Glossary

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E
Effective date

The date on which the coverage under a person's health plan goes into effect. Typically, the effective date of your coverage can be found on your ID card.

Emergency

A serious medical condition resulting from injury or illness that arises suddenly and requires immediate medical attention.

Employee Assistance Program (EAP)

Programs that offer access to professional counselors who provide confidential assessment and short-term counseling to employees and their families. Counselors assist employees in dealing with various issues, including marriage and family problems, stress-related problems, financial and legal difficulties, and psychological and workplace conflict. The program often includes 24-hour phone access. Check with your employer to see if there is an EAP available to you.

Employee Retirement Income Security Act of 1974 (ERISA)

A law that regulates employer-based health, pension and other benefit plans.

Enrollee

A subscriber or dependent covered under a health plan, sometimes also referred to as a "member."

Essential Benefit

As defined by PPACA, and essential benefit are a set of health care service categories that must be covered by certain plans, starting in 2014. These include doctor office visits, hospitalizations, and prescriptions.

Exchange

A new way for people and small businesses to buy health plans. Starting in 2014, state-run exchanges will offer a variety of plans.

Excluded Services

Specific conditions or circumstances that are not covered under a health plan. (One example might be plastic surgery.) These are listed in the plan's Certificate of Coverage or other plan documents and sometimes can be found described in general in marketing or other plan materials. Check these exclusions carefully before enrolling in any plan.

Exclusion

Specific conditions or circumstances that are not covered for benefits under a health plan. These are listed in detail in the plan's Certificate of Coverage (COC) or other plan document and sometimes described more generally in marketing or other plan materials. Check exclusions carefully before enrolling in a plan.

Experimental Services or Procedures

Also called "investigational." Health care services, supplies, treatments or drug therapies that have yet been determined to be effective and safe in treating the illness or injury for which their use is proposed.

Explanation of Benefits (EOB)

Under some health insurance plans, an Explanation of Benefits form is provided directly to the enrollee to explain how a health benefits claim was paid. In addition to claims payment information, the EOB often includes information on the appeals process. EOBs are sometimes mailed and are often now available through the Internet.

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