Employer eligibility

Keep the employer group and proposed effective scope connected to a parent policy. The eligibility extension identifies its policy and organization. The coordinator records the employer, effective-from date, eligible member count and plan reference before submission. A submitted revision is the unit the underwriter reviews. If the evidence changes, the reviewer needs the revised version rather than an earlier approval applied to new facts.

• Prepare. Insurance Coordinator links the extension to its policy and organization and records the employer and plan evidence.
• Review. Authorized Underwriter checks the submitted extension revision and records a reasoned decision for the parent policy.
• Complete. Insurance Coordinator follows the approved extension and checks the operation receipt before treating the result as complete.

The decision is recorded separately from the extension. A review decision identifies the parent policy, source revision, reviewer, decision date and reason; check it with the submitted extension and operation key. Approval can move the extension toward completion; rejection or return keeps a visible reason for the coordinator. The operation receipt identifies the guarded action and effects so a repeated request does not silently create another extension.

Keep the submitted extension beside its parent policy when reading the review decision. The decision record names the policy, source revision, reviewer and operation key; the extension carries its own revision and status. Check both records and the receipt before applying approval to the extension. A returned submission needs a corrected revision and another independent decision.

Agree the employer identifier, plan reference and meaning of eligible members. Decide what constitutes sufficient evidence for an underwriter, how a returned submission is corrected, and who verifies completion against the policy. Keep the same organization scope across the parent and extension.

For an employer adding a newly eligible group, the coordinator opens the parent policy and records the planned effective date, member count and plan reference. The underwriter checks that submitted revision and records a reasoned decision. The coordinator follows an approval through completion and checks the receipt. If the reviewer returns it, the coordinator revises the extension and submits the new revision for another decision.

• Eligibility review inbox — Shows submitted extensions awaiting the underwriter.
• Eligibility progress board — Shows each extension from draft through completion or rejection.

Follow employer eligibility review, then use the data model to check the policy, extension, decision and receipt references.