Understanding eligibility

The following information is intended to provide a broad definition of the term, eligible, and other terms used in conjunction with it, in relation to its meaning to business practices.

Eligible — the state of being qualified or entitled to benefits.

Eligible dependent — the summary of plan benefits will have specific information about a plan's rules for dependent eligibility, but generally eligible dependents are:

Eligible person or individual — A person entitled to benefits. This generally includes both the subscriber and dependents.

Eligibility — Term used internally to collectively describe the data that determines whether a person is eligible, and to describe those people.

Eligibility status — The state of a subscriber and/or dependent in relation to coverage during a defined period. Usually one of the following:

Related Topics

Viewing eligibility status

Benefit Quickview