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:
A subscriber's legal spouse
A subscriber's unmarried children who have not yet reached the end of the calendar year of their 19th birthday
A subscriber's 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
Any unmarried 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
A subscriber's 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 disabilities
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:
Active — patient is currently eligible
Inactive — patient is not currently eligible
Proposed — eligibility will need to be confirmed with Customer Service