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:
Patient
Name —
the names of anyone who has ever been covered under this subscriber.
Relationship
— the
relationship of each person to the subscriber: subscriber, spouse, or
dependent.
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
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
button to see what
benefits the patient has.