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Effective date
The date on which your coverage begins.
An enrollment in or voluntary disenrollment from a Medicare Advantage plan, Medicare prescription drug plan or Medicare Parts A and B.
Election period
The time during which you can join a Medicare plan through a private insurer or Medicare Parts A and B.
Electronic Data Interchange (EDI)
A method of enrollment where the enrollment information for the individual is provided by the group benefits administrator to Humana in an electronic file.
Requirements which must be met in order to enroll for insurance plan coverage.
Eligibility date
The date on which you qualify to enroll for benefits under insurance plan coverage.
Eligibility period
A specified length of time, following the eligibility date, during which you remain qualified to enroll in an insurance plan.
Eligibility: Medicaid
The process in which the state decides whether you are qualified for healthcare coverage through the Medicaid program. Each state has its own criteria for eligibility.
Eligibility: Medicare Part B
You are automatically eligible for Part B if you are eligible for premium-free Part A. You are also eligible for Part B if you are not eligible for premium-free Part A but are age 65 or older AND a resident of the United States or a citizen or an alien lawfully admitted for permanent residence. In this case, you must have lived in the United States continuously during the five years immediately prior to the month during which you enroll in Part B.
Eligibility: Medicare Part D
To enroll in Medicare Part D (the prescription drug plan), you must be eligible for Medicare Part A and/or enrolled in Part B; you must also live in the geographic area where the plan you want to enroll in is offered.
Eligible dependent
A dependent, such as a spouse, domestic partner or a child, who qualifies to receive coverage under your insurance plan. As the policy holder, you may need to pay an additional premium to cover an eligible dependent.
Emergency room (hospital)
The area of a hospital solely designated for diagnosing and treating injuries or illnesses requiring immediate attention.
Endodontics (root canals)
A dental specialty concerned with the treatment of diseases of the dental pulp (nerves, blood vessels, etc., within the tooth).
Dental specialists who limit their practice to treating disease and injuries of tooth pulp.
An individual who has signed up for coverage in a benefit plan.
Enrollment period
See “Open Enrollment Period.”
EOB (Explanation of Benefits)
A summary of how your plan processed your claim.
Estimate (Dental)
Details on how dental benefits would be covered by a member's plan.
Estimated retail drug price
The average cost of a drug on the open market. This price is calculated from a national average wholesale price and does not take into account a prescription drug benefit, the actual cost of a specific drug, mail-order savings or possible reimbursements to the dispensing pharmacy. Pricing may vary by pharmacy and by the specific quantity, strength and dosage of the medication. You should always contact your pharmacy for details on pricing for specific medications.
Evidence of Coverage (EOC)
A Centers for Medicare and Medicaid Services (CMS)-approved document that details plan benefits and services; the EOC includes CMS mandated amendments that may occur during the year. All Humana Medicare enrolled members will receive a copy of the EOC.
Evidence-based medicine
Medical best practices that are based on the actual, observed results of patient treatment as opposed to theory or generalized medical practice.
Excluded amount
The amount that was excluded from payment consideration. For example, if the doctor has a discounted arrangement with Humana, that amount will show up in this space with an explanation below. In such a situation, you are not responsible for this amount.
Services or items not covered under your benefit plan.
Exclusive Provider Organization (EPO)
If you belong to an EPO, you must receive care from Humana network providers; services rendered by unaffiliated providers are not reimbursed.
Expenses requiring verification
For spending accounts, these are expenses that Humana's systems have not verified. You may need to submit receipts or copies of Explanation of Benefits (EOBs) for these expenses to meet IRS and plan requirements.
Explanation of Benefits (EOB)
A summary of how your plan processed your claim.
Extended Care Health Option (ECHO)
ECHO is a supplemental program to the TRICARE basic program. It provides eligible and enrolled ADFMs with additional benefits for an integrated set of services and supplies designed to assist in the treatment and/or reduction of the disabling effects of the beneficiary’s qualifying condition. Qualifying conditions may include moderate or severe mental disability, a serious physical disability or an extraordinary physical or psychological condition such that the beneficiary is homebound.