Also called certificate of coverage EOC COC Any certificate, agreement, contract, brochure, or letter of entitlement issued to an enrollee setting forth the coverage and its conditions to which an enrollee is entitled.
This document, often called an "Evidence of Coverage" (EOC), is your binding agreement or contract with your HMO. It explains your health care benefits, any limits to your coverage, the HMO's policies and procedures and what costs you will have to pay.
The document given to HMO members that describes the covered benefits and exclusions, utilization review requirements, cost sharing, and other coverage provisions. The Evidence of Coverage is similar to a policy contract that other insurers issue.
The legal document describing a memberâ€(tm)s coverage under a HMO health plan.
or Summary Plan Description(SPD)- The health plan agreement or contract with your health plan. It explains your health care benefits, any limits to your coverage, the health plan's policies and procedures and what costs you will have to pay. Back to Glossary Index
The document issued by a Pplan to an enrollee that sets forth the plan's covered services, and which describes the costs, procedures, benefits, conditions, limitations, exclusions and other obligations to which enrollees are subject thereunder.
A document which, along with your enrollment form and other attachments, explains your covered services, defines Medi-CareFirst's obligations and explains your rights and responsibilities as a member.
The document, which explains the covered services, defines our obligations, and explains your rights and responsibilities as a member of AdvantageCare.
the contract between you and your Medicare plan. This is a large, thick book that explains your coverage.
The legal document(s) describing covered health care services, copayments, all exceptions, reductions, limitations and exclusions for HMO members. The EOC is amended by any riders and endorsements. The policy document for MD-Individual Practice Association, Inc. (M.D. IPA) federal members is the Federal Employees Health Benefit (FEHB) brochure, RI 73-100.
A supplement, which outlines your specific Horizon HMO, benefits, and exclusions. The Evidence of Coverage is used in conjunction with your member handbook.
See Certificate of Coverage.
the certificate describing HPS policies, services, benefits, exclusions and limitations. Copies of the Evidence of Coverage are available on request.
The EOC is provided to members upon enrollment into a Medicare Part D prescription drug plan, annually thereafter. The EOC includes the following information about the plan: how to use it; details about benefits and how to access them; definition of the formulary; exclusions and limitations; the plan's service area; quality and assurance information; how to file appeals and grievances; and explains how people with limited incomes can get extra help. It is an important legal document.
A document that describes the coverage provided by a group insurance policy and that is distributed by the group policyholder to each group insured.
