GlossaryHealth InsuranceM to O
You will find an expanded list and definition of terms in this glossary health insurance M to O section.
Use it often, especially when you begin to review your health insurance policy and benefits.
M
major medical insurance plan: A type of traditional medical expense
coverage that provides
you substantial benefits for hospital surgical expenses and providers' fees.
malpractice: Unprofessional, incompetent or inappropriate medical care.
maternity coverage: Many individual plans and some small-group plans for
groups of fewer than
15 employees don't cover the costs associated with pregnancy and birth. However,
federal law
requires that group plans cover maternity if a group has 15 employees or more.
Medicaid: State programs supported by federal matching funds, that
provide health insurance
and other public health assistance to qualified low-income persons.
Medigap (Medical supplemental insurance): Specifically designed to
supplement Medicare's
benefits and is regulated by federal and state law. This type of coverage helps
seniors cover the
costs of "gaps" in the coverage provided by Medicare.
medically necessary: A medical treatment that is covered under your
health insurance policy
and that your doctor, hospital, or provider has determined essential for your
medical well-being,
specific illness, or underlying condition.
mental health services: Behavioral health care services that may be
provided on an inpatient,
outpatient or partial hospitalization basis.
Multiple Employer Welfare Arrangement (MEWA): An employee welfare
arrangement
designed to provide benefits to employees of two or more employers.
N
National Association of Insurance Commissioners (NAIC): National
organization of state
officials charged with regulating insurance. NAIC assesses the quality of
managed care plans.
Publishes information about the quality, accreditation and performance of health
plans so
consumers can make informed decisions while choosing health insurance.
nondiscrimination: A requirement that group health plans cannot
discriminate against you
simply based on your health status. Also, Your coverage within a group health
plan cannot be
denied or restricted, nor can you be charged a higher premium.
network: A group of doctors, hospitals and other health-care providers
contracting with a health
plan, usually to provide care at special rates and to handle paperwork with the
health plan.
non-cancellable policy: A policy that guarantees you can receive
insurance, as long as you pay
the premium. It is also called a guaranteed renewable policy.
non-severe mental health: Generally psychologically-
based mental health problems, such as phobias, manias and mild-to-moderate
depression. In most cases, these problems can be treated without a stay at a
treatment facility.
nursing home care: Care given in a nursing home that includes custodial
and nursing services.
O
out-of-network: Health care services you receive outside the HMO, POS or
PPO network.
outpatient surgery: Surgery that does not involve an overnight stay in a
hospital.
over-utilization: Inappropriate or excessive use of medical services.
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