E

Exchange-participating Health Benefits Plan

Health coverage offered through state health care exchanges.

Exchange-participating Health Benefits Plan Contract

Contracts between insurance providers and state health care exchanges allowing the provider to offer plans through the exchange.

Excise Tax

A tax paid by the manufacturer or retailer of a good or service, as opposed to directly by the consumer (as in a sales tax).

Exclusion

An item, treatment, or service not covered by an individual's insurance.

Exclusive Provider Organization

A type of health plan that requires enrollees to visit only pre-approved doctors or health care providers.

Experience Rating

Refers to setting premiums based on past costs for that individual or group, as a method of estimating future costs.

Explanation of Benefits

A statement sent to the covered individual from the health insurance company that explains the benefits they are receiving from their plan.

Extended Care Facility (ECF)

Health care facility for patients who require long term care.

Extension of Coverage

A situation in which health insurance providers may extend coverage after the normal coverage period expires, most commonly in the case of disability.

Extent of Disability

A measure of the severity of a patient's disability that dictates their coverage level. For example, often insurance policies require an individual to be completely disabled before beginning disability payments, though many offer some amount of payment for partial disability.

Resource Utilization Group (RUG)

A payment system under Medicare for skilled nursing facilities.