The date on which health insurance becomes effective.
Healthcare and health insurance definitions.
See electronic funds transfer.
The ability to make electronic payments directly to a bank account. For example, individuals may choose to pay their monthly premiums via EFT instead of mailing a check. Insurance carriers may choose to pay providers via EFT.
The age, service, and other requirements specified by a plan document or employer as pre-conditions to enrolling in a health plan.
A medical emergency is any situation where you risk losing your life or a limb if you don’t get immediate medical care. See ACA Uniform Glossary
More often referred to as a member, this is a person or dependent who’s getting coverage on a health plan.
Process by which an individual becomes covered under a health or dental plan.
Abbreviation for emergency room.
A set of health care service categories that must be covered by certain plans, starting in 2014 as part of the Affordable Care Act. EHB’s include hospitalization, maternity care, emergency care, preventive care and other services. See Healthcare.gov for more information.
See certificate of creditable coverage (COC).
An online marketplace where individuals and small employers can purchase health insurance. Buying health insurance in an exchange is optional; however, most federal assistance to help individuals and families pay for health insurance through an exchange.
Healthcare services that your health plan doesn’t pay for or cover. See ACA Uniform Glossary
Services, supplies, treatments, or drug therapies that the health plan has determined are not generally accepted as proven and effective in treating the illness for which their use is proposed. Also called “investigational” or “unproven” procedures.
Every time you use your health insurance benefits, your insurance company will send you a statement that shows the service you had (like an office visit) and how they applied your benefits to it. This statement is called an Explanation of Benefits. If you need help reading or understanding your PacificSource EOB, please view our What is an EOB? video.
A nursing home type of setting that offers skilled, intermediate, or custodial care.