A - C D - F G - I J - L M - O P - R S - V W - Z | Resource Center
Major Medical Insurance
A type of medical expense insurance that provides broad coverage for most of the expenses associated with treating a covered illness or injury.
Managed Care
An organized way to manage costs, use, and quality of the health-care system. The major types of managed care plans are health maintenance organizations (HMOs), point-of-service (POS) plans, and preferred provider organizations (PPOs).
Medicaid
A joint federal-state health insurance program that is run by the states and covers certain low-income people (especially children and pregnant women) and disabled people.
Medical Application
An application for insurance in which the proposed insured is required to undergo some type of medical examination. The results of the medical examination are then reported to the insurance company.
Medical Expense Insurance
Any of several types of health insurance designed to pay for part or all of an insured's health care expenses, such as hospital room and board, surgeon's fees, visits to doctors' offices, prescribed drugs, treatments, and nursing care. See also hospital confinement insurance, hospital-surgical expense insurance, major medical insurance, and specified expense coverage.
Medicare
The federal health insurance program for: people 65 years of age or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure with dialysis or a transplant, sometimes called ESRD.
Medicare Supplement
Medical expense coverage that provides benefits for certain expenses not covered under Medicare. This coverage is available only to individuals who are covered by Medicare and can be purchased by individuals or by employers to cover retired employees.
Network
Groups of physicians, hospitals and other health care providers working with the health plan to offer care at negotiated rates.
Network Provider
Physicians, hospitals or other providers of medical services that have agreed to participate in a network, to offer their services at negotiated rates, and to meet other negotiated contractual provisions. Also called "participating provider."
Noncancellable Policy
A policy that guarantees you can receive insurance, as long as you pay the premium. It is also called a guaranteed renewable policy.
Nonscheduled Dental Plan
A dental plan which pays benefits for procedures based on the dentist's actual charges, as long as the charges are usual, customary, and reasonable.
Open Enrollment
A period each year during which employees have an opportunity to change their employer-provided health care coverage. They usually can choose among various plans from different health insurance providers.
Out-Of-Network
Health care services received outside the HMO or PPO network.
Out-Of-Plan
This phrase usually refers to physicians, hospitals or other health care providers who are considered non-participants in an insurance plan (usually an HMO or PPO). Depending on an individual's health insurance plan, expenses incurred by services provided by out-of-plan health professionals may not be covered, or covered at a reduced benefit level.
Out-of-Pocket Costs
Insured health care costs for which one is responsible, because of the application of deductibles, coinsurance and co-payments.
Out-of-pocket maximum
Total dollar amount an insured will be required to pay for covered medical services during a specified period, such as one year. The out-of-pocket maximum may also be called the stop-loss limit or catastrophic expense limit.
A - C D - F G - I J - L M - O P - R S - V W - Z | Resource Center
