A state service organization to assist children younger than 21 years of age who have conditions leading to health problems. It operates with federal grant support under Title V of the Social Security Act. In some states this program may be known as Children’s Special Health Care Services (CSHCS) or State Children’s Health Insurance Program (SCHIP) .

Provision that may appear in a hospital or medical insurance policy; allows payment for normal pregnancy.

In an obstetrical case, inpatient hospital care that includes use of the delivery room, postpartum care, and care of the newborn infant.

Individual (mid- to late-teen) considered mature enough to understand a physician’s recommendations for treatment and give his or her informed consent. Also see minor and emancipated minor .

Endowment insurance policy that has reached the end of its term during the lifetime of the insured and is due for payment.

Date on which an endowment policy matures and begins to pay out benefits to the policyholder.

Dollar amount sum (factor) to annualize insurance claims where less than 1 year’s experience is obtainable. For example, if only 10 months of claims exist, the total dollar amount is multiplied by a maturity factor of 1.2 to obtain a 1-year claim amount (10 × 1.2 = 12).

Sum set by an insurance company as the greatest amount that it will pay for a specific medical benefit or procedure. Third-party actual payment may be less than the maximum allowable because of the insured’s deductible and coinsurance. Also called maximum allowable charge, maximum allowable amount, allowed amount , or approved amount .

Formerly a provision of the Medicare program that affected nonparticipating (nonpar) physicians before January 1, 1991. It set a limit on fees billed by a nonpar provider for professional and incident to professional services. This system was replaced with the resource-based relative value scale (RBRVS). See limiting charge .