|
|
|
Word
|
Definition
|
|
Maintenance Bond
|
Maintenance Bond: A type of surety bond under which the surety guarantees that the contractor will fulfill its obligations during the warranty period.
|
|
|
|
Major Medical Insurance
|
Major Medical Insurance: A form of health insurance covering expenses relating to a catastrophic illness or injury.
|
|
|
|
Malpractice Insurance
|
Malpractice Insurance: See Medical Malpractice Insurance and Professional Liability Insurance.
|
|
|
|
Managed Care
|
Managed Care: A health care system integrating the financing and delivery of health care services by a group of providers. In a managed care system, standards are set for efficiency and quality assurance. A coordinated approach to the design, financing and delivery of health care, which balances price and utilization controls with access to care. Also a general term for organizing doctors, hospitals and other providers into groups in order to enhance the cost-effectiveness and manage the quality of health care.
|
|
|
|
Managed Care Organization (MCO)
|
Managed Care Organization (MCO): An entity that provides or contracts for managed care. Includes entities such as HMOs, PPOs, POS plans, EPOs, etc.
|
|
|
|
Managed Competition
|
Managed Competition: A purchasing strategy for health care that encourages those managed care plans that do the best job of improving quality, cutting cost and satisfying patients to flourish.
|
|
|
|
Managed Indemnity Plan
|
Managed Indemnity Plan: An indemnity plan that uses some utilization management techniques (such as hospital precertification) to monitor how doctors and patients use health care services. As there is no network, providers have no relationship or contract with the health plan. This is not a true managed care plan.
|
|
|
|
Managing Agent
|
Managing Agent: The agency support mechanism behind syndicates on Lloyd's. Employs the underwriting staff and maintains compliance with Lloyd's rules.
|
|
|
|
Managing General Agent (MGA)
|
Managing General Agent (MGA): An agent who produces and underwrites business for an insurer and either adjusts or pays claims or negotiates reinsurance on behalf of the insurer.
|
|
|
|
Mandatory Securities Valuation Reserve (MSVR)
|
Mandatory Securities Valuation Reserve (MSVR): A reserve required by state insurance regulators as a liability on a life insurer's statutory financial statements intended to capture realized and unrealized gains and losses sustained by the insurer's fixed-income and equity portfolios. In December, 1991, the National Association of Insurance Commissioners (NAIC) proposed that the MSVR be replaced by Asset Valuation Reserves and Interest Maintenance Reserves, effective with 1992 statutory financial statements. See Asset Valuation Reserve and Interest Maintenance Reserve.
|
|
|
|
Manual Rates
|
Manual Rates: An insurer's standard rates as established in its rating or underwriting manuals.
|
|
|
|
Manuscript Policy
|
Manuscript Policy: An insurance policy drafted to meet the specific needs of insurer and insured.
|
|
|
|
Marine Insurance
|
Marine Insurance: A form of insurance covering transportation and communication activities, as well as goods in transit. See Inland Marine Insurance and Ocean Marine Insurance.
|
|
|
|
Market Assistance Plan
|
Market Assistance Plan: A program that provides assistance to consumers of insurance who have experienced difficulty in obtaining coverage in the voluntary markets.
|
|
|
|
Market Capacity
|
Market Capacity: The aggregate amount of insurance capable of being underwritten by all insurers operating in a relevant market.
|
|
|
|
Master Policy
|
Master Policy: The practice of combining several locations or operations under coverage provided by a single insurance policy.
|
|
|
|
Material Duties
|
Material Duties: In LTD plans, the basic and essential requirements of a job. To be
considered disabled, employees must be unable to perform material duties, not incidental or
insignificant tasks.
|
|
|
|
Mature
|
Mature: Within the context of life insurance, a policy whose face amount has become payable.
|
|
|
|
Maximum Benefit
|
Maximum Benefit: For disability benefits, the maximum dollar amount an insured will
receive while disabled. For health benefits, the total dollar amount the insurer will pay on
any given individual.
|
|
|
|
Maximum Benefit Duration
|
Maximum Benefit Duration: The longest period for which employer-sponsored disability
benefits will be paid, provided that the employee remains continuously disabled. Typically,
the lesser of the number of years until Social Security normal retirement age or the age
specified in the plan.
|
|
|
|
Maximum Medical Improvement (MMI)
|
Maximum Medical Improvement (MMI): The
point at which an employee who has been disabled reaches a plateau in recovery, so that
any remaining impairment is considered to be permanent. In workers' compensation, MMI
triggers the transition from temporary to permanent Disability benefits.
|
|
|
|
Maximum Monthly Benefit
|
Maximum Monthly Benefit: The highest dollar amount that an employee who has been
disabled will receive each month from the employer's LTD plan.
|
|
|
|
Maximum Probable Loss
|
Maximum Probable Loss: See Probable Maximum Loss.
|
|
|
|
McCarran-Ferguson Act
|
McCarran-Ferguson Act: Federal legislation enacted in 1945, in which Congress agreed to defer to state regulatory authorities in the regulation of the insurance industry. The legislation specifically provides for a limited federal antitrust exemption.
|
|
|
|
MCO
|
MCO:See Managed Care Organization.
|
|
|
|
Medicaid
|
Medicaid: State-administered programs created by federal legislation in 1966 that provide assistance to pay for health care benefits for disadvantaged persons regardless of age. Federal matching funds supplement such payments. The state, under broad federal guidelines, determines what benefits are covered, who is eligible and how much providers will be paid.
|
|
|
|
Medicaid
|
Medicaid is a state administered program and each state sets its own guidelines regarding eligibility and
services. There are stringent restrictions in order to receive Medicaid. These may include your age, whether you
are pregnant, disabled, blind, or aged; your income and resources (like bank accounts, real property, or other
items that can be sold for cash); and whether you are a U.S. citizen or a lawfully admitted immigrant. The rules
for counting your income and resources vary from state to state and from group to group. There are special rules
for those who live in nursing homes and for disabled children living at home.
|
|
|
|
Medical Malpractice Insurance
|
Medical Malpractice Insurance: A form of insurance that covers a health care professional's liability for any actual or alleged breach or neglect of duty committed in the conduct of the insured's duties.
|
|
|
|
Medical Necessity
|
Medical Necessity: Services/procedures which are approved in accordance with
recognized medical standards as effective and appropriate and are essential to retard,
reduce or eliminate an impairment.
|
|
|
|
Medical Only
|
Medical Only: A type of workers' compensation claim that involves no wage replacement
(because no work time was lost) but only reimbursement of medical expenses.
|
|
|
|
Medical Record
|
Medical Record: A written or electronic account of a patient's medical history, current
illness, diagnosis, details of treatments, chronological progress notes, and discharge
recommendations. This is a legal document the patient is entitled to read and is
authenticated by the physician's signature. There are strict rules regarding the
confidentiality of the medical record.
|
|
|
|
Medical Savings Account (MSA)
|
Medical Savings Account (MSA): A program analogous to an Individual Retirement Account (IRA), permitting tax-preferred savings toward medical expenses. The Health Insurance Portability and Accountability Act of 1996 provided for an experiment of the concept, and some Republicans have proposed its adaptation (via a Medicare Medical Savings Account, or MMSA) to Medicare.
|
|
|
|
Medical Trend
|
Medical Trend: A quantitative measure of the change in medical costs per plan member. Medical trend is driven by numerous factors, including inflation, medical care consumption patterns, physician practice patterns (e.g., referrals), new medical technology, defensive medicine and cost shifting.
|
|
|
|
Medicare
|
Medicare: A federally funded insurance program adopted in 1966 that provides health insurance coverage for hospital and physicians' services to persons age 65 and older and certain other disabled persons. A nationwide, federal health insurance program for people age 65 and older. It also covers certain people under 65 who are disabled or have chronic kidney disease. Medicare Part A is the hospital insurance program; Part B covers physicians' services.
|
|
|
|
Medicare
|
Medicare: Federally administered health insurance plan intended primarily for person age
65 and older; also available to individuals with disabilities after they have received Social
Security Disability Insurance benefits for 24 months. Medicare has two parts, part A covers
hospital costs; part B covers medical expenses.
|
|
|
|
Medicare
|
Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over, or who are disabled for at least two years and five months.
|
|
|
|
Medigap Insurance
|
Medigap Insurance: A form of health insurance sold by private insurers to supplement coverage or otherwise fill in coverage gaps provided by the Medicare program. Also known as MedSupp (Medicare Supplemental) Insurance.
|
|
|
|
Members' Agent
|
Members' Agent: A Lloyd's underwriting agency; introduces members to an underwriting syndicate but does not manage one.
|
|
|
|
Mental Illness
|
Mental Illness: A psychiatric or psychological condition regardless of cause such as
schizophrenia, depression, manic depressive or bipolar illness, anxiety, personality disorders
and/or adjustment disorders or other conditions. These conditions are usually treated by a
mental health provider or other qualified provider using psychotherapy, psychotropic drugs,
or other similar methods of treatment.
|
|
|
|
Mental Illness Limitation
|
Mental Illness Limitation: Limit on the period of time (often 24 months) over which LTD
benefits will be paid when an employee is disabled as a result of mental, emotional, or
nervous condition that is being treated on an outpatient basis. The limitation does not apply
while the individual is confined to a hospital or institution.
|
|
|
|
MEWA or "Multiple Employer Welfare Arrangement
|
[The following is from the DOL] Once it has been determined that an ERISA-covered welfare plan provides benefits to the employees of two or more employers, a determination must be made as to whether any of the exclusions from MEWA status apply to the arrangement. Pursuant to ERISA Section 3(40)(A), three types of arrangements are specifically excluded from the definition of "multiple employer welfare arrangement," even though such arrangements may provide benefits to the employees of two or more employers. Each of these types of arrangements is discussed in general terms below.
1. Plans maintained pursuant to collective bargaining agreements
Section 3(40)(A)(i) specifically excludes any plan or other arrangement that is established or maintained "under or pursuant to one or more agreements which the Secretary finds to be collective bargaining agreements."
This exception generally includes the type of plans commonly referred to as "multiemployer plans," a term which in some instances has been confused with the term "multiple employer welfare arrangements." Multiemployer plans, as distinguished from MEWAs, are established and maintained under collective bargaining agreements negotiated between unions and employers or an association of employers, and, in accordance with the Labor Management Relations Act, employer contributions to the plans are held in a trust that is jointly administered by labor trustees (appointed by the union) and management trustees (appointed by the employers or employer association).
In general, a collective bargaining agreement is an agreement or contract that is the product of good faith bargaining between bona fide employee representatives and one or more employers. Determinations as to whether a particular document is the product of good faith bargaining between bona fide employee representatives and one or more employers can be made only upon an examination of relevant facts and circumstances, taking into consideration the pertinent provisions of the National Labor Relations Act, 29 U.S.C. § 151 et seq., and the cases decided thereunder, as well as other relevant laws.
For purposes of Section 3(40), an employee benefit plan will generally be considered to be established or maintained "under or pursuant to a collective bargaining agreement" if the agreement is a bona fide collective bargaining agreement and the agreement provides, directly or indirectly, for establishment or maintenance of a plan for the benefit of employees represented by a union in the collective bargaining process.
While no one item is determinative, factors generally indicative of a bona fide collective bargaining agreement may, among others, include: the agreement provides for wages, benefits, working conditions or resolution of grievances; the agreement is executed by representatives of a labor organization/union which is either certified by the National Labor Relations Board or is elected by the majority of employee of signatory employers as the exclusive bargaining representative of the employees; neither the agreement nor of the labor organization/union was promoted by the employer(s); and the agreement is the product of good faith bargaining.
|
|
|
|
MEWA Welfare Arrangement
|
MEWA or "Multiple Employer Welfare Arrangement: The term "multiple employer welfare arrangement" means:
1. an employee welfare benefit plan (as defined below), or
2. any other arrangement (other than an employee welfare benefit plan)
• which is established or maintained for the purpose of offering or providing [welfare plan benefits]
• to the employees of two or more employers (including one or more self-employed individuals), or to their beneficiaries.
[except that such term does not include any such plan or arrangement pursuant to collective bargaining agreements, and certain limited exceptions] See full explanation here.
|
|
|
|
MGA
|
MGA: See Managing General Agent.
|
|
|
|
Miller Act
|
Miller Act: Federal legislation enacted in 1935 that requires surety bonds to be supplied by those providing goods and services to the federal government. Some individual state governments have enacted similar legislation in relation to their own outside contracting activities.
|
|
|
|
Minimum Monthly Benefit
|
Minimum Monthly Benefit: The lowest dollar amount an employee who has been disabled
will receive each month from the employer's LTD plan. Some plans guarantee a minimum
benefit, regardless of income received from other sources.
|
|
|
|
Minimum Premium Plan
|
Minimum Premium Plan: A program under which an insurer provides administrative services and insures large claims for a self-insured group.
|
|
|
|
Miscellaneous Surety Bond
|
Miscellaneous Surety Bond: A surety bond that guarantees the performance of various obligations of a principal, including guarantees of honesty (such as notary public bonds), financial guarantees (such as utility deposit bonds) and other credit guaranty bonds.
|
|
|
|
Monetary Threshold
|
Monetary Threshold: A type of "no fault" insurance system, in which the claimant has the right to sue for damages if they exceed a specified minimum dollar limit.
|
|
|
|
Monoline Insurer
|
Monoline Insurer: An insurer that writes only a single line of business. Over time, the term has been expanded to include insurers writing predominantly a single line of business.
|
|
|
|
Monopolistic Fund
|
Monopolistic Fund: A state-run workers' compensation insurance that allows virtually no competition from private insurers for primary business. (Private insurers may insure excess business.)
|
|
|
|
Monopolistic State Fund
|
Monopolistic State Fund: In certain states, a fund set up as an agency of a state
government, from which all employers who are not self-insured or covered by group self-
insurance are required to purchase workers' compensation insurance.
|
|
|
|
Moral Hazard
|
Moral Hazard: The increase in the chance of loss caused by the disregard of traditionally "moral" behavior, e.g., misrepresentation, concealment, arson.
|
|
|
|
Morale Hazard
|
Morale Hazard: The increase in the chance of loss caused by the insured's indifference or carelessness because of the existence of insurance, e.g., failure to check brakes regularly.
|
|
|
|
Morbidity
|
Morbidity: The expected incidence and severity of illness and accidents in a specified
group.
|
|
|
|
Morbidity Experience
|
Morbidity Experience: The incidence of disability due to disease or physical impairment.
|
|
|
|
Mortality Experience
|
Mortality Experience: The incidence of death based upon the experience of a particular insurer.
|
|
|
|
Mortality Table
|
Mortality Table: A statistical listing of anticipated death rates for various age groupings, normally expressed as deaths per thousand.
|
|
|
|
Mortgage Redemption Insurance
|
Mortgage Redemption Insurance: A form of decreasing term insurance that covers the life of a person taking out a mortgage. Death benefits are designed to provide for payment of the outstanding balance of the loan. See Decreasing Term Insurance.
|
|
|
|
MSA
|
MSA: See Medical Savings Account.
|
|
|
|
MSVR
|
MSVR: See Mandatory Securities Valuation Reserve.
|
|
|
|
Multiemployer Plan
|
Multiemployer Plan: A multiemployer plan is a collectively bargained plan maintained by more than one employer, usually within the same or related industries, and a labor union. These plans are often referred to as "Taft-Hartley plans". (ERISA Secs. 3(37) and Sec. 4001(a)(3)) Multi-employer plans are excluded from the definition of MEWAs:
|
|
|
|
Multiline Insurer
|
Multiline Insurer: An insurer that issues insurance policies covering a wide range of perils. Such insurers may underwrite life, health and property-casualty risks.
|
|
|
|
Multi-Peril or Multiple-Peril
|
Multi-Peril or Multiple-Peril: A term describing an insurance policy covering a wide range of perils, rather than a single peril or limited range of perils.
|
|
|
|
Multiple Employer Trust
|
Multiple Employer Trust: An arrangement whereby a number of unrelated employers join together for the purpose of providing group medical coverage.
|
|
|
|
Multiple Fund
|
Multiple Fund: A fund operated by an investment company that raises money from shareholders and invests in a group of stocks, bonds or other investments. It is professionally managed for the benefit of the shareholders. Each share in the fund represents part ownership of many different stocks, bonds, etc. Many insurance companies sell mutual funds.
|
|
|
|
Mutual Insurance Company
|
Mutual Insurance Company: An insurance company owned by its policyholders, in contrast to a stock insurance company, which is owned by its stockholders.
|
|