Glossary ?
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What is Major Medical Expense Insurance?
Policies designed to help offset the heavy medical expenses resulting from catastrophic or prolonged illness or injury. They generally provide benefits payments for 75 to 80 percent of most types of medical expenses above a deductible paid by the insured.

What is Malpractice Insurance ?
Insurance against the risk of suffering financial damage due to professional misconduct or lack of ordinary skill. Malpractice requires that the patient prove some injury and that the injury was the result of negligence on the part of the professional. A practitioner is liable for damages or injuries caused by malpractice.

What is Managed Behavioral Health Program ?
A program of managed care specific to psychiatric or behavioral health care. This usually is a result of a "carve-out" by an insurance company or managed care organization (MCO). Reimbursement may be in the form of sub-capitation, fee for service or capitation. See also Carve-Out.

What is Managed Care Plan ?
A health plan that uses managed care arrangements and has a defined system of selected providers that contract with the plan. Enrollees have a financial incentive to use participating providers that agree to furnish a broad range of services to them. Providers may be paid on a pre-negotiated basis. (See also Health Maintenance Organization, Point-of-Service Plan, and Preferred Provider Organization.)

What is Managed Health Care Plan ?
An arrangement that integrates financing and management with the delivery of health care services to an enrolled population. It employs or contracts with an organized system of providers that delivers services and frequently shares financial risk.

What is Mandated Providers ?
Providers whose services must be included in coverage offered by a health plan. State or federal law can require these mandates.

What is Manual Rates ?
Rates based on a health plan's average claims data and adjusted for certain factors, such as group demographics or industry.

What is Market Share ?
A certain percentage of the market area or targeted market population. Usually used to describe a forecasted goal or a past penetration of the market.

What is Maximum Out-of-Pocket Expenses ?
Limit on total number of co-payments or limit on total cost of deductibles and co-insurance under a benefit plan.

What is Medical Group Practice ?
The American Group Practice Association, the American Medical Association, and the Medical Group Management Association define medical group practice as: provision of health care services by a group of at least three licensed physicians engaged in a formally organized and legally recognized entity sharing equipment, facilities, common records and personnel involved in both patient care and business management.

What is Miscellaneous Expenses ?
Hospital charges, other than room and board, such as those for x-rays, drugs, laboratory fees, and other ancillary services.

What is Modified Community Rating ?
Rating of medical service usage in a given area, adjusted for data such as age, sex, etc. See also Community Rating.

What is Modified Fee-for-Service ?
System that pays providers fees for services provided, with certain maximum fees for each service. See also Fee for Service, Benefits, and Preferred Providers.

What is MSO ?
One of the following: Medical Staff Organization An organized group of physicians, usually from one hospital, into an entity able to contract with others for the provision of services, or Management (or Medical) Services Organization An entity formed by, for example, a hospital, a group of physicians or an independent entity, to provide business-related services such as marketing and data collection to a grouping of providers like an IPA, PHO or CWW. This second definition is becoming the almost exclusive usage. See Management Services Organization or Medical Services Organization.