Common Health Insurance Terms M-Z
Maximum Benefit Amount : The lifetime maximum dollar amount set by an insurance carrier that limits the total amount the plan must pay for all healthcare services provided to a subscriber in his lifetime.
Medicare : A federal government hospital expense and medical expense insurance plan primarily for elderly and disabled persons.
Medicare Supplement: A private medical expense insurance plan that supplements Medicare coverage. Also known as a Medigap policy.
Network: The group of physicians, hospitals, and other medical care providers that a specific managed care plan has contracted with to deliver medical services to its members.
Out-Of-Pocket Maximums : Dollar amounts set by insurance carriers that limit the amount a member has to pay out of his or her own pocket for particular healthcare services during a particular time period.
Outpatient: Care and treatment that is provided to a patient who is able to return home after care without an overnight stay in a hospital or other inpatient facility.
Pre-Existing Condition : Generally a condition for which an individual received medical care during the three months immediately prior to the effective date of coverage.
PPO : Preferred provider organization. A healthcare benefit arrangement designed to supply services at a discounted cost by providing incentives for members to use designated healthcare providers.
Prior Authorization: A program that requires physicians to obtain certification of medical necessity prior to dispensing drug or services.
Small Group : In California, a business with 2 to 50 eligible employees.
Workers' Compensation: A state-mandated insurance program that provides benefits for healthcare costs and lost wages to qualified employees and their dependents if an employee is unable to work because of a work-related injury or illness.
Maximum Benefit Amount : The lifetime maximum dollar amount set by an insurance carrier that limits the total amount the plan must pay for all healthcare services provided to a subscriber in his lifetime.
Medicare : A federal government hospital expense and medical expense insurance plan primarily for elderly and disabled persons.
Medicare Supplement: A private medical expense insurance plan that supplements Medicare coverage. Also known as a Medigap policy.
Network: The group of physicians, hospitals, and other medical care providers that a specific managed care plan has contracted with to deliver medical services to its members.
Out-Of-Pocket Maximums : Dollar amounts set by insurance carriers that limit the amount a member has to pay out of his or her own pocket for particular healthcare services during a particular time period.
Outpatient: Care and treatment that is provided to a patient who is able to return home after care without an overnight stay in a hospital or other inpatient facility.
Pre-Existing Condition : Generally a condition for which an individual received medical care during the three months immediately prior to the effective date of coverage.
PPO : Preferred provider organization. A healthcare benefit arrangement designed to supply services at a discounted cost by providing incentives for members to use designated healthcare providers.
Prior Authorization: A program that requires physicians to obtain certification of medical necessity prior to dispensing drug or services.
Small Group : In California, a business with 2 to 50 eligible employees.
Workers' Compensation: A state-mandated insurance program that provides benefits for healthcare costs and lost wages to qualified employees and their dependents if an employee is unable to work because of a work-related injury or illness.
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