DB Claims 3 - Insured-specific Flashcards
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Initial Employee
An employee hired before the Policyholder or coverage effective date.
Initial Enrollment Period
Time period when initial employee’s enrolled for coverage and during which new employees have to enroll for coverage without Evidence of Insurability.
Scheduled Enrollment Period
A period of time each the year when employees can change their coverage or apply for coverage if they are late enrollees.
Life Event Benefit (LEB)
A change in your situation (e.g. such as marriage, child birth, etc.) that can make you eligible for a Special Enrollment Period, allowing you to enroll in insurance outside the yearly Open Enrollment Period.
Special Scheduled Enrollment Period
A period of time each the year when all new employees will be effective or existing employees apply for coverage if they are late enrollees.
New Employee
An employee hired on or after the Policyholder or coverage effective date.
Insured
A person covered under a group insurance contract.
Dependent Child
A child born to the Employee, adopted by Employee, a stepchild living with Employee, whom the Employee has legal guardianship, or whom the Employee must provide insurance in accordance with court order.
Dependent Spouse
The legal spouse of insured under age 70.
Waiting Period
The period of time in which an employee must be working full-time before they become eligible for coverage.
Guaranteed Issue (GI)
The maximum amount of coverage allowed without Evidence of Insurability.
Late Enrollee
An employee who did not elect coverage in a timely manner.
Evidence of Insurability (EOI)
When any employee must provide proof that they are insurable because they are a late enrollee or they are requested over the Guaranteed Issue Amount.
