Eligible complainants

Entities protected by FSA rules contained in Dispute resolution: Complaints Handling. They are: private individuals; a commercial customer with a group annual turnover below £1m; a charity with an annual income below £1m; and a trustee of a trust with a net asset value of less than £1m.

Eligible dependents

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.

Eligible expenses

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.