Content Overview 
- Adverse Determination
- Annual Limits
- Case Manager
- Certificate of Creditable Coverage
- Coordination Of Benefits
- Co-Insurance
- Co-Pay
- Covered Charges
- Department Of Insurance
- Deductible
- Eligibility
- Experimental Treatment
- Explanation Of Benefits
- Extensions
- Fee-For-Service (Indemnity)
- Formulary
- Lifetime Limits
- HMO
- Medical Necessity (Medically Necessary)
- Out Of Network
- Out-of-Pocket Maximum (also known as "Stop Loss" or "Cap")
- Palliative Care
- POS
- PPO
- Renewability
- Pre-Existing Health Condition
- Stop Clause (also known as "Stop Loss Clause")
- Underwriting (What It Is And How It Works)
- U.S. Department Of Labor
- Usual, Customary and Reasonable "(UCR")
- Utilization Management
Glossary of Health Insurance Terms To Know
Eligibility
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Eligibility refers to whether you are eligible to purchase a particular health insurance policy. It is important to learn whether you are eligible for a type of health insurance policy in which you are interested.
In the health insurance arena, eligibility refers to whether an individual is eligible to obtain a particular health insurance plan.
With the Affordable Care Act (sometimes referred to as ACA or “Obamacare”), insurance companies can no longer deny individuals from purchasing health insurance coverage, based on gender, age, or health status. However, there are still groups of individuals who are ineligible to purchase health insurance. For example, individuals who are not lawfully present in the United States and individuals who are incarcerated are not permitted to buy a health insurance plan in the Marketplace.
Eligibility also refers to eligibility for government or other programs that provide health coverage, such as Medicare and Medicaid. Eligibility for Medicare, Medicaid and other government programs depends on the specifics of the particular program.
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