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Health Insurance Terms and Definitions for Documentation, Coverage and More

Health Insurance Glossary Page 2

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Documentation. The paperwork that insurers generally require before processing a claim; it may include a letter of medical necessity, an operative report, or an itemized hospital bill.

Durable Medical Equipment. Equipment such as a manual or power wheelchair, braces, or a walker.

Electronic Claim-filing System. A system of health insurance claim-filing and processing through the use of computers and electronic cards.

EOBS (Explanation of Benefits Statement). The statement sent by an insurer to a consumer, listing charges, dates of service, the amount of reimbursement, and an explanation of the insurer's determination of that amount.

EOMBS (Explanation of Medicare Benefits Statement). A statement from Medicare that includes the name of the provider the dates of service, the Medicare allowable amount, and other related information.

Equipment Exchange or Recycling Program. A system for selling or buying used durable medical equipment, established through the various Tech Act programs.

ERISA (Employee Retirement Income Security Act). A federal law that regulates the operation of self-funded plans.

Family Coverage. Coverage for dependents.

Family Deductible. A provision that allows an insurer to assume that the yearly individual deductible has been met for all family members once several family members have met the deductible.

Fee-for-Service Plan. See Traditional Plan.

Gatekeeper. See Primary Care Physician.

Group Plan. A health insurance plan provided through a group such as a corporation or a business.

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