Health Insurance Glossary

MSA (Medical Savings Account):: A tax-advantaged personal savings account used in conjunction with a high-deductible health insurance plan. MSAs are currently being phrased out and replaced with HSAs. See HSA.

Major Medical Insurance:: A type of medical insurance plan that provides benefits for a broad range of healthcare services, both inpatient and outpatient. Major medical insurance plans often carry a high deductible.

Managed Care:: A general term used to describe a variety of healthcare and health insurance systems that attempt to guide a member's use of benefits, typically by requiring that a member coordinate his or her healthcare through a primary care physician, or by encouraging the use of a specific network of healthcare providers. The management of healthcare is intended to keep costs -and monthly premiums- as low as possible. There are several different types of managed care health insurance plans, including HMO, PPO, and POS plans

Maternity (Inpatient):: Typically, inpatient maternity services include hospitalization and physician fees associated with the birth of a child.

Maternity (Outpatient):: Typically, outpatient maternity services include OB-GYN office visits during pregnancy and immediately after giving birth.

Maternity Coverage:: Maternity coverage means the insurance covers part or all of the medical cost during a woman's pregnancy. Coverage is broken down into inpatient and outpatient services. Typically, inpatient coverage includes hospitalization and physician fees associated with child birth. Outpatient coverage pays for prenatal and postnatal OB-GYN office visits.

Max Duration:: Maximum duration is the longest coverage period offered by the plan.

You should choose a plan which has a coverage period which will safely cover your insurance needs while you are waiting for a standard long-term policy to begin. You should apply for short-term coverage only if you know with certainty that you will have standard, long-term coverage (or coverage through an employer) at a future date.

Maximum Out-Of-Pocket Costs:: An annual limitation on all cost-sharing for which patients are responsible under a health insurance plan. This limit does not apply to premiums, balance-billed charges from out of network health care providers or services that are not covered by the plan.

Medicaid:: A state-funded healthcare program for low income and disabled persons.

Medical Necessity:: A basic criterion used by health insurance companies to determine if healthcare services should be covered. A medical service is generally considered to meet the criteria of medical necessity when it is considered appropriate, consistent with general standards of medical care, consistent with a patient's diagnosis, and is the least expensive option available to provide a desired health outcome. Of course, preventive care services that may be covered under a health insurance plan are not always subject to the criteria of medical necessity.

Medicare:: A national, federally-administered health insurance program authorized in 1965 to cover the cost of hospitalization, medical care, and some related health services for most people over age 65 and certain other eligible individuals.

Medicare Beneficiary:: Anyone entitled to Medicare benefits based on the rules for eligibility outlined by the Social Security Administration.

Medicare Supplement Insurance:: Health insurance provided to an individual or group that is intended to help fill in the gaps in the coverage provided by Medicare.

Member:: Anyone covered under a health insurance plan, an enrollee or eligible dependent.

Mental Health Inpatient:: Typically, mental health inpatient refers to services rendered when a patient stays at a hospital or other medical facility for treatment of a mental health condition.

Mental Health Office Visits:: Typically, mental health office visits include visits to a licensed medical provider for treatment of a mental health condition.

please note, however, that definitions of certain terms may vary across insurance companies.

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