In group health insurance, the conditions that an individual must meet to obtain coverage such as age, employment status, and continued employment.
Insurance Encyclopedia
Eligibility guarantee
Promise of payment to the medical provider for services rendered to a member of an insurance plan who later is discovered to be ineligible for benefits.
Eligibility period
Time (usually 31 days) that follows the eligibility date during which a member of an insured group can apply for insurance.
Eligibility period (Health Insurance)
The time frame during which medical costs accumulated will be reimbursed by a medical policy. This term can also mean the time frame during which prospective insureds can enroll in a group life program or health program without having to prove their insurability.
Eligibility Period, Health
The period of time during which one may sign up for a group insurance plan without giving evidence of insurability. (02) The period of time under a Major Medical Policy during which reimbursable expenses may be incurred.
Eligibility period/qualifying period
Period of time during which potential members of a group life scheme may join without evidence of good health.
Eligibility requirements
Insurance underwriting conditions that must be met by an insurance applicant with the purpose of becoming insured.
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This term refers to conditions which an employee must satisfy to participate in an employee benefit plan, or conditions which an employee must satisfy to obtain certain employee benefits.
Eligibility requirements (Health Insurance/Life Insurance)
Conditions that must be met before being deemed eligible for coverage under group insurance or pension plan.
Eligibility verification
1. Procedure performed by a provider or health facility of checking and confirming that a patient is a member of an insurance plan and that the member identification number is correct. 2. Process of an insurance company to validate that a patient is a member of a plan and the authorization of payment for a medical service before it is rendered. Also called insurance verification or verification .
eligibility verification confirmation (EVC)
Reference number on a printout from the Medi-Cal point of service device that verifies an inquiry was received and eligibility information was transmitted.