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.
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.
The defined date a member becomes eligible for benefits under an existing contract.
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.
An employee who meets the eligibility requirement specified in the group contract to qualify for coverage.
Reasonable and customary charges or the agreed upon health services fee for health services and supplies covered under a health plan.
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.
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.