Elective Benefits

Lump sum payments that the insured may choose in lieu of periodic payments for certain injuries.

Eligibility Date

Date a person becomes eligible for benefits.

Eligibility Period

(1) Period of time during which potential members of a Group program may enroll without providing evidence of insurability. (2) Period of time under Major Medical policy during which reimbursable expenses may be accrued.

Eligibility Requirements

Requirements imposed for coverage eligibility, usually in a group insurance or pension plan.

Eligible Dependent

Dependent of insured person eligible for coverage according to the requirements in the contract.

Eligible Employee

Employee who is eligible based on the requirements detailed in the group contract.

Eligible Expenses

Expenses, defined in the plan, that are eligible for coverage. May involve specified health services fees or "customary and reasonable charges."

Eligible Person

Similar to eligible employee, however the contract may cover people who are not employees of a specified employer. An example might be members of an association, union, etc.

Elimination Period

Sometimes designates the probationary period, but most often states the waiting period in a Health Insurance policy. See also Probationary Period and Waiting Period.

Emergency

Injury or disease that happens suddenly and requires treatment within 24 hours.

Emergency Accident Benefit

Group medical benefit reimbursing the insured for expenses incurred for emergency treatment of accidents.

Employee Benefit Program

Benefits offered to an employee by his employer at his place of work, covering contingencies such as medical expenses, disability, retirement, and death, paid for wholly or in part by the employer. These benefits are usually insured.

Employee Certificate of Insurance

Employee's evidence of participation in a group insurance plan; a brief summary of plan benefits. The employee is provided with a certificate of insurance in lieu of the actual insurance policy.

Employee Contribution

Employee's share of premium costs.

Employer Contribution

Portion of the cost of a health insurance plan that is paid by the employer.

Enrollee

Eligible individual enrolled in a health plan; does not include eligible dependent.

Enrolling Unit

Organization (such as employer) that contracts for participation in a health insurance plan.

Enrollment

Total number of enrollees in a health plan. May also be used to refer to the process of enrolling people in a health plan.

Enrollment Period

Amount of time an employee has to sign up for contributory health plan.

Evidence of Insurability

Statement of information needed for underwriting of an insurance policy.

Exclusive Provider Organization (EPO)

Preferred provider organization where individual members use specific preferred providers rather than having a choice of preferred providers. EPOs are characterized by a primary physician who monitors care and makes referrals to a network of providers.

Expected Claims

Estimated claims for a person or group for a contract year based on actuarial statistics.

Expected Morbidity

Expected incidence of sickness or injury within a group during a period of time as shown on a morbidity table.

Experimental or Unproven Procedures

Health care services, supplies, procedures, therapies, or devices that the health plan determines to be either (1) not proven by scientific evidence to be effective, or (2) not accepted by health care professionals as being effective.

Explanation of Benefits (EOB)

Statement sent to participant listing services, amounts paid by the plan, and total amount billed to the patient.

Extended Care Facility

Facility, such as a nursing home, which is licensed to provide 24-hour nursing care service in accordance with state and local laws. Three levels of care are defined as: skilled, intermediate, custodial, or any combination.

Extended Coverage

Provision in Health policies, usually Group, to allow the insured to receive benefits for specified losses sustained after the termination of coverage, such as maternity expense benefits incurred for a pregnancy in progress at the time of the termination.