Health Insurance Glossary

Mail Order Program
Used as an alternative to retail pharmacies, members can order and refill their prescriptions via postal mail, Internet, fax, or telephone. Once filled, the prescriptions are mailed directly to the member’s home.
Maintenance Drug
A medication that is anticipated to be taken regularly for several months to treat a chronic condition such as diabetes, high blood pressure and asthma.
Managed Care
A general term for organizing doctors and hospitals into health care delivery networks with the intent of lowering costs and managing the medical care provided. HMOs were the earliest form of managed care. Today there are many different kinds of plans, including Preferred Provider Organization (PPO) plans.
Mandated Benefits
Specific component of health care coverage required by state or federal government.
Maternity Care
The care and treatment related to pregnancy and delivery of a newborn child.
Maximum Annual Copayment
The limit on the amount of money a member spends in copayments in a calendar year for covered in-network expenses.
Medical Equipment
See Durable Medical Equipment (DME).
Medical Underwriting
The process of reviewing each applicant's personal health history and current health status to determine enrollment eligibility.
Medically Necessary
The term "medically necessary" describes the use of a service or supply which is: commonly and customarily recognized as appropriate in the diagnosis and treatment of a member's/ subscriber's illness or injury; appropriate with regard to standards of good medical practice; not solely for the convenience of the member/subscriber, his or her physician, hospital or other health care provider; and the most appropriate supply or level of service which can be safely provided to the member/subscriber.
Title XVIII of the Social Security Act, which provides health care benefits to Social Security pensioners 65 and older and to eligible disabled individuals.
Medicare Approved Charge
Amount on which Medicare bases its payment for medical services. It is the lower of either Medicare's fee schedule or the doctor's or supplier's actual charge for a service or supply.
Medicare Eligible Employees
All eligible employees over 65 that are not TEFRA eligible, as well as any retirees over 65. Medicare would be the primary coverage for these individuals.
Medicare Payment
The amount Medicare Part A or Medicare Part B paid for covered health care service charges.
Medicare Supplement Contract
Health insurance plan available to Medicare eligibles to cover the costs of physicians' services and other medical and health services not covered by Medicare.
Medicare (Part A)
Part of the Medicare law providing benefits for hospitalization, extended care and nursing home care to Medicare beneficiaries with no premium payment.
Medicare (Part B)
Part of the Medicare law providing medical-surgical benefits to Medicare beneficiaries for a modest premium.
See Medicare Supplement Contract.
An eligible individual who is enrolled in an insurance plan. A member may be a subscriber or a dependent.
Mental Health Services
Services primarily to treat any disorder that affects the mind or behavior.