Health Insurance Glossary
Health / Health Insurance Glossary
Long-Term Care Policy: Insurance policies that cover specified services for a specified period of time. Long-term care policies (and their prices) vary significantly. Covered services often include nursing care, h . . . View Full Definition
Long-Term Disability Insurance: Pays an insured a percentage of their monthly earnings if they become disabled.
LOS: LOS refers to the length of stay. It is a term used by insurance companies, case managers and/or employers to describe the amount of time an individual stays in a hospital or in-patient facility.
Loss Rate: The number and timing of losses that will occur in a given group of insureds while the coverage is in force.
Mail-Order Pharmacy Programs: Programs that offer drugs ordered and delivered through the mail to plan members at a reduced cost.
Managed Behavioral Health Organization (MBHO): An organization that provides behavioral health services using managed care techniques.
Managed Care: A medical delivery system that attempts to manage the quality and cost of medical services that individuals receive. Most managed care systems offer HMOs and PPOs that individuals are encour . . . View Full Definition
Managed Care Organization (MCO): Any entity that utilizes certain concepts or techniques to manage the accessibility, cost, and quality of healthcare. Also known as a managed care plan.
Managed Dental Care: Any dental plan offered by an organization that provides a benefit plan that differs from a traditional fee-for-service plan.
Managed Indemnity Plans: Health insurance plans that are administered like traditional indemnity plans but which include managed care 'overlays' such as precertification and other utilization review techniques.
Management Services Organization (MSO): An organization, owned by a hospital or a group of investors, that provides management and administrative support services to individual physicians or small group practices in order to relie . . . View Full Definition
Manual Rating: A rating method under which a health plan uses the plan's average experience with all groups—and sometimes the experience of other health plans—rather than a particular group's experience to . . . View Full Definition
Market Segmentation: The process of dividing the total market for a product or service into smaller, more manageable subsets or groups of customers.
Market Segments: Subsets or manageable groups of customers in a total market.
Marketing Director: Individual responsible for marketing a managed care plan, whose duties include oversight of marketing representatives, advertising, client relations, and enrollment forecasting.
Maximum Dollar Limit: The maximum amount of money that 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 . . . View Full Definition
Mccarran-Ferguson Act: A federal act that placed the primary responsibility for regulating health insurance companies and HMOs that service private sector (commercial) plan members at the state level.
Medicaid: A jointly funded federal and state program that provides hospital expense and medical expense coverage to the low-income population and certain aged and disabled individuals.
Word of the Day:
Profit And Loss Statement: A detailed statement of income and expenses of a business that reveals the operating position of the business over a period of time. Commonly referred to a P&L.
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