Maximum amount of insurance benefits payable under an insurance policy.

Largest dollar amount that an insurance company will pay for an insured’s claims in a lifetime and/or the greatest dollar amount paid for all illnesses and injuries for each insured as long as the certificate is in effect. Also called total certificate membership benefit maximum and lifetime maximum .

Medicare Part A coverage that means a reserve of 60 days of inpatient hospital care available over an individual’s lifetime that the individual may use after he or she has used the maximum 90 days allowed in a single benefit period. For each lifetime reserve day, Medicare pays all covered costs except for a daily coinsurance ($534 in 2009). Also referred to as lifetime reserve or reserve days .

Refers to assignment of job duties that are less physically or mentally stressful than those that an individual previously performed before a work injury. This inexact phrase should not be used in workers’ compensation reports.

Phrase used in workers’ compensation cases that describes an aggravation of a preexisting or underlying condition. This occurrence causes a temporary or permanent increase in disability that may require new medical treatment or a change in the existing treatment.

MEDICAL,USA: 1. Maximum amount of insurance benefits payable under an insurance or managed care contract. 2. Restriction or denial of insurance coverage to certain age groups.
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expressed either on a per occurrence basis (e.g., per accident or event) or on an aggregate basis (e.g., all losses under a single policy, or for all policies during an underwriting period).
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Maximum amount a policy will pay either overall or under a particular coverage.
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Maximum amount for which an Insurer may be liable for any loss, as set forth in the Policy.

1. Statement in an insurance contract that the maximum amount an insurance company agrees to pay in case of loss. 2. In the Medicare program, agreement given to the patient to read and sign before rendering a service if the participating physician thinks that it may be denied for payment because of medical necessity or legal responsibility. The patient agrees to pay for the service; also known as Advance Beneficiary Notice (ABN), waiver of liability, or responsibility statement .

Type of medical insurance policy that covers only medical expenses caused by a specific disease that is named in the policy. Also called dread disease policy .

Hybrid form of business that combines the elements of partnerships and corporations. The owners are called members and receive protection from individual liability for company debts. For tax purposes, it is considered a partnership. Gains and losses are claimed by members on their own income tax returns.