Total amount a health insurance plan will pay for medical care for any individual insured.

In workers’ compensation, the point of greatest recovery after all treatment has been used within a reasonable time period to allow for optimal recovery and other physiological adjustments to occur. Also see permanent and stationary (P & S) .
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US: Maximum Medical Improvement (MMI) is a treatment plateau in each person’s healing process. It can mean that the patient has fully recovered from the injury or that the patient’s medical condition has stabilized to the point that no major medical or emotional change can be expected in the injured workers’ condition. This occurs despite continuing medical treatment or rehabilitative programs the injured worker partakes in.

In workers’ compensation disability rating, it is a measurement of long-term impairment often expressed as a percentage of total body function.

Limit on the total medical expenses (number of copayments, deductibles, and coinsurance) that an insured must pay that are not covered under a managed care contract.

Highest dollar amount per time period that a plan will insure. This is only applicable for service categories where there are enhanced benefits being offered by the plan because Medicare coverage does not allow a maximum plan benefit coverage expenditure limit.

Annual dollar amount above which earnings in employment covered under the health insurance (HI) program are not taxable. Beginning in 1994, the maximum tax base was eliminated under HI. Also called contribution base .

Greatest amount an insurance carrier will pay for a specific benefit or policy during a specified time period.

Federal legislation (Public Law 15) enacted in 1945 providing that even though the insuring or provision of health care may be national in scope, the regulation of insurance is left to the states. Under the Act, insurance is exempt from some federal antitrust statutes to the extent that it is regulated by the states. The exemption primarily applies to gathering data in concert for the purpose of ratemaking. Otherwise, antitrust laws prohibit insurers from boycotting, acting coercively, restraining trade, or violating the Sherman or Clayton Acts.
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Passed by Congress in 1945, this act states that regulation and taxation of insurance by the states is in the public interest and that congressional silence should not be construed as a barrier to state regulation.

1. Acronym that means a Doctor of Medicine degree. See medical doctor (MD) . 2. See Doctor of Osteopathy (DO) .