Glossary of Insurance Terms

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Effective Date: The date an insurance policy goes into effect. This is sometimes referred to as the Policy Date.

Electronic Funds Transfer (EFT): An arrangement in which premium payments are drawn from an insured's bank account. This is also referred as Auto-Draft or Pre-Arranged Withdrawal (PAW or PAC).

Emergency Care: Care for a person with a medical condition or behavioural condition of sudden onset that manifests itself by acute symptoms of sufficient severity (including sever pain) such that a person who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in placing the health of the insured person in serious jeopardy, serious impairment to bodily functions, serious disfigurement of the insured person, serious impairment of any bodily organ or part of the insured person, or in the case of behavioural condition, placing the health of the insured person or other persons in serious jeopardy.

Employer Contribution: The total amount of premium an employer is required to pay for each employee covered under the employer offered group health insurance coverage. An employer is usually required to contribute at least 50 percent of each enrolled employee's premium. Employers are usually only required to contribute to the employee cost and not the cost for an employee's dependents.

Employee Participation: An insurance company will usually require a certain percentage of eligible employees to participate in the employer offered group health insurance plan. This percentage varies by company and by group size. If this percentage is not met the insurance company may not offer coverage.

Endorsement: Used to clarify or make revisions to particular provisions of a health or life insurance policy.

Enrollee: An individual who is enrolled and eligible for coverage under a health insurance policy. This is also referred to as a Member, Insured or Participant.

Estate Planning: The planning for the administration of an estate upon the death of an individual. Estate planning typically involves establishing wills and/or trusts to minimize the loss of estate value due to estate taxes and is often funded with life insurance.

Evidence of Insurability: Factual information used by insurance companies to determine an applicant's qualification for insurance. Examples of information used may include paramedical exams, medical records, application statements, and motor vehicle reports among others.

Examiner: A health care professional designated to provide paramed or medical exams on insurance applicants.

Exclusions: Specific conditions or circumstances listed in an insurance policy for which the policy will not provide benefit payments.

Expiration Date: The date on which an Insurance policy ceases to provide coverage on the insured.

Explanation of Benefits: A statement sent by a health plan to a covered person who files a claim. The explanation of benefits (EOB) lists the services provided, the amount billed, and the payment made. The EOB statement must also explain why a claim was or was not paid, and provide information about the individual's rights of appeal.

Extra Premium: The amount charged in addition to the regular premium to cover any extra hazard or special risk such as aviation or hazardous activities. This is commonly referred to as Flat Extra.

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