Glossary (E)
Glossary (E)
A B C D E F G H I J L M N O P Q R S T U V W
Frequently Asked Questions
- elective surgery
- A surgical procedure that is not associated with an emergency or maternity condition and can be scheduled for the convenience of the member or surgeon.
- eligibility date
- The date on which an individual becomes entitled to benefits under an insurance plan.
- emergency first aid
- The initial exam and treatment of conditions resulting from accidental injury.
- encounter
- Used in managed care to define a face-to-face meeting between a professional provider and a member during which health care services or supplies are provided but no claim is generated. Encounters are included in the capitation agreement with the provider.
- enrollee
- Another term for member; preferred by automotive groups and by Medicare.
- enrollment period
- The period of time when individuals in a group may enroll for health benefits.
- EOB
- See explanation of benefits.
- EOMB
- See explanation of Medicare benefits.
- episode of care
- A defined period of illness that has a definite start and end date.
- ERISA
- A federal law, the Employment Retirement Income Security Act of 1974 regulates employee retirement and welfare plans.
- evidence-based medicine
- A set of procedures, pre-appraised resources and information tools that help practitioners apply evidence from research to the care of individual patients.
- exact fill
- Product name used by Blues’ automotive groups and others for supplemental coverage that brings Medicare beneficiaries in their group plans to the same level of benefits as active employees.
- experience rating
- A method of determining a group’s premium rates based wholly or partly on the group’s own claims experience.
- experimental
- See investigational.
- explanation of benefits
- A statement to Blues subscribers or members that details what services have been paid and what may be owed.
- explanation of medicare benefits
- A statement to beneficiaries that details what services Medicare has paid and what they may owe.
- extended care
- Long-term care, especially after hospitalization, requiring inpatient stay in a facility such as a nursing home or rehabilitation facility.
