Glossary - Know exactly like a health insurance expert!

What is Eligibility Date?
The date that a person is eligible for benefits.

What is Eligibility Period?
(1) The period of time during that potential members of a Group Life or Health program might enroll without providing evidence of insurability. (2) The period of time under a Major Medical policy during that reimbursable expenses might be accrued.

What is Eligibility Requirements?
Requirements imposed for eligibility for coverage, usually in a group insurance or pension plan.

What is Eligible Dependent?
A dependent of an insured person who is eligible for coverage according to the requirements set forth in the contract.

What is Eligible Expenses?
Expenses as defined in the health plan as being eligible for coverage. This could involve specified health services fees or "customary and reasonable charges."

What is Eligible Person?
Similar to eligible employee except it could be a contract covering people who are not employees of a specified employer. An example might be members of an association, union, etc.

What is Emergency Accident Benefit?
A group medical benefit that reimburses the insured for expenses incurred for emergency treatment of accidents.

What is Employee Assistance Programs (EAPs)
?Mental health counseling services that are sometimes offered by insurance companies or employers. Typically, individuals or employers do not have to directly pay for services provided through an employee assistance program.

What is Employee Contribution?
The employee's share of the premium costs.

What is Employer Contribution?
The portion of the cost of a health insurance plan that is borne by the employer.

What is Enrollee?
An eligible individual who is enrolled in a health plan _ does not include an eligible dependent.

What is Enrollment?
Used to describe the total number of enrollees in a health plan. It might also be used to refer to the process of enrolling people in a health plan.

What is Enrollment Period?
The amount of time an employee has to sign up for a contributory health plan.

What is Entire Contract Clause?
A provision in an insurance contract stating that the entire agreement between the insured and the insurer is contained in the contract, including the application if it is attached, declarations, insuring agreements, exclusions, conditions and endorsements.

What is Evidence of Insurability?
The statement of information needed for the underwriting of an insurance policy.

What is Examination?
The medical examination of an applicant for Life or Health insurance.

What is Examined Business?
Coverage written on an applicant who has been examined and who has signed the application but has paid no premium.

What is Examiner?
A physician appointed by the medical director of a Life or Health insurer to examine applicants.

What is Exclusive Provider Organization (EPO)?
A type of preferred provider organization where individual members use particular preferred providers rather than having a choice of a variety of preferred providers. EPOs are characterized by a primary physician who monitors care and makes referrals to a network of providers.

What is Exclusions ?
Medical services that are not covered by an individual's insurance policy.

What isExpected Claims?
The estimated claims for a person or group for a contract year based usually on actuarial statistics.

What is Expense?
A policy's share of the company's operating costs, fees for medical examinations and inspection reports, underwriting, printing costs, commissions, advertising, agency expenses, premium taxes, salaries, rent, etc. Such costs are important in determining dividends and premium rates.

What is Explanation of Benefits (EOB)?
The statement sent to a participant in a health plan listing services, amounts paid by the plan, and total amount billed to the patient.

What is Explanation of Medicare Benefits?
A notice that is sent to the Medicare patient that provides information designed to explain how the claim is to be paid.

What is Extended Care Facility?
A facility such as a nursing home that is licensed to provide 24-hour nursing care service in accordance with state and local laws. Three levels of care might be provided--skilled, intermediate, custodial, or any combination.

What is Extension of Benefits?
A condition in the insurance policy that allows coverage to continue beyond the expiration date of the policy in the case of employees who are not actively at work or dependents who are hospitalized on that date. The extended coverage applies only where the employee or dependent is disabled as of that date and continues only until the employee returns to work or the dependent leaves the hospital.