Individuals who are permitted to apply and maintain membership in a health insurance plan (i.e., spouse and children of the insured). Under some insurance policies, parents, other family members, and domestic partners may be insured as dependents.

Medications that are covered by a prescription drug plan. In a Medicare Part D plan, drugs that qualify are listed on the plan’s formulary.

Employed worker who qualifies for health insurance plan benefits as one who is insured.
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An employee who is eligible based on the requirements as indicated in the group contract.

Specific medical services and supplies for which the insurance plan or federal or state program will pay for covered persons under the terms of the plan.
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Expenses as defined in the health plan as being eligible for coverage. This could involve specified health services fees or “customary and reasonable” charges.

Individuals allowed insurance under a group policy such as individual employer groups, multiple employer groups, labor union groups, credit-debtor groups, and certain association groups.

Types of medical care expenses that an insurance plan covers.

Individuals in a group who qualify for a group insurance plan, or in a family who qualify for a family insurance plan.