Early Periodic Screening, Diagnostic & Treatment Services (EPSDT)
The comprehensive benefit set covered for children under Medicaid.
The date when your health insurance coverage effectively begins.
Electronic Health Record
A long-term, comprehensive collection of an individual’s health information, which can include names and information of providers and types of care received.
Electronic Medical Record
A record of an individual’s health, kept and updated by their physician. While this may be confused with an electronic health record, it is specific to their primary car physician as opposed to the entire history of their care.
Employee Assistance Programs (EAPS)
Counseling services for mental health that are offered by insurance companies or employer group plans. These services usually do not require direct payment.
Employer Mandate/Employer Responsibility
According to health care reform, employers with 50 or more full-time employees must provide them with health insurance plans. The employer must meet required minimums for coverage costs that they pay and providing essential benefits. Employers who do not meet the criteria or fail to provide insurance will be charged penalty fees each year based on the number of employees they have.
Employer Tax Credits
Also known as Small Business Health Care Tax Credits, these provide a tax credit to small group employers with under 25 full-time employees and a yearly income under $50,000 for a percentage of premiums (35% in 2010, will increase to 50% in 2014).
Essential Health Benefits
Under the Affordable Care Act, as of 2014 all health insurance plans sold in state health insurance exchanges are required to cover a certain set of benefits as outlined by the law. These benefits must include maternity and newborn care, ambulatory (walk-in) patient services, hospitalization, emergency services, substance abuse and mental health disorder services, preventive and wellness services and chronic disease management, prescription drugs, rehabilitative services, laboratory services, and pediatric care, such as dental and vision. Insurance plans in Exchanges and Medicaid must cover these services.
A new approach to the health insurance market, intended to increase competition among companies and improve the overall quality of care for an affordable rate. Individuals and small businesses are the target audience for exchanges, which will offer a choice of plans that meet government standards for benefits and prices. Beginning in 2014, every state will have an exchange available. Read more about exchanges in this article.
Services or items that are not covered by your insurance contract, most commonly used in the context of pre-existing conditions and maternity care.
Explanation of Benefits (EOB)
The insurance company’s written outline of a claim, describing the payment in detail. It shows what the insurance company has paid, and the balance owed by the client. The EOB is sometimes accompanied by a benefits check.
1. HealthInsurance.org, “Health insurance glossary”. http://www.healthinsurance.org/glossary/
2. HealthCare.gov, “Glossary – E”. http://www.healthcare.gov/glossary/e/index.html