A medical delivery system that attempts to manage the quality and cost of medical services which individuals receive. Most managed care systems offer PPOs that individuals are encouraged to use for their health care services. Some managed care plans attempt to improve health quality by emphasizing prevention of disease.

The maximum amount of money that an insurance company (or self-insured company) will pay for claims within a specific time period. Maximum dollar limits vary greatly. They may be based on or specified in terms of types of illnesses or types of services. Sometimes they are specified in terms of lifetime or sometimes for a year.

Services, supplies or prescription drugs that are needed to diagnose or treat a medical condition. Your insurer will review the information provided and decide if it is accepted as standard practice, appropriate for the condition, age etc. and that it is not for convenience or cosmetic reasons. Sometimes additional information is required from you or the provider to make that determination.