Ah, I see, so dialing 011 with E164 processing settings enabled would replace the 011 with a + and the following number with country code would be formatted correctly.
actually, the other way around, the plus is replaced with the required prefix
If you use a mobile and do a lot of international travelling, calling numbers in various countries, you probably store your numbers as + (country code) areacode and number. The + means that you can store the numbers once, and dial them from/to any country, using any mobile provider and don't have to know what the local country uses as a long distance access code. A North American number would be stored as +1NXXNXXXXXX, where 1 is the country code, not the long distance access, and all mobile provider understand that.
It works the same way in 3CX when you enable E164, but because 3CX is deployed in many countries, you have to specify what the + will represent (convert the + to). 3CX will convert that into the required prefix, then send use that to the outbound rules, which do a match, manipulate digits as required, and send the call to the desired provider.
Normally, 3CX callers won't dial a + as the leading digit,
but it may be stored in a directory with the leading +.
Most providers don't require a leading + to be sent , and are quite content with all digts. Of course there are always exceptions, and it is best to confirm what format your provider wants for all types of calls.