Single charge for a day in the hospital regardless of actual charges or costs incurred (e.g., a plan that pays $800 for each day regardless of the actual cost of service). Some insurance plans may have separate categories of per diem (e.g., intensive care unit, medical, and surgical, each with a different reimbursement rate). Also called per diem payment.

Cost for each insurance plan’s enrolled member for each month (each effective member for each month the member was effective). This is calculated by taking the number of units divided by member months. A variation is called per contract per month (PCPM).

Cost for each insurance plan’s enrolled member for the year. Also see per member per month (PMPM).

Distribution of a deceased member’s share of the life insurance proceeds to the beneficiary’s children.

Employed to report utilization for health plan members (e.g., hospital utilization shown in days PTMPY).

Phrase used in managed care plan contracts that refers to the flat-rate payment made to a provider for one patient encounter.

Dollar amount that the insured must pay for each accident or illness before major medical benefits begin payment. Also called per-disability deductible.

Greatest amount that a medical expense insurance policy will pay for medical benefits from any illness or injury.

Fixed dollar amount that is calculated as a percentage of the average monthly premium paid by each member of a managed care plan. It is paid to the provider each month instead of another payment method. This phrase is used in managed care plan contracts and is one of two methods used to compute a capitation payment.