Medicare beneficiary’s highest dollar liability amount (copayments, deductibles, and coinsurance) for a specified time period.

Third-party reimbursement arrangement in which a participating provider agrees to accept the contract’s schedule of allowances as the total fee for each covered health care service rendered.

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.