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.

Managed Care

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.

Mandated Benefits

State or federally required benefits.

Mandated Providers

Medical care providers whose services must be included by state or federal law.

Manual Rates

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.

Medical Supplies

Items essential in treating a patient's illness or injury.

Medically Necessary

Service or treatment deemed absolutely necessary in treating a patient and the ommission of such could adversely affect the patient's condition.

Member

Persone covered under a health plan (enrollee or eligible dependent).

Member Certificate

Term for certificate of coverage.

Member Month

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.

Minimum Premium

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.

Miscellaneous Expenses

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.

Morbidity

Relative incidence of disease.

Morbidity Rate

Ratio of incidence of sickness to number of well persons in given group of people over defined period of time.

Morbidity Table

Table exhibiting incidence of sickness at specified ages in the same fashion that mortality table shows the incidence of death at specified ages.

Multi-Disciplinary

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.