Eligible Members

In insurance, eligible members refer to individuals who are eligible to participate in an insurance plan or program. Eligibility criteria can vary depending on the type of insurance and the specific plan or program.

For example, in an employer-sponsored health insurance plan, eligible members may include:

• Full-time employees who work a minimum number of hours per week or month

• Part-time employees who work a minimum number of hours per week or month

• Dependents of eligible employees, such as spouses and children

The key features of eligible members in insurance may include:

• Meeting specific criteria to qualify for coverage under a particular insurance plan or program

• Potentially being subject to waiting periods before being eligible to enroll in certain plans or programs

• Qualifying individuals may be required to pay premiums or other costs associated with their coverage

• The eligibility of members may be subject to change based on factors such as employment status or changes in personal circumstances.

Next Up

Each month, Mployer collects and presents some of the most relevant and most pressing recent changes in law, compliance, and policy in areas related to employee benefits, health care, and human resources.
Union membership in the U.S. has declined from 20% to 10% of the workforce over the past 40 years, yet total union workers have only fallen by 15%. Public sector employees remain five times more likely to be unionized than private sector workers, and union strength varies significantly by industry and region.
Rising demand for GLP-1 weight-loss drugs like Ozempic is forcing employers to rethink coverage. While some see potential long-term healthcare savings, others are restricting access due to soaring costs. With nearly half of employers reporting GLP-1 claims making up 10%+ of healthcare expenses, balancing affordability with employee wellness remains a key challenge.