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.
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:
unmarried children who have not yet reached the end of the calendar year
of their 19th birthday
unmarried children who are over age 19 and eligible to be claimed by the
subscriber as dependents under the U. S. Internal Revenue Code during
the current calendar year
children for whom the subscriber or the subscriber's legal spouse are
financially responsible for medical, health, or dental care under the
terms of a court decree or who have been named as alternate recipients
under a qualified medical child support order
children who are over age 19, but who were (and continue to be) totally
and permanently disabled before age 19 by a physical or mental condition.
Those children must also be eligible to be claimed by the subscriber or
the subscriber's legal spouse as dependents under the U. S. Internal Revenue
Code during the current calendar year. The subscriber may be required
to submit medical reports confirming their initial or continuing total
Eligible person or individual —
A person entitled to benefits. This generally includes both the subscriber
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:
is currently eligible
is not currently eligible
will need to be confirmed with Customer Service