Health Insurance Glossary

Effective Date

The date health insurance coverage begins.

Eligible Dependent

A dependent of a covered person (spouse, child, or other dependent) who meets all requirements specified in the contract to qualify for coverage and for who premium payment is made.

Eligible Expenses

The lower of the reasonable and customary charges or the agreed upon health services fee for health services and supplies covered under a health plan.

Employee Assistance Programs (EAPs)

Mental health counseling services that are sometimes offered by insurance companies or employers. Typically, individuals or employers do not have to directly pay for services provided through an employee assistance program.

Endorsement

A document that is attached to a slip, cover note or policy which evidences one or more changes in the terms of the insurance or reinsurance contract to which it refers.

Enrollee

The person who is the primary insured. Under an individual or family policy, this person is the applicant. Under an employer-sponsored group health policy, this person is the employee.

Episode of Care

The health care services given during a certain period of time, usually during a hospital stay.

Evidence of Insurability

Proof of physical condition. This may be provided through physician records or by the results of an examination.

Excess

The amount or proportion of some or all losses arising under an insurance or reinsurance contract that is the insured or reassured must bear. If the loss is less than the amount of the excess then the insured/reassured must meet the cost of it (unless there is other insurance in place to cover the excess).

Exclusion

A term in an insurance or reinsurance contract that excludes the insurer or reinsurer from liability for specified types of loss. An exclusion may apply throughout a policy or it may be limited to specific sections of it. In certain circumstances an exclusion may be limited or removed altogether following the payment of an additional premium.

Exclusions and Limitations

Medical services that are either not covered or limited in benefit by a health insurance insurance policy.

Exclusion Period

A period of time when an insurance company can delay coverage of a pre-existing condition. Sometimes this is called a pre-existing condition waiting period.



Contact Information

Medical Insurance Consultants
Park House
45 The Park
Yeovil
Somerset
BA20 1DF

T: 0800 163 870
E: [email protected]


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Accreditations

Medical Insurance Consultants Ltd is authorised and regulated by the Financial Conduct Authority and is entered on the Financial Services Register under reference 309026.

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