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.

1. Specific geographic area in which a managed care plan enrolls its members. 2. In the TRICARE program, a certain region defined by ZIP codes that is approximately 40 miles in radius surrounding each U.S. military treatment facility. Also called service area.

System in which medical services planning and resource budgeting are based on the population in a specific geographic area in which a managed care plan enrolls its members.

Federal health programs created to benefit a certain group of people (e.g., Medicare for elderly and some disabled individuals and Medicaid for the indigent).

Classification in the Medicaid program of aged, blind, or disabled individuals or families and children who meet financial eligibility requirements for Aid to Families with Dependent Children, Supplemental Security Income, or an optional state supplement.

One of the divisions of the Current Procedural Terminology (CPT) code book. The book is divided into seven code sections and appendices. Within each of the main sections are subsections and categories divided according to anatomical body system, organ, or site; procedure or service; condition; and specialty.

1. Three-digit code that represents a single disease or a group of closely related conditions in the diagnostic code book titled International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) . 2. Letter with two digits that represents a single disease or a group of closely related conditions in the diagnostic code book titled International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). Also referred to as three-character category.