GLOSSARY OF HEALTH INSURANCE TERMS

E

Effective Date — the date on which a policy's coverage of a risk goes into effect.

Eligible Dependent — a person entitled to receive health benefits from someone else's plan, also called a dependent.

Elimination Period — most often used to designate the waiting period in a health insurance policy.

Employee Assistance Program (EAP) — a service, plan or set of benefits that are designed for personal or family problems, including mental health, substance abuse, gambling addiction, marital problems, parenting problems, emotional problems or financial pressures. This is usually a service provided by an employer to the employees, designed to assist employees in getting help for these problems so that they may remain on the job.

Employee Retirement Income Security Act of 1974 (ERISA) — also called the Pension Reform Act, this act regulates the majority of private pension and welfare group benefit plans in the U.S. It sets forth requirements governing participation, crediting of service, vesting, communication and disclosure, funding, fiduciary conduct and other areas.

ENT (otolaryngologist) — a physician who specializes in diseases of the ear, nose and throat.

Experience — a term used to describe the relationship of premium to claims for a plan, coverage, or benefits for a stated time period. Usually expressed as a ratio or percent.

Explanation of Benefits (EOB) — a statement sent to covered individuals explaining services provided, amount to be billed, and payments made. A summary of benefits provided to subscribers by the carrier. Same as Evidence of Coverage.

Extended Care Facility (ECF) — a nursing, long-term, or convalescent home offering skilled nursing care and rehabilitation services on a 24-hour basis.

Extension of Benefits — an insurance policy provision that allows medical coverage to continue past termination of employments. See also COBRA.