Health

Maintenance of Effort
A requirement of the Medicare catastrophic coverage act that affects employers with plans that duplicate 50% or more of the new catastrophic benefits. Under MOE, they have to "maintain their effort" by providing eligible employees/retirees/dependents with additional benefits or a "refund" equal in value to the duplicated benefits.

Major Hospitalization Policy
The same as Major Medical Insurance, except that it applies to expenses incurred only when the insured is hospitalized. See also Major Medical Insurance.

Major Medical Insurance
A type of Health Insurance that provides benefits up to a high limit for most types of medical expenses incurred, subject to a large deductible. Such contracts may contain limits on specific types of charges, like room and board, and a percentage participation clause sometimes called a coinsurance clause. These policies usually pay covered expenses whether an individual is in or out of the hospital.

Managed Care
A system of health care where the goal is a system that delivers quality, cost effective health care through monitoring and recommending utilization of services, and cost of services.

Managed Health Care Plan
A plan which involves financing, managing, and delivery of health care services. Typically, it involves a group of providers who share the financial risk of the plan or who have an incentive to deliver cost effective, but quality, service.

Mandated Benefits
Benefits required by state or federal law.

Mandated Providers
Types of providers of medical care whose services must be included by state or federal law.

Manual Rates
Rates based on average claims data for a large number of groups. These rates are then adjusted for specific groups based on that group's characteristics, such as the type of industry, changes in benefits from the standard, etc.

Market Assistance Plan (MAP)
A plan promulgated by the Department of Insurance to assist buyers to obtain certain types of insurance when they are limited in availability.

Maximum Allowable Costs (MAC) List
A list of prescriptions where the reimbursement will be based on the cost of the generic product.

Maximum Disability Policy
A form of noncancellable Disability Income Insurance that limits an insurer's liability for any one claim but not the aggregate amount of all claims. In other words, 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
The most a member will pay considering co-payments, coinsurance, deductibles, etc.

Medicaid
A medical benefits program administered by states and subsidized by the federal government. Under this plan, various medical expenses will be paid to those who qualify. It is technically referred to as Title XIX Benefits.

Medical Care Insurance
See Medical Expense Insurance.

Medical Examination
The examination of an applicant for insurance or a claimant by a physician who acts in the capacity of the insurer's agent.

Medical Examiner
The physician who examines an applicant or claimant on behalf of the insurer and as an agent of the insurer.

Medical Expense Insurance
A form of Health Insurance that provides benefits for medical, surgical, and hospital expenses. This term is used to include coverage under the names Hospital-Surgical Expense Insurance and Medical Care Insurance.

Medical Information Bureau (MIB)
A data pool service that stores coded information on the health histories of persons who have applied for insurance from subscribing companies in the past. Most Life and Health insurers subscribe to this bureau to get more complete underwriting information.

Medical Loss Ratio
Total health benefits divided by total premium.

Medical Supplies
Any items which are essential in carrying out the treatment of a patient's illness or injury.

Medically Necessary
A service or treatment which is absolutely necessary in treating a patient and which could adversely affect the patient's condition if it were omitted.

Medicare
The United States federal government plan for paying certain hospital and medical expenses for persons qualifying under the plan, usually those over 65. The hospital benefits are Part A, and the medical expense portion is Part B. Part A is compulsory social insurance; Part B is voluntary government-subsidized, government-operated insurance.

Medicare Beneficiary
Anyone entitled to Medicare benefits based on the designation by the Social Security Administration.

Medicare Supplement Insurance
Insurance coverage sold on an individual or group basis which helps to fill the gaps in the protection provided by the Medicare program. Medicare supplements cannot duplicate any benefits provided by Medicare, but may pay part or all of Medicare's deductibles and copayments, and may cover some services and expenses not covered by Medicare.

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

Member Certificate
Another term for certificate of coverage.

Member Month
The total number of participants who are members for each month.

Members Per Year
The total number of member months divided by 12.

Mental Health Services and Supplies
Items required for treatment of mental illness, including substance abuse and alcoholism.

Minimum Premium
A cost plus arrangement whereby the employer pays the insurer only a portion of the premium which is to be used for administration costs. The remainder is placed in a "bank account" which is then used by the insurer to pay claims.

Miscellaneous Expenses
Ancillary expenses, usually hospital charges other than daily room and board. Examples would be X-rays, drugs, and lab fees. The total amount of such charges that will be reimbursed is limited in most basic hospitalization policies.

Modified Arbitration Procedure
Rules at Lloyd's of London providing an informal method of resolving disputes between members and agents when the sum involved is unlikely to exceed 10,000.

Modified Community Rating
A method of determining rates for medical services based on data from a given geographic area.

Modified Fee-For-Service
A situation where reimbursement is made based on the actual fees subject to maximums for each procedure.

Morbidity
The relative incidence of disease.

Morbidity Rate
The ratio of the incidence of sickness to the number of well persons in a given group of people over a given period of time. It may be the incidence of the number of new cases in the given time or the total number of cases of a given disease or disorder.

Morbidity Table
A table showing the incidence of sickness at specified ages in the same fashion that a mortality table shows the incidence of death at specified ages.

Multi-Disciplinary
Treatment which involves care provided by a wide range of specialists.

Multiple Employer Trust (MET)
A trust consisting of multiple small employers in the same industry, which is formed for the purpose of purchasing group health insurance or establishing a self-funded plan at a lower cost than would be available to the employers individually.

Multiple Employer Welfare Arrangements
Employer funds and trusts providing health care benefits to individuals.

Multiple Option Plan
Under this plan, employees can optionally choose from an HMO to a PPO to a major medical plan.