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Glossary

  1. M

    managed care
    The integration of both the financing and delivery of health-care within a system that seeks to manage the accessibility, cost and quality of that care.
    managed dental care
    Any dental plan offered by an organization that provides a benefit plan that differs from a traditional fee-for-service plan.
    MCO
    See managed care organization.
    Medicaid
    A joint federal and state program that provides hospital expense and medical expense coverage to the low-income population and certain aged and disabled individuals.
    medical advisory committee
    The MCO committee that evaluates proposed policies and action plans related to clinical practice management, including changes in provider contracts, compensation, and changes in authorization procedures, reviews data regarding new medical technology and examines proposed medical policies.
    medical director
    The health plan physician executive who is responsible for the quality and cost-effectiveness of the medical care delivered by the plan's providers. Also known as a chief medical officer.
    medical group practice
    See consolidated medical group.
    medical underwriting
    The evaluation of health questionnaires submitted by all proposed plan members to determine the insurability of the group.
    Medicare
    A federal government program established under Title XVIII of the Social Security Act of 1965 to provide hospital expense and medical expense insurance to elderly and disabled persons.
    Medicare Part A
    The Medicare component that provides basic hospital insurance to cover the costs of inpatient hospital services, confinement in nursing facilities or other extended care facilities after hospitalization, home care services following hospitalization, and hospice care.
    Medicare Part B
    The Medicare component that provides benefits to cover the costs of physicians' professional services, whether the services are provided in a hospital, a physician's office, an extended-care facility, a nursing home or an insured's home.
    Medicare SELECT
    A Medicare supplement that uses a preferred provider organization to supplement Medicare Part B coverage.
    Medicare supplement
    A private medical expense insurance policy that provides reimbursement for out-of-pocket expenses, such as deductibles and coinsurance payments, or benefits for some medical expenses specifically excluded from Medicare coverage.
    Medigap policies
    Individual medical expense insurance policies sold by state-licensed private insurance companies.
    member services
    The broad range of activities that an MCO and its employees undertake to support the delivery of the promised benefits to members and to keep members satisfied with the company.
    MHS
    See Military Health System.
    MSO
    See Management Services Organization.
    mutual company
    A company that is owned by its members or policyowners.
    My Blue Community℠
    Online community that empowers members to make informed appropriate health choices based on either experiences from other healthcare consumers with similar circum?stances or expert advice.