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Glossary

We've compiled a list of common health care and health insurance related terms to help you better understand words commonly used in our industry and on our web site.

Terms appear in alphabetical order. To use the glossary, please choose the first letter of the term you would like to view.

A|B|C|D|E|F|G|H|I|J|K|L|M|N|O|P|Q|R|S|T|U|V|W|X|Y|Z


E

EFFECTIVE DATE
The date a contract takes effect.

ELECTRONIC DATA INTERCHANGE (EDI)
The application-to-application interchange of business data between organizations using a standard data format.

ELIGIBILITY DATE
The defined date a member becomes eligible for benefits under an existing contract.

ELIGIBLE DEPENDENT
A dependent of a covered employee who meets that requirements specified in the group contract to qualify for coverage and for whom premium payment is made.

ELIGIBLE EMPLOYEE
An employee who meets the eligibility requirement specified in the group contract to qualify for coverage.

ELIGIBLE EXPENSES
Reasonable and customary charges or the agreed upon health services fee for health services and supplies covered under a health plan.

ELIGIBLE PERSON
An individual who meets the eligibility requirement specified in the provisions of the contract.

EMPLOYEE RETIREMENT INCOME SECURITY ACT (ERISA)
A comprehensive federal statute governing employee benefit and pension plans.

ENROLL
To agree to participate in a contract for benefits from an insurance company or health maintenance organization. A person who enrolls is an enrollee or member.

EXPLANATION OF BENEFITS (EOB)
A summary statement that explains claim payment and/or the reason for denial of specific charges.