Effective date
The date on which insurance coverage goes into effect. (Not always the same as the date the application is completed.)
Elimination period
The number of days you must wait after receiving long-term care before receiving insurance benefits.
Emergency care
A medical emergency includes severe pain, an injury, sudden illness, or suddenly worsening illness that would cause a reasonably prudent layperson to expect that delay in treatment may cause serious danger to the person's health if he/she does not get immediate medical care.
Emergency services
Services delivered by an appropriately trained health care professional that are required to diagnose and stabilize an emergency condition.
Written agreement attached to a policy to add or subtract insurance coverages.
Enrollment period
The amount of time an employee has to sign up for a contributory health plan.
ERISA (Employee Retirement Income Security Act of 1974)
The federal law that mandates reporting and disclosure requirements for self-insured health plans. It also prohibits states from regulating insurance plans offered by employers to their employees if the employer is self-insured.
Excess charge
The difference between a doctor's or other health care provider's actual charge and the Medicare-approved payment amount.
Exclusions or limitations
Specific situations, conditions, or circumstances that are listed in the insurance policy as not being covered.
Experience rating
The process of using a group's own premium and claims experience to calculate premium rates. If the claims experience for the previous year was favorable, the insurer considers reducing the premium rates for the coming year. If the experience was unfavorable, the insurer attempts to discover the reason and may propose higher premiums for the next year.
Explanation of Medicare Benefits (EOMB)
A notice that is sent to you after the doctor files a claim for Part B services that explains what the provider billed, the Medicare-approved amount, how much Medicare paid, and the amount you must pay.

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