Entitlement: A Household Member who is entitled to coverage under a medical insurance policy, for example, an employer based plan or a group health plan. Entitlement evidence captures details such as the name of the entitled Household Member, the cost of coverage for the household member, an indication of whether a waiting period applies and the enrollment date when coverage can begin. It may be that one Household Member is automatically covered under a medical plan but an extra fee is payable to provide coverage for another member of the household. In this case entitlement to coverage exists for the other Household Member. In other situations, a waiting period is required before coverage under a health plan can begin, for example, a minimum of six months continuous service with an employer. In this case entitlement to coverage exists following completion of the waiting period. Example Linda Smith is covered under a medical insurance plan. Linda Smith has a dependent child Susan Smith. A case worker creates an Entitlement record for Susan Smith which is associated with Linda Smith's medical insurance record. Susan Smith is entitled to coverage under Linda Smith's policy for an extra fee. |
