Medications that are covered by a prescription drug plan. In a Medicare Part D plan, drugs that qualify are listed on the plan’s formulary.
Tag: MEDICAL
Eligible employee
Employed worker who qualifies for health insurance plan benefits as one who is insured.
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An employee who is eligible based on the requirements as indicated in the group contract.
Eligible expenses
Specific medical services and supplies for which the insurance plan or federal or state program will pay for covered persons under the terms of the plan.
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Expenses as defined in the health plan as being eligible for coverage. This could involve specified health services fees or “customary and reasonable” charges.
Eligible groups
Individuals allowed insurance under a group policy such as individual employer groups, multiple employer groups, labor union groups, credit-debtor groups, and certain association groups.
Eligible medical expenses
Types of medical care expenses that an insurance plan covers.
Eligible members
Individuals in a group who qualify for a group insurance plan, or in a family who qualify for a family insurance plan.
Eligible person
1. Individual who qualifies and is permitted to apply and maintain membership in a health insurance plan. 2. Individual who was covered under a group health plan and who may qualify to purchase an individual insurance policy regardless of previous health problems.
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Similar to eligible employee except it could be a contract covering people who are not employees of a specified employer. An example might e members of an association, club, committee or union.
Elimination period
MEDICAL,USA,REFERENCE: See: waiting period (WP) .
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The duration of time between the beginning of an insured person’s disability and the start of a policy’s benefits. Also called waiting period.
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The period that must elapse before disability income is payable under a health insurance policy covering disability income loss.
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This is the period between the onset of the disability and the time the insured begins to draw benefits. As with higher deductibles in property insurance, the longer waiting period, the lower the premium. Frequently offered waiting periods are 30, 60, 90, 180, 365, and 720 days. The decision about a waiting period depends on the amount of savings a person has.
ELOS
See: estimated length of stay (ELOS) .
EM
HCPCS Level II modifier that may be used with CPT or HCPCS Level II codes indicating emergency reserve supplies for end-stage renal disease (ESRD). This is for supplies dispensed to patients on home dialysis.