Definition of Dependent for Health Insurance

Written by gregory gambone Google
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Definition of Dependent for Health Insurance
Whom does your health insurance company consider a dependent? (family image by redrex from Fotolia.com)

Insurance is regulated at the state level, so each state has slightly different rules and legislation regarding the treatment and identification of dependents for health insurance. However, the vast majority of states have adopted nearly identical definitions of "dependent" for the purpose of determining health insurance coverage eligibility. By understanding the various classifications of dependents and potential dependents, identifying ineligible family members will be much easier.

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Spouse

For determining health insurance coverage eligibility, your spouse is always considered a dependent. Regardless of the type of health care plan you purchase, or which your employer provides, you can include your spouse on that plan. If divorce occurs, your then-ex-spouse is no longer eligible to receive coverage under your plan. For billing and invoicing uniformity, most health insurance companies will continue to pay claims and insure your ex-spouse for the remainder of the month during which the divorce was finalised. At the end of that month, your ex-spouse will no longer be protected by your health insurance policy, and the carrier will not pay any further claims.

Cohabiters

Not every state or insurance company considers cohabiters as dependents eligible to receive health insurance coverage. The issue of domestic partnerships and insurance coverage remains an ongoing controversial debate. This is especially true when the domestic partnership involves same-sex couples. Many states and insurance companies have opted to view cohabiters as dependents eligible for coverage, but only if the primary insured can provide proof of the relationship's stability and duration. Those carriers that will provide benefits to same-sex couples often require the presentation of a marriage certificate, even if the state in which you live does not support homosexual unions. Surprisingly, many insurance companies resist covering heterosexual cohabiters more than homosexual partners, and restrict male-female unmarried couples from receiving benefits.

Children

Health insurance companies always view your minor children as dependents. The definition of "children" in this case is expanded to include your natural blood children, adopted children and even stepchildren. The majority of health insurance policies do not charge a higher premium to families with more children than to those with fewer. If you have 10 children, your policy premium would be no higher than if you had only one child. Your children are considered dependents and can be covered by your health insurance plan regardless of whether they actually live in your house. This is most commonly seen after a divorce, where one parent is required to provide medical coverage but not also granted residential custody. However, when considering stepchildren, if your second marriage also ends in divorce, the biological children of your second ex-spouse are no longer considered your own children and are then ineligible to remain covered by your plan.

Children of a Cohabiter

Further confusing and complicating the definition of a dependent for health insurance benefits is the presence of children within a domestic partnership. The biological and adopted children of the primary insured may be covered without question. However, the complication arises when your cohabiter has his own children. If your partner is of the same sex, and your insurance company is willing to extend coverage to that person, then including your partner's children within the definition of an eligible dependent should not be too difficult. Unfortunately, there is no guarantee that an insurance company will define your cohabiter's children as eligible dependents, regardless of whether your partner is covered. The definition of dependent, when considering children of a cohabiter, can be confusing and challenging to a health insurance company, and there is often a rigid list of criteria that must be met in order to fit within the confines of the company's definition.

Adult Children

Any children who are deemed eligible dependents by your health insurance company will only be considered as such until they are independent. The vast majority of states and insurance companies identify child dependents as minors below the age of 18 and cease to provide health coverage at the end of the month in which your child's birthday occurs. Only two exceptions usually exist which allow you to continue providing health insurance coverage to your adult children: if your child becomes a full-time student at a college or other higher education institution immediately following high school graduation, her coverage will continue until her college graduation or her 23rd birthday; if your child is mentally disabled and unable to live independently after age 18, his coverage will remain in force indefinitely and he will always fit within the definition of a dependent. In March of 2010, President Obama signed into law the Patient Protection and Affordable Care Act and the Reconciliation Act of 2010, which mandated that before the end of the year, health carriers must allow the adult children of insured members to remain covered as dependents until their 26th birthday, but only if the parent chooses to allow the continuation.

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