In workers’ compensation, change in a preexisting condition that causes a temporary or permanent increase in disability or creates a need for additional or different medical treatment. An aggravation may be caused by either a new injury or by work activity involving a physical, chemical, or biological factor.

In a managed care contract, the maximum amount (limit) for which a member is insured for any single event.

A maximum dollar amount which may be collected for any disability, period of disability, or under the policy.******Maximum amount for which an insured may collect for any disability, period of disability, or covered medical service under an insurance policy.******The maximum amount that may be claimed during a certain period or under the policy.
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The maximum amount that may be collected for any disability or period of disability under the policy.

Agreement in a managed care plan to relieve the amount of liability for insurance claims that are in excess of the amount anticipated for the contract year. Also see stop loss.

Insurance coverage that becomes effective when an employer who has self-insurance has its total group medical insurance claims reach a specific threshold chosen by the employer. This threshold is a percentage of its yearly predicted group health claim costs.

Under a system developed by Johns Hopkins University called adjusted clinical groups (ACGs) , ACGs are a comprehensive family of measurement tools designed to help explain and predict how health care resources are delivered and consumed. ACGs are based on building blocks called aggregated diagnosis groups (ADGs). ADGs are a grouping of diagnosis codes that are similar in terms of severity and likelihood of persistence of the health condition over time. There are two categories of ADGs, ambulatory diagnostic groups–major diagnostic category (ADG-MDC) and ambulatory diagnostic groups–hospital dominant (ADG-HosDom).