Key insurance terms that start with "E"

A document sent by your insurance company that explains how it processed a medical claim. The EOB shows what services were provided, what the provider charged, what your insurance paid, and what you owe. It's important to review your EOB to check for billing errors and understand your costs.

A waiver that excuses you from the requirement to have health insurance under the Affordable Care Act. The ACA previously required most people to have health insurance or pay a penalty. Certain groups of people, such as Native Americans and members of recognized religious sects, are exempt from this requirement.

A type of health insurance plan where you must use doctors and hospitals within the plan's network, except in emergencies. EPO plans typically don't cover out-of-network care except for emergency services. EPO plans often have lower premiums than PPO plans but require you to stay in-network.

Health care services that your insurance plan will not pay for. Common excluded services include cosmetic surgery, experimental treatments, and some alternative medicine. It's important to understand what your plan excludes to avoid unexpected out-of-pocket costs. You can find excluded services listed in your plan documents.

Ten categories of health care services that all health insurance plans must cover under the Affordable Care Act. These include ambulatory services, emergency services, hospitalization, maternity care, mental health and substance abuse services, prescription drugs, rehabilitation services, laboratory services, preventive and wellness services, and pediatric services including dental and vision care.

The process of choosing a health insurance plan and officially signing up for coverage. Enrollment typically happens once a year during open enrollment periods, but you may enroll at other times if you have a qualifying life event like losing a job or getting married. Once enrolled, you become an active member of the plan.

Health insurance provided by your employer as a job benefit. Many employers offer health insurance to their employees, often paying part or all of the premium. If you have employer coverage, you may not be eligible for marketplace subsidies, and you may have special enrollment opportunities when coverage changes.

Medical services provided to treat an emergency medical condition. Under the ACA, all health plans must cover emergency services at any hospital, whether in-network or not. You have the right to seek emergency care without prior authorization and without using in-network providers.

Medical care provided in a hospital's emergency room for serious health conditions that require immediate treatment. Emergency room care is often more expensive than other types of care, but your insurance plan must cover emergency room visits for emergency medical conditions. You don't need prior authorization for true emergencies.

A serious health problem that requires immediate care to prevent death or serious harm. Under the ACA, all health insurance plans must cover emergency medical conditions and emergency services at any hospital, regardless of whether the hospital is in-network. You should seek emergency care whenever you believe you have an emergency.

The date your health insurance coverage begins. This is an important date to know because your plan's benefits don't apply before this date. Common effective dates are the first of the month following enrollment or the date specified by your employer's plan.