Plan Member

A plan member is an individual who is enrolled in and eligible to receive benefits under a group insurance plan. Typically, the plan member is an employee of a company or a member of an organization that sponsors the group policy. The plan member is covered for the benefits outlined in the plan - such as health, dental, life, and disability insurance - and may also extend coverage to eligible dependents, including a spouse or children.

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The plan member’s rights and responsibilities are defined in the group benefits booklet or certificate of insurance. These include maintaining accurate personal information, paying any required contributions, and following claim submission procedures. The plan member is distinct from the plan sponsor or policyholder, which is the employer or organization that owns the group contract with the insurer.

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Example:

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If your employer offers group health and dental benefits, you are the plan member once you enroll in the program. You can submit claims for eligible expenses and may add your spouse and children to the plan if they qualify as dependents.

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What to Watch For:

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Keep your plan information up to date, especially after life events such as marriage, divorce, or the birth of a child. Submit claims within the insurer’s deadlines and retain copies of receipts. If you leave your employer, your coverage as a plan member usually ends, but you may be eligible to convert to an individual plan within a set timeframe.