- Medical policy
- Documentation that provides medical necessity and coverage guidelines for our members.
- Medically necessary
- Health care services and supplies that are evaluated as appropriate and necessary based on diagnosis and cost-effectiveness, and that are consistent with national medical practice guidelines on type, frequency and length of treatment.
- Medicare supplement
- Supplementary coverage, available to persons eligible for Medicare, to help pay remaining balances after Medicare has made payment.
- Medigap insurance
- Private insurance policies that supplement Medicare and cover the difference between what Medicare pays and the allowed charges for covered and uncovered services.
- Member
- A person covered by a health plan.
- Member ID
- The identification number assigned to a member.
- Member ID card
- A card that identifies members of a plan. It lists the identification number, group number and effective date of the plan and includes important phone numbers.
- Member responsibility
- The amount the member is responsible for of the total charge for health care services received.
- Neonatology
- Diagnosis and treatment of disorders in newborns.
- Nephrology
- Diagnosis and treatment of fluid and electrolyte disorders and hypertension, including disorders of the kidney.
- Network
- The hospitals, physicians and other medical professionals who sign a contract with a health plan to provide care for its members. Also referred to as participating or in-network providers.
- Neurology
- Diagnosis and treatment of diseases and injuries of the nervous system (brain, spinal cord, nerves), medically rather than surgically.
- Nurse midwife
- A licensed health care professional who provides gynecological services and care for women during and after normal pregnancy and labor.
- Nurse practitioner
- A licensed registered nurse who has gained additional knowledge and skills through an organized program of study and clinical experience.
- Obstetrics/gynecology (ob/gyn)
- The medical specialty that focuses on women's health care issues like pregnancy, childbirth, family planning and annual checkups.
- Obstetrics
- Health care during and after a woman's pregnancy.
- Occupational therapy
- A branch of medicine that involves a program of activities to help patients regain a degree of independence or return to employment.
- Office
- Location, such as a clinic, where the health professional routinely provides health examinations, diagnosis and treatment of illness or injury.
- Open-access plans
- Benefit plans that allow members to see network providers for specialty care without a referral from another doctor.
- Open enrollment
- The period of time when an employee may change enrollment status or benefit plans, usually without evidence of good health or waiting periods.
- Ophthalmology
- Diagnosis and treatment of glaucoma and muscle disorders of the eye, including cataract surgery and laser treatment, and vision evaluation and prescribing of corrective lenses.
- Oncology
- The medical science or specialty concerned with the diagnosis and treatment of tumors, commonly various forms of cancer.
- Optometry
- The art or profession of examining the eye for defects and prescribing corrective lenses or exercises to correct the defect.
- Oral and maxillofacial surgery
- Diagnosis and treatment of disorders of the mouth, teeth, jaws and facial structures, including surgical correction of facial deformities and fractures.
- Oral surgery
- Field of dentistry dealing with surgery of the mouth and its related structures.
- Orthopedic surgery
- A branch of medicine that involves surgical treatment of skeletal deformities and injuries.
- Orthotics
- Specialized field relating to orthopedic appliances, braces and other devices used to support weight, prevent or correct deformities, or align and improve the function of movable parts of the body.
- Osteopath
- Similar to medical doctors, osteopaths (also referred to as doctors of osteopathic medicine or DOs) emphasize the role of the bones, muscles, and joints in the healthy functioning of the human body.
- Otolaryngology
- The diagnosis and treatment, medically and surgically, of diseases and disorders of the ear, nose and throat. Also referred to as ENT.
- Outpatient
- A portion of a hospital which provides diagnostic, therapeutic (both surgical and non-surgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.
- Out-of-network
- The option to see health care providers who don't have a contract with the health plan. When benefit plans include this option, members share more of the cost when receiving care from out-of-network providers.
- Out-of-pocket costs
- The portion of health care costs that a member is responsible for, including copays, coinsurance, deductibles and noncovered services.
- Out-of-pocket maximum
- The most a member must pay each year toward allowed health care costs. Once the out-of-pocket maximum is reached, the health plan pays 100 percent until the end of the calendar or benefit year.