Benefit Quickview

You can look at your coverage information (benefits) or see if you or other family members are currently covered (eligibility) by selecting Benefits/Eligibility on the menu. The Benefit Quickview screen appears.

The following information is displayed:

Member Information section — lists the name of the person who carries the insurance (subscriber). The Member Number is an assigned number unique to the subscriber. In most cases, the member number is the same as the subscriber's Social Security number.

Patient Information section — shows information about the people covered under the member including the member. These people are usually family members and are referred to as patients on this screen. For each family member it shows:

1. Patient Name — the names of anyone who has ever been covered under this subscriber.
2. Relationship — the relationship of each person to the subscriber: subscriber, spouse, or dependent.
3. Eligible — the person's eligibility for benefits:

• Active — the person is currently covered
• Future — the patient has future eligibility
• Dependent Enrollment Only— dependents can be enrolled
• Inactive — the person is not currently covered
• Pending — the person's eligibility needs to be confirmed with Customer Service
• Overage — the patient is overage
• Overage Certification Required— the patient requires overage certification
• Benefits — select the button to see what benefits the patient has.

Client Benefit Information— this displays information about the client's selected benefit plan. If you call Customer Service with questions on benefits, this information may help them assist you.

Understanding eligibility for dependents

Eligibility is the determination of a person being qualified or entitled to benefits. The summary of a plan's 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

Related Topics

Viewing benefits