Glossary — Learn Insurance Terms and Phrases

Here are some terms that get thrown around whenever people are talking about insurance. There are some very basic ones — and some pretty advanced ones. Look around — hopefully it will give you a better sense of what the insurance companies are talking about.

  1. ALL
  2. A
  3. B
  4. C
  5. D
  6. E
  7. F
  8. G
  9. H
  10. I
  11. J
  12. K
  13. L
  14. M
  15. N
  16. O
  17. P
  18. Q
  19. R
  20. S
  21. T
  22. U
  23. V
  24. W
  25. X
  26. Y
  27. Z

Earned Income

Gross salary, wages, commissions, fees, etc., you get from being actively employed

Elimination Period

The consecutive number of days for which no benefits are payable at the start of a disability or Long Term Care claim

EMTALA law (Emergency Medical Treatment and Labor Act)

A law that says that emergency rooms cannot refuse any patient, regardless of their ability to pay.

EOB – Explanation of Benefits

An Explanation of Benefits (sometimes called a Claims Summary), is a document the health insurance company sends you and your medical providers telling you how your medical claims (expenses) have been processed. For you it is simply an FYI. The EOB lists the treatments that took place, the portion of the cost that is covered (called the negotiated rate), and the amount remaining for you to pay directly to the doctor. From the EOB (or Claims Summary), the doctor (or hospital) will send you an adjusted bill. When you receive an EOB from your health insurance company, keep it filed away in a safe place (where the dog can’t eat it!) so that you have it available for reference when you receive the bill from your doctor.   Use the information on the EOB to make sure your doctor (or hospital) is billing you for the correct amount.

EPO

Exclusive Provider Organization.   An EPO network is a PPO-HMO mash-up.   Benefits are available only IN the EPO network.   Like a PPO network, you can pick and choose your own doctors at any time.   But there are NO benefits OUT of the network, except for emergencies.

Essential Health Benefits

As of 1/1/14, under the Affordable Care Act (ACA) there will be 10 Essential Health Benefits that every health insurance plan must include:

1.  Ambulatory patient services

2.  Emergency services

3.  Hospitalization

4.  Maternity and newborn care

5.  Mental health and substance use disorder services, including behavior health treatment

6.  Prescription drugs

7.  Rehabilitative and habilitative services and devices

8.  Laboratory services

9.  Preventive and wellness and chronic disease management

10.  Pediatric services, including oral and vision care

Exclusions

Certain conditions and causes which are not covered by a policy

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