Major Hospitalization Policy
Same as Major Medical Insurance, except applies to expenses incurred only when insured is hospitalized. See also Major Medical Insurance.
Major Medical Insurance
Health Insurance providing benefits up to a high limit for most types of medical expenses incurred, subject to a substantial deductible. Contracts may contain limits on specific types of charges, like room and board, and a percentage participation clause (coinsurance clause). Policies usually pay covered expenses whether an individual is in or out of the hospital.
System of health care with the goal being a system delivering quality, cost effective health care through monitoring and recommending utilization of services, and cost of services.
Managed Health Care Plan
Plan involving financing, managing, and delivery of health care services. Typically, involves a group of providers sharing the financial risk of the plan or who having incentive to deliver cost effective, but quality, service.
State or federally required benefits.
Medical care providers whose services must be included by state or federal law.
Rates based on average claims data for large number of groups. Rates are adjusted for specific groups based on a particular group's characteristics, such as the type of industry, changes in benefits from the standard, etc.
Maximum Allowable Costs (MAC) List
List of prescriptions where reimbursement is based on cost of comparable generic product.
Maximum Disability Policy
Noncancellable Disability Income Insurance limiting insurer's liability for any one claim but not the aggregate amount of all claims. For any one claim there is a maximum amount payable, but there could be any number of separate claims for different disabilities.
Maximum Out-of-Pocket Costs
Largest amount insured will pay considering copayments, coinsurance, deductibles, etc.
Medical Expense Insurance
Health Insurance providing benefits for medical, surgical, and hospital expenses. Include coverage under the names Hospital-Surgical Expense Insurance and Medical Care Insurance.
Medical Loss Ratio
Total health benefits divided by total premium.
Items essential in treating a patient's illness or injury.
Service or treatment deemed absolutely necessary in treating a patient and the ommission of such could adversely affect the patient's condition.
Persone covered under a health plan (enrollee or eligible dependent).
Term for certificate of coverage.
Monthly total number of participants who are members.
Members Per Year
Number of member months divided by 12.
Mental Health Services and Supplies
Required for treatment of mental illness, which include substance abuse and alcoholism.
Cost plus arrangement with the employer paying the insurer only a portion of the premium which to be used for administration costs. Remainder is placed in a "bank account" and then used by the insurer to pay claims.
Expenses, usually hospital charges other than daily room and board. Examples: X-rays, drugs, and lab fees. Total amount of these charges to be reimbursed is limited in most basic hospitalization policies.
Relative incidence of disease.
Ratio of incidence of sickness to number of well persons in given group of people over defined period of time.
Table exhibiting incidence of sickness at specified ages in the same fashion that mortality table shows the incidence of death at specified ages.
Treatment involving care provided by a range of specialists.
Multiple Option Plan
Employees optionally choose from an HMO to a PPO to a major medical plan.