Inpatient Stay. A period of uninterrupted Inpatient confinement that begins with formal admission and ends upon discharge. An Inpatient Stay may include a Medically Necessary transfer from one Hospital to another Hospital as an Inpatient. Maintenance Medications. A prescription drug that is prescribed to you by your Provider for treatment of a long-term condition or illness (e.g., blood pressure medication, cholesterol medication). Medications that are prescribed to treat short-term conditions (e.g., antibiotics) are not considered Maintenance Medications. Maintenance Therapy. Any service, procedure, treatment, or therapy that has the primary purpose of preserving the present level of function and prevents deterioration of that function, as opposed to improving a function (within a reasonable timeframe established in a plan of care) to an extent that may allow for a more independent existence. Maintenance Therapy occurs when the condition of the patient receiving the service, procedure, treatment, or therapy does not or is not expected to materially improve within a reasonable timeframe established in a plan of care, or when the goals of a treatment plan have been met. Marketplace. In Maine, the Federally Facilitated Marketplace. Maximum Allowable Amount or Maximum Allowance. The maximum amount that a Member and Health Options will pay a Network Provider for a Covered Service. The Maximum Allowable Amount or Maximum Allowance equals the Usual, Customary, and Reasonable Charge for a Covered Service.
Appears in 4 contracts
Samples: Member Benefit Agreement, Member Benefit Agreement, Member Benefit Agreement
