Review Activity: Maxicare Terminologies

Formal, written consent given to an individual or entity to conduct an activity without requiring additional approval. This is a letter given to the Provider as a guarantee that all expenses incurred by member will be paid by Maxicare

Products under full risk would require payment for the membership fees. Computation for the membership fee (premium based) is based on certain factors such as age, nature of work, number of enrollees etc. In this type of funding arrangement, risk is on the part of Maxicare.

It is an organization that provides or arranges a managed care for individuals or employers at a fixed fee/premium or prepaid contract.

The maximum amount that a member can avail per year.

An illness or disease that exists prior to the effective date of the member’s coverage to Maxicare

The type of hospital room and board pre-assigned by Maxicare to the Member based on the plan enrolled in.

The maximum amount that a member can avail per illness per member per year.

An unbundled product consists of selected benefits falling either to outpatient or inpatient coverage. Minimum of 100 heads to be enrolled.

Requires the account to set up and maintain a revolving fund with Maxicare from which money intended to pay for the incurred usage/claims of the members will be drawn out.

An official document issued to members as evidence of entitlement to services.