Severe medical injury or prolonged illness where the total cost of treatment will exceed the amount specified in the managed care contract.

Ongoing review of cases that involve patients who encounter catastrophic or very high medical expenses. Sometimes referred to as large case management. See case management.

Request for health benefits coverage for a case of severe injury or prolonged illness where it is foreseen that there may be very high medical expenses involved.

1. Health benefit insurance policy that offers minimal coverage for medical expenses under a specific level such as $10,000 a year but gives coverage for severe and prolonged chronic illness or injury that may cause the patient difficult financial hardship. Generally there is no maximum amount of coverage for this type of plan, but there may be some coinsurance. 2. Under a Medicare Part D plan, the name for the step in which the plan pays nearly all of the patient’s drug expenses until the end of the year, with no upper limit. The patient pays only a small share of the drug expenses (approximately 5%). Also called catastrophic insurance, catastrophic health insurance, catastrophic plan, or major medical.

Medical services for a patient who has suffered a severe injury or has a long-term illness that may substantially diminish a family’s income and resources.

Severe injury or illness that has very large expenses and for which the patient must be treated long term.

Highest amount of money the patient must pay out of pocket during a certain period of time for specific covered charges. When obtaining health insurance, setting a maximum amount protects the insured.