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Glossary

E

Effective Date of Coverage

The date on which coverage under an insurance plan begins for the eligible participant and any other insured person.

Emergency Accident Care

The initial outpatient treatment of accidental injuries including related diagnostic services.

Emergency Medical Care

Services provided for the initial outpatient treatment, including related diagnostic services, of a medical condition displaying itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, which possesses an average knowledge of health and medicine, could reasonably expect that the absence of immediate medical attention could result in:

  1. placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy;
  2. serious impairment to bodily functions; or
  3. serious dysfunction of any bodily organ or part.

Experimental/Investigational

Treatment, a device, or prescription medication that’s recommended by a physician, but is not considered by the medical community as a whole to be safe and effective for the condition for which the treatment, device, or prescription medication is being used. This includes any treatment, procedure, facility, equipment, drugs, drug usage, devices, or supplies not recognized as accepted medical practice; and any of those items requiring federal or other governmental agency approval not received at the time services are rendered. The insurer will make the final determination as to what is experimental or investigational.

E

Effective Date of Coverage

The date on which coverage under an insurance plan begins for the eligible participant and any other insured person.

Emergency Accident Care

The initial outpatient treatment of accidental injuries including related diagnostic services.

Emergency Medical Care

Services provided for the initial outpatient treatment, including related diagnostic services, of a medical condition displaying itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, which possesses an average knowledge of health and medicine, could reasonably expect that the absence of immediate medical attention could result in:

  1. placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy;
  2. serious impairment to bodily functions; or
  3. serious dysfunction of any bodily organ or part.

Experimental/Investigational

Treatment, a device, or prescription medication that’s recommended by a physician, but is not considered by the medical community as a whole to be safe and effective for the condition for which the treatment, device, or prescription medication is being used. This includes any treatment, procedure, facility, equipment, drugs, drug usage, devices, or supplies not recognized as accepted medical practice; and any of those items requiring federal or other governmental agency approval not received at the time services are rendered. The insurer will make the final determination as to what is experimental or investigational.