Health insurance to finance the expense of major illness and injury. Characterized by large benefits maximums ranging up to $250,000 or by no benefits limits, the insurance, above an initial deductible, reimburses the major part of all charges for hospitalization, doctors, private nurses, medical appliances, prescribed out-of-hospital treatments, and drugs and medicines. The insured person as coinsurer pays the remainder.
A general term used to describe organizations that attempt to manage how, when, where, and why you use health services. Many types of managed care exists, but they share the same characteristics: formal enrollment by patients; limited selection of health care providers; contractual arrangements between managed care organizations and certain providers; capitation; utilization review (e.g., preadmission screening); case management of catastrophic illnesses; discharge planning; and testing for medical necessity and some level of care coordination. The concept aimed at controlling health care costs that encompasses health maintenance organizations, preferred provider organizations, and point-of-service plans.
A catchphrase for proposed government action to intervene in the health care market to make it work better.
The premium rate developed for group insurance coverage from the company’s standard rate tables, normally referred to as its rate manual or underwriting manual.
A retirement plan, including a plan covering self-employed individuals, that is made available by a sponsoring organization such as a bank, an insurance company, a mutual fund, or a stock brokerage firm for adoption by employers.
A policy issued to an employer or trustee that establishes a group insurance plan for designated members of an eligible group.
A pooling of directed and/or discretionary trusts (a trust for which the bank acts as trustee and also has investment responsibility for all or part of the assets).
Payments into a plan that are proportionate to employee contributions. Matching contributions encourage employees to contribute money. A typical practice is to match some percentage of the employee’s contributions up to a dollar or percentage maximum.
Matching gift program
A commitment by the employer to match employees’ gifts to the charities of their choice.
See medical case management.
Medical case management (MCM)
An arrangement to review and coordinate the care prescribed for seriously ill individuals in an effort to provide equally effective but less costly care.
Medical expense reimbursement plan
An uninsured medical plan that reimburses employees for specified medical expenses out of employer funds.
A subsidized program of federal payment or reimbursement for medical care provided to eligible elderly and disabled individuals.
A Medicaid HMO is a plan available only to eligible Medicaid recipients. Medicaid contracts with HMOs to provide services to you. Your state determines your benefits package. Since this is a type of HMO, you must have a PCP and you probably will be required to use network providers and get written referrals to see specialists.
A Medicare HMO is a plan offered to eligible Medicare recipients. Medicare contracts with HMOs to provide benefits. Medicare HMO must give you all the health care services that are covered under the Medicare program, except hospice services. Since it is a type of HMO, you must have a PCP and you probably will be required to use network providers and get written referrals to see specialists. Most Medicare HMOs offer a prescription benefit and offer the consumer an option with less CO-payment and deductibles.
Member, Society of Pension Actuaries (MSPA)
A professional designation earned by passing seven actuarial exams.
See multiple-employer trust.
See multiple-employer welfare arrangement.
See mortgage interest differentials program.
The minimum contribution that must be made by a plan sponsor that maintains a defined benefit, money-purchase, or target benefit pension plan.
Minimum-funding standard account
A special account maintained for pension plans (generally defined benefit, money-purchase, or target benefit plans) to determine whether the plan has satisfied the minimum-funding standards established by ERISA. Each year, this account is charged with the plan’s liabilities (e.g., normal cost, amortization of past-service cost, increases in plan liabilities resulting from plan amendments, and experience losses). Also, the account is credited with contributions under the plan, amortization of decreases in plan liabilities resulting from plan amendments, experience gains, and any other reductions in plan liabilities. If the account shows a deficiency (charges are in excess of credits), an excise tax may be imposed.
The smallest number of employees permitted under state law to effect a group for insurance purposes.
Minimum participation requirements
Provisions contained in pension plans that define which employees may participate in the plan and when they become eligible to join. REA, which amended ERISA, prohibits a minimum age for eligibility that is above age 21 and a service length of more than one year.
Minimum premium plan (MPP)
An arrangement under which an insurance carrier will, for a fee, handle the administration of claims and insure against large claims for a self-insured group.
A relocation benefit in the form of a lump-sum payment to compensate employees for the disruption of an overseas move, above and beyond direct relocation expenses.
Modified life insurance
A modified form of whole life in which the premiums increase as the insured person ages, although more slowly than under a term life policy.
Money-purchase pension plan
A benefits or retirement plan in which employer and employee contributions are fixed, flat amounts or percentages of pay, with benefits paid on the basis of accumulated contributions at the time the benefit becomes payable.
The incidence and severity of sicknesses and accidents in a well-defined class or classes of persons.
Mortality assumption death rate
An actuarial assumption involving the probability of death at given ages; it is used when estimating the amount of future retirement benefits that will become payable.
A statistical table showing the death rate at each age, usually expressed as a certain number per thousand.
Mortgage interest differentials (MID) program
A relocation benefit designed to compensate employees for the difference in old and new home mortgage rates.
See money-purchase pension plan.
See Member, Society of Pension Actuaries.
An employee benefits plan maintained pursuant to the terms of a collective bargaining agreement that covers the employees of two or more employers.
Multiple-employer trust (MET)
A legal trust established by a plan sponsor that brings together a number of small, unrelated employers for the purpose of providing group medical coverage on an insured or a self-funded basis.
Multiple-employer welfare arrangement (MEWA)
An arrangement that provides welfare benefits, other than collectively bargained benefits-to the employees of two or more employers. Self-funded MEWAs are not subject to state regulation. Also called a multiple-employer trust.
Mutual life insurance company
A life insurance company without stockholders whose management is directed by a board elected by the policyholders. Mutual companies, in general, issue participating insurance.
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