Major Medical Insurance – Health insurance to finance the expense of major illness and injury. Characterized by large benefit maximums ranging up to $250,000 or no limit, the insurance, above an initial deductible, reimburses the major part of all charges for hospital, doctor, private nurses, medical appliances, prescribed out-of-hospital treatment, drugs, and medicines. The insured person as coinsurer pays the remainder.
Malpractice Insurance – Coverage for a professional practitioner, such as a doctor or a lawyer, against liability claims resulting from alleged malpractice in the performance of professional services.
Managed Care – Health care systems that integrate the financing and delivery of appropriate health care services to covered individuals by arrangements with selected providers to furnish a comprehensive set of health care service, explicit standard for selection of health care providers, formal programs for ongoing quality assurance an utilization review, and significant financial incentives for members to use providers and procedures associated with the plan.
Manual Rate – The premium rate developed for a group insurance coverage from the company’s standard rate tables normally referred to as its rate manual or underwriting manual.
Master Policy (or Master Contract) – The policy issued to a group policyholder setting forth the provisions of the group insurance plan. The individuals insure under the policy are then issued certificates of insurance.
Maximum Dollar Limit – The maximum amount of money an insurance company (or self-insured company) will pay for claims within a specific time period. Maximum dollar limits vary greatly. They may be based on or specified in terms of types of illnesses or types of services. Sometimes they are specified in terms of lifetime, sometimes for a year.
Medicaid – State programs of public assistance to persons whose income and resources are insufficient to pay for health care. Title XIX of the federal Social Security Act provides matching federal funds for financing state Medicaid programs, effective January 1, 1996.
Medical Information Bureau (MIB) – An organization that serves as a clearinghouse for medical information for the life insurance industry. When a person applies for life insurance, the insurance company sends the applicant’s medical test results and any indication of health impairments to the MIB. This information is then available to other insurers when they are investigating an applicant’s insurability. Access to MIB-coded information is restricted to authorized medical, underwriting, and claim personnel in member companies. No member company can request information from the MIB unless the individual being investigated gives written consent. An insurance company cannot base its underwriting decision solely on information provided by the MIB.
Medically Necessary – Health care service or treatment ordered by a provider that can not be omitted without harming the patient’s health status, as judged against generally accepted standards of medical practice.
Medicare – A program of Hospital Insurance (Part A) and Supplementary Medical Insurance (Part B) protection provided under the Social Security Act.
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.
Medigap – A term sometimes applied to private insurance products that supplement Medicare insurance benefits.
Medigap Insurance Policies – Offered by private insurance companies, not the government, these policies are designed to pay for some of the costs Medicare does not cover. Not to be confused with Medicare or Medicaid.
Minimum Group – The least number of employees permitted under a state law to effect a group for insurance purposes; the purpose is to maintain some sort of proper division between individual policy insurance and the group forms. Miscellaneous Expenses – Expenses in connection with hospital insurance, hospital charges other than room and board, such as X-rays, drugs, laboratory fees, and other ancillary charges. (Sometimes referred to as ancillary charges.)
Minimum Premium Plan (MPP) – A group health insurance plan that is partially self-insured by the group policyholder but fully administered by an insurance company. The premium is small because the group policyholder pays most of the claims itself.
Mode of Premium Payment – The frequency with which premiums are paid monthly, quarterly, semiannually, or annually.
Multiple Employer Trust (MET) – A legal trust established by a plan sponsor that brings together a number of small, unrelated employers for the purpose of providing group medical coverage on an insured or self-funded basis.