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Effective Date

The effective date is the day your insurance coverage officially begins. From this date forward, you are eligible to receive benefits for covered health, dental, life, or disability expenses under the terms of your policy. The effective date is established once your application has been approved, all requirements are met, and the first premium payment has been received, unless otherwise specified in the policy.

In group insurance, the effective date usually corresponds to the employee’s start date or the date they become eligible for benefits after completing a probationary or waiting period. In individual insurance, the effective date is confirmed in your policy documents or certificate of insurance and may differ from the date you applied or were approved. Knowing your effective date ensures that you understand when coverage begins and helps avoid gaps between plans.

Example:

If your health insurance application is approved on March 10 and your policy states that coverage becomes effective on April 1, any eligible expenses incurred on or after April 1 will be reimbursable, while costs before that date will not.

What to Watch For:

Keep a record of your policy’s effective date and review it when changing plans or employers to ensure continuous coverage. Waiting periods or specific benefit delays, such as for dental or major medical expenses, may apply even after the effective date. For travel insurance, coverage typically begins on the departure date listed in the policy.

Related Terms

Eligibility Period

The eligibility period is the window of time during which an individual can apply for or enroll in an insurance plan after first becoming eligible. It ensures that applicants join coverage within a reasonable timeframe, helping insurers manage risk and prevent people from waiting until they need care to apply. Eligibility periods are common in both group and individual insurance and are especially important for guaranteed issue or conversion options.

Eligibility Window (Guaranteed Issue)

An eligibility window in a guaranteed issue (GI) plan is the period after losing group benefits during which you can enroll in personal health coverage without completing medical questions. This window is typically 60 to 90 days. Applying within it ensures uninterrupted protection for prescription drugs, dental care, and health services that were previously employer-sponsored.

Eligible Expenses

An eligible expense is any medical or dental service, product, or treatment that qualifies for reimbursement under the terms of your insurance plan. To be eligible, the service must meet several criteria: it must be medically necessary, performed by a licensed or approved provider, and fall within the plan’s specific limits and exclusions.

Elimination Period

The elimination period is the waiting time that must pass after an illness or injury occurs before disability insurance benefits begin to be paid. It functions like a deductible measured in days rather than dollars. During this period, you are responsible for your own income replacement through savings, sick leave, or other sources.

Endodontics

Endodontics is a branch of dentistry focused on treating the interior of the tooth, most commonly through root canal therapy. It addresses infections, inflammation, or damage to the dental pulp and surrounding tissue. Most dental plans classify endodontics as a restorative service, meaning it typically falls under the same category as fillings and crowns.

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