1. Qualifying factors that must be met before a patient receives benefits (medical services) under a specified insurance plan, government program, or managed care plan. 2. Refers to the process whereby an individual is determined to be eligible for health care coverage through the Medicaid program. Eligibility is determined by the State. Eligibility data are collected and managed by the State or by its fiscal agent. In some managed care waiver programs, eligibility records are updated by an enrollment broker who assists the individual in choosing a managed care plan in which to enroll.
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UK: Conditions that govern a person’s right of entry into a pension scheme or right to receive a particular benefit. The conditions may relate to age, service, status and type of employment but there must be no discrimination in eligibility on grounds of sex. The Barber judgment applies to all retirement benefits earned after 17 May 1990 and is endorsed by regulations under PA95 for equal treatment between the sexes.

Month, day, and year an individual and/or spouse and dependents become eligible for benefits under an insurance plan or date he or she may apply for insurance.
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The date that a person is eligible for benefits.

In group health insurance, the conditions that an individual must meet to obtain coverage such as age, employment status, and continued employment.

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.

Time (usually 31 days) that follows the eligibility date during which a member of an insured group can apply for insurance.

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.

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 .

Reference number on a printout from the Medi-Cal point of service device that verifies an inquiry was received and eligibility information was transmitted.

In group health insurance, the length of time an employee must be employed by an employer before he or she is eligible for insurance coverage. Also called probationary period .

An individual is eligible for premium-free (no cost) Medicare Part A (hospital insurance) if he or she is 65 or older and receiving, or eligible for, retirement benefits from Social Security or the Railroad Retirement Board, or is younger than 65 and has received Railroad Retirement disability benefits for the prescribed time and meets the Social Security Act disability requirements, or had Medicare-covered government employment, or is younger than 65 and has end-stage renal disease (ESRD). If an individual is not eligible for premium-free Medicare Part A, he or she can buy Part A by paying monthly premium if he or she is 65 or older and enrolled in Part B, a resident of the United States, and either a citizen or an alien lawfully admitted for permanent residence who has lived in the United States continuously during the 5 years before the month in which they apply.