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Glossary of Insurance Terms

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Managed Care: A system of managing and financing health care delivery to ensure that services provided to manage care plan members are necessary, efficiently provided, and appropriately priced.

Material Misrepresentation: A statement made by an applicant or proposed insured in the policy's application which is not factually correct. If the truth had been disclosed, the insurance company would not have issued the policy, would have issued it differently, or would have issued it with limited benefits or a higher premium.

Maternity Care: Care that promotes the overall health of mother and child from conception, during pregnancy and delivery, and through the post partum period after delivery.

Medical Examination: An exam completed by a physician. The exam may be required as a part of medical underwriting.

Medical Information Bureau (MIB): A service that compiles medical information and application history of individuals who have applied for insurance in the past. Most insurance companies check an applicant's Mill report during underwriting.

Medically Necessary: Those covered services required to preserve and maintain the health status of a covered person on accordance with the accepted standards of medical practice m the medical community in the area where services are rendered. In other words, services or treatments are considered medically necessary and appropriate if they could not have been omitted without adversely affecting the patient's condition or the quality of medical care provided.

Member: An individual or dependent who is enrolled in and covered by a managed health care plan. Also referred to as an Enrollee, Beneficiary, Participant, Covered Person, Subscriber and Eligible Individual.

Mental Health/Behavioural Health: A condition or disease regardless of its cause, listed in the most recent edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.

Misrepresentation: The act of making, issuing, circulating, or causing to be issued or circulated any written or verbal statement that does not accurately represent the correct policy terms.

Mode: The term of premium payments for an insurance policy. Typical modes include monthly, quarterly, semi-annual and annual.

Moral Hazard: A condition of morals or habits that could affect and individual's insurability.

Mortality: The frequency of deaths in proportion to a specific population.

Mortality Rate: The number of deaths in a group of people, usually expressed as deaths per thousand.

Mortality Table: A table or chart listing the probabilities of death occurring at various ages. This is often used by insurance companies to establish rating and underwriting guidelines.

Multi-Year Premium Mode: A premium payment option where future annual premiums are paid in advance at a discount.

Mutual Insurance Company: An insurance company which is owned by its policy owners. Net earnings and savings of the company are distributed to the policy owners in the form of dividends.

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