The minimum number of hours per week that an employee is required to work to qualify for and maintain eligibility for benefits.

The portion of the payment for medical services that an individual is responsible for. For example, your health coverage may pay for 80% of the costs of a service, while you will have to pay the remaining 20%.

The federal government pays benefits planners in communities around the country to help people think ahead about work incentives and benefits issues. CWIC'S are benefits planners who are trained by the Social Security Administration to assist beneficiaries with programs including Supplemental Security Income (SSI), and Social Security Disability Insurance (SSDI) in addition to other related programs.

A set amount an individual must pay upon receiving medical services. For example, you may have to pay $10 each time you visit the doctor.

The date an individual is enrolled in coverage. The effective date is usually not the same as the date of hire.

Definition of disability may be two-tiered: an inability to participate in the employee's own occupation (regular work) on the first tier, and an inability to participate in any occupation (any work) on the second tier. Refer to policy for definitions of disability.

Coverage offered to an individual through a group, such as employer-sponsored, association-affiliated or professional group coverage.

The first time an individual is eligible to enroll in a group’s benefits programs. During this period, the individual’s medical history is not subject to review. Once enrolled, however, pre-existing condition exclusionary periods may apply.

Any medical care received by an individual for a medical condition. Examples of medical treatment include being prescribed medication, physician consultations, and therapy for a mental or physical condition.

The review of an individual’s medical history and/or medical records to determine if the individual is eligible for coverage. Medical underwriting, which may include new medical testing, can be used to deny coverage or determine if a particular pre-existing condition will be covered.

The annual time period when an individual may add or change coverage in an employer-provided or association-affiliated insurance plan. Changes during most of these annual periods will require medical underwriting to add benefits not elected during the initial enrollment period. The federal government calls this period "open season", and other insurers may use different terms.

Any condition for which “medical care” was received within six months prior to the effective date of insurance coverage. Medical care includes the use of prescription drugs and physician consultations and services. During a pre-existing condition exclusionary period, coverage for that condition is either not provided or can be limited.

The period of time from the coverage effective date that the insurer does not cover a pre-existing medical condition. The individual will normally be covered for the condition once the specified time has elapsed.

A regularly scheduled payment to an insurer or health care plan.

The period of time an individual is required to be employed by a company or be a member of an association before becoming eligible to enroll for the group’s health coverage. Also known as the minimum service requirements.

Rights that allow an individual to qualify for health coverage without having to undergo medical underwriting. Special Enrollment Rights can be requested from an employer within 30 days after previous health coverage is exhausted or terminated. They apply to individuals who do not enroll during the initial enrollment period or have lost their health coverage.

See Service Wait.