Health Insurance Glossary

Effective Date
Date on which a group member's coverage begins, typically occurring at the end of an eligibility period stipulated by the group.
Elective Surgery
Surgery for a condition that is not considered an emergency.
Eligibility
Insured person's qualification for coverage as an eligible member under the contract at the time health care is rendered.
Eligibility Period
Period of time before a group member becomes eligible for benefits. This is defined by each group.
Emergency Care
Care for patients with severe or life-threatening conditions that require immediate intervention.
Emergency Surgery
Procedure that must be performed in a situation that is serious or life-threatening for the patient.
Enrollee
An individual who is enrolled and eligible for coverage under a health plan contract. Also known as the "insured."
Enrollment
Process by which a person completes an enrollment form or application in order to become a member of health insurance coverage under a contract.
Evidence of Coverage (EOC)
A summary detailing the terms, conditions and limitations of your group coverage.
Exclusion
Specific circumstances or services listed in the contract for which benefits will not be provided.
Experimental Procedures
Any service or supply that is in the developmental stage or is in the process of human or animal testing.
Expiration Date
See Termination Date.
Explanation of Benefits (EOB)
A statement a member receives that describes how a claim was processed for benefits, including the member's liability for services rendered

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