- Eligibility
- The conditions a person must satisfy to be covered by the health plan contract.
- Eligible charges
- Services that are covered according to the health plan contract.
- Emergency
- A sickness or injury so serious that failure to get immediate care could put a person's life in danger or cause serious harm. Some examples are possible heart attack (severe chest pain or pressure), uncontrollable bleeding, breathing problems, poisoning and unconsciousness.
- Endocrinology
- A science dealing with the endocrine glands, which produce secretions that help control metabolic activity.
- Experimental procedures
- Any services, supplies, treatments, procedures or devices that are determined by the health plan to be not generally accepted by informed health care professionals in the United States as effective in treating the condition for which their use is proposed or not scientifically proven to be effective in treating the condition.
- Explanation of health care benefits (EOB)
- A notice sent from the health plan to the member describing the resolution of a claim. It includes services provided, amount billed, payment made and any costs that are the member's responsibility.
- Family practice
- A medical specialty that focuses on health care for the entire family, including obstetric care and minor surgical procedures.
- Gastroenterology
- Diagnosis and treatment of stomach, intestine, liver and pancreas diseases.
- General practitioner
- A physician who does not limit his or her field of practice to a specialty.
- Geriatrics
- Diagnosis and treatment of diseases and conditions specific to aging.
- Gynecology
- Medical and surgical treatment for disorders and diseases of the female reproductive and urinary systems.
- Health care provider
- A hospital, clinic, physician or other facility that provides health care services.
- Health cost summary
- A statement that shows health plan and any financial account use and costs for calendar year-to-date. The summary is for a subscriber and any covered dependents.
- Health plan responsibility
- The amount or portion of the total charge for health care services that the health plan is responsible for.
- Health risk assessment
- A confidential tool that helps employees identify their individual health risks and offers suggestions to reduce those risks.
- Home health care
- Services provided in the home to aged, disabled, sick or convalescent people who don't require institutional care. Services are provided by a home health agency, visiting nurse, or other hospital or community group.
- Hospice
- A facility or program that provides supportive care for people who are terminally ill.