|
|
Glossary Of Terms |
Please Note: This information is a general reference tool. All terms, conditions and amounts may not be applicable to your benefit plan. Please refer to your Plan Document for a complete listing of terms, conditions, coverage and exclusions of your benefit plan.
Terms Beginning with the Letter "M"
Managed Care is a health care system that finances and delivers care. The goal is to provide health care that is cost effective and of high quality.
Maximum Benefit Amount is the amount shown in the Schedule of Benefits. It is the total amount of benefits that will be paid under the Plan for all Covered Charges incurred by a Covered Person.
Medical Care Facility means a Hospital, a facility that treats one or more specific ailments or any type of Skilled Nursing Facility.
Medical Emergency means a sudden onset of a condition with acute symptoms requiring immediate medical care and includes such conditions as heart attacks, cardiovascular accidents, poisonings, loss of consciousness or respiration, convulsions or other such acute medical conditions.
Medically Necessary care and treatment is recommended or approved by a Physician or Dentist; is consistent with the patient's condition or accepted standards of good medical and dental practice; is medically proven to be effective treatment of the condition; is not performed mainly for the convenience of the patient or provider of medical and dental services; is not conducted for research purposes; and is the most appropriate level of services which can be safely provided to the patient.
All of these criteria must be met; merely because a Physician recommends or approves certain care does not mean that it is Medically Necessary.
The Plan Administrator has the discretionary authority to decide whether care or treatment is Medically Necessary.
Medicare is the Health Insurance for the Aged and Disabled program under Title XVIII of the Social Security Act, as amended.
Mental Disorder means any disease or condition, regardless of whether the cause is organic, that is classified as a Mental Disorder in the current edition of International Classification of Diseases, published by the U.S. Department of Health and Human Services or is listed in the current edition of Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association.
Morbid Obesity is a diagnosed condition in which the body weight exceeds the medically recommended weight by either 100 pounds or is twice the medically recommended weight in the most recent Metropolitan Life Insurance Co. tables (or similar actuarial tables) for a person of the same height, age and mobility as the Covered Person.
Motor Vehicle means an automobile, truck, motor driven trailer, motorcycle or other vehicle normally intended for use on public highways. Motor Vehicle does not include a snowmobile, motor boat, all-terrain vehicle or similar type of motor driven vehicle that is not intended for use on public highways.
Motor Vehicle Accident means an accident involving the ownership, operation, maintenance, or use of a Motor Vehicle, including, but not limited to, unloading or loading a Motor Vehicle and including, but not limited to duties and passengers.
|
|
About Us 
