Healthcare Glossary

Key healthcare terms

E

Effective date
This is the date on which your coverage begins.
Effective date (HumanaOne)
People who are entitled to Medicare and eligible for Medicaid are dual eligible.
Election
An enrollment in or voluntary disenrollment from a Medicare Advantage plan, Medicare prescription drug plan, or Medicare Parts A and B is called an election.
Election period
Your election period is 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 retiree is provided by the group benefits administrator to Humana in an electronic file, the EDI includes necessary information such as your HCFA number, geographic data and date of birth
Eligibility
Requirements that must be satisfied by people who wish to be insured to establish eligibility.
Eligibility date
This is the date on which you become eligible to apply for benefits under the benefit plan.
Eligibility period
The eligibility period is a specified length of time, following the eligibility date, during which you remain eligible to apply for benefits under a benefit plan without evidence of insurability.
Eligibility: Medicaid
This refers to the process in which the state decides whether or not you are qualified for healthcare coverage through the Medicaid program.
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
This is a dependent, such as a spouse 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.
In most states, you can enroll children who are between 2 weeks old and 25 years old in a HumanaOne health benefits plan. Qualifications for eligible dependents may vary for Short-Term Medical plans.
Eligible expenses
This is either the maximum allowable charge or a set service fee for dental or vision services and supplies — whichever is lower — that your plan will cover.
Eligible Person
This includes former employees (or their eligible dependents) of a group and its participating affiliates who are eligible to participate in a Medicare Advantage plan.
Emergency care
Emergency care is given for a medical situation in which you believe your health is in serious danger.
Emergency room (hospital)
The area of a hospital solely designated for diagnosing and treating emergency injuries or illnesses is the emergency room.
Employer authorization form
An employer must complete this mandatory Concentra form, and the employee must bring it to a Concentra medical center in order to be admitted as a patient.
Enamel
The hard surface covering the dentin portion of the crown of the tooth is enamel.
End date
Date on which the member's coverage ends.
End Stage Renal Disease (ESRD)
Permanent kidney failure requiring dialysis or a kidney transplant is known as WSRD.
Endodontics (root canals)
Root canals are a dental specialty concerned with the treatment of diseases of the dental pulp (nerves, blood vessels, etc., within the tooth).
Endodontist
Endodontists are dental specialists who limit their practice to treating disease and injuries of tooth pulp.
End-Stage Renal Disease (ESRD)
ESRD is permanent kidney failure that requires dialysis or a kidney transplant.
Enrolled member
An eligible person who has elected to enroll in a Humana Group Medicare plan is an enrolled member.
Enrollee
This refers to an individual covered by a benefit plan.
Enrollment booklet
This booklet or pamphlet contains a general explanation of your plan's benefits. It is also known as Summary Plan Descriptions.
Enrollment period
This refers to the range of days during which you can join a Medicare health plan if it is open and accepting new Medicare members. If a health plan chooses to be open for enrollment, it must allow any eligible person with Medicare to join.
EOB
An EOB is the Explanation of Benefits that explains how your plan will pay your claim.
Ergonomics
This is the study of how individuals interact with their environment. In a work setting, ergonomics can be used to design tasks, tools, or equipment to improve productivity and/or prevent injury.
Erosion
Defect in the surface of a tooth, which cannot be accounted for by abrasion, in which the enamel is worn and smooth. This usually results from chemical action in the mouth.
Erupt, eruption
When a new tooth comes in, it erupts when it breaks the surface of the gums, and you can see it.
Erupt/eruption
In dental care, this refers to when a new tooth comes in. It erupts when it breaks the surface of the gums and you can see it.
Estimate
Details on how benefits would be covered by a member's plan when a provider submits an estimate of services.
Estimated retail price
This is 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
This is a complete list of your benefits under a Medicare Advantage plan.
Evidence of Coverage (EOC)
A CMS approved document that details plan benefits and services, the EOC includes CMS mandated amendments that may occur during the year. All Humana Group Medicare enrolled members, will receive a copy of the EOC as well as any amendments that are mandated during the plan year.
Evidence of insurability
Medical information that shows an individual is medically eligible for insurance coverage is known as evidence of insurability. You may or may not need to provide this information, depending on your employer's contract with Humana.
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 is known as evidence-based medicine
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.
Exclusions
Services not covered under your benefit plan are referred to as exclusions.
Exclusive Provider Organization (EPO)
If you belong to an EPO, you must receive care from affiliated 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.
Expiration date
This is the date on which your dental contract expires. It may also refer to the date on which you are no longer eligible for benefits.
Explanation of benefits (EOB)
The EOB is not a bill. It details how the claim was processed and indicates the portion of the claim paid to the provider and the portion of the claim you need to pay (if applicable).
Explanation of Benefits (EOB)
The EOB is not a bill. It details how the claim was processed and indicates the portion of the claim paid to the dentist and the portion of the claim you need to pay (if applicable).
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 retardation, a serious physical disability, or an extraordinary physical or psychological condition such that the beneficiary is homebound.
Extraction
Separation and surgical removal of a tooth from its surrounding tissues.
Eyeteeth
Pointed teeth used to tear food (two upper and two lower), also known as cuspids or canines.