Member

A member is an individual who is enrolled and covered under a group insurance plan, typically through their employer, association, or organization. The member is often referred to as the insured employee or plan participant and receives coverage for benefits such as health, dental, life, and disability insurance. The member may also extend coverage to eligible dependents, such as a spouse or children, under the same plan.

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In a group insurance contract, the employer or organization is the policyholder, while the member is the beneficiary of the coverage. Members receive a certificate of insurance that outlines their benefits, eligibility, and claims procedures. They are responsible for maintaining up-to-date information with the plan administrator, paying any employee premium contributions, and following the insurer’s claim submission requirements.

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Example:

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If your employer offers a group benefits plan, you are a member of that plan once you enroll. You can submit claims for eligible health and dental expenses for yourself and your covered dependents.

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What to Watch For:

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Review your plan’s eligibility rules to ensure you remain an active member, as coverage may end if you leave the organization or change employment status. Keep your dependent and beneficiary information current. For claims, confirm whether your plan allows online submission or requires paper forms through the employer or insurer.