and coordinating all aspects of a patient's medical care. In order for a patient to receive a specialty care referral or hospital admission, this physician must preauthorize the visit, unless there is an emergency. |
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| Proof of Claim (POC) |
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A written statement filed with the Liquidator on a form approved by the liquidation court by a claimant (including guaranty associations) stating amounts claimed against the assets of the liquidated estate. |
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| Property Insurance |
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A form of insurance that indemnifies an insured for losses, damage and loss of use of tangible property. |
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| Provider |
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Any individual, group of individuals, or organization that provides a health care service, such as a physician, hospital, group practice, nursing home, pharmacy, etc. |
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