Eligible Expenses

What Does Eligible Expenses Mean?

Eligible expenses, in the context of insurance, refer to costs defined within a health insurance plan as qualifying for coverage. These expenses must meet the specific conditions set for the individual or group to ensure their eligibility for coverage. The specific list of what qualifies varies by plan, so it’s worth reviewing before you choose a health insurance plan.

Insuranceopedia Explains Eligible Expenses

For expenses to be eligible for reimbursement, they must meet the following conditions:

1. The expenses must be for health services or products used in the treatment of a medical condition.
2. The expenses must be incurred by the insured, their spouse, or an eligible dependent.
3. The expenses must be incurred before the run-out period stipulated in the plan.
4. The expenses must be incurred during the eligibility period of coverage.

Eligible expenses are also what gets applied to your deductible and out-of-pocket maximum each plan year, alongside your premiums, co-pays, and coinsurance.