The facilities, providers, and suppliers your health insurer or plan has contracted with to provide healthcare services. See ACA Uniform Glossary
Healthcare and health insurance definitions.
Those services excluded from coverage by your health plan.
Non-life-threatening emergency, a situation treated by routine examinations, diagnostic work-ups for chronic conditions, routine prenatal care, elective surgery, and scheduled follow up visits for prior emergency conditions. Receiving nonemergent care in an emergency room setting is usually not covered by health plans.
Drugs that are not specifically listed on an insurer’s formulary are considered nonformulary drugs and typically have a higher cost for the member. (Occasionally an insurer make may a list of prescription drugs that are nonformulary, to make it easier for members to compare.)
A provider who doesn’t have a contract with your health insurer or plan to provide services to you. You’ll pay more to see a nonpreferred provider. Check your policy to see if you can go to all providers who have contracted with your health insurance or plan, or if your health insurance or plan has a “tiered” network and you must pay extra to see some providers. See ACA Uniform Glossary
A registered nurse who has advanced skills in the assessment of physical and psychosocial health status of individuals, families, and groups.