| Definition | An individual who is covered by a health insurance plan, typically as a policyholder or dependent. | The primary policyholder who purchases and maintains the health insurance plan, often responsible for premium payments. |
| Role | Receives healthcare coverage and benefits as part of the health insurance plan either as the primary policyholder or a dependent. | Responsible for selecting and enrolling in the health insurance plan, making premium payments, and managing the policy. |
| Primary Responsibility | Primarily focused on accessing healthcare services, using the insurance coverage, and understanding plan benefits. | Primarily responsible for managing the health insurance policy, including enrollment, premium payments, and plan changes. |
| Dependents | May include dependents, such as spouse, children, or other eligible individuals, who are covered under the same policy. | May include themselves as a policyholder and may also cover dependents under the same policy. |
| Access to Policy Details | Typically has access to policy details and coverage information but may not manage the policy or premium payments. | Has access to policy details, manages enrollment, premium payments, and can make changes to the policy, such as adding or removing dependents. |
| Premium Payments | May not be responsible for premium payments directly, as this is often the responsibility of the subscriber. | Responsible for making premium payments to the insurance provider to keep the policy active. |
| Changes to Policy | Typically does not have the authority to make significant changes to the policy, such as changing the coverage options or canceling the policy. | Can make changes to the policy, including adding or removing dependents, adjusting coverage, or canceling the policy if needed. |
| Communication with Provider | May interact directly with healthcare providers for services, but billing and claims processing are often handled by the subscriber. | Coordinates with healthcare providers for services and manages the administrative aspects of the insurance coverage, including claims and billing. |
