It would be a happier, healthier world if we could add our extended family to our health plans. But health insurers have to draw the lines somewhere. Here's a look at those lines.
If I get married, can my spouse's child be added to my health plan? Is there a timeframe in which enrollment must take place?
Yes, a stepchild is eligible to be a dependent on your health plan up to the age of 26. If your coverage is an employer group plan that provides benefits to children, you will be given at least 30 days to enroll the new dependent. An eligible child can be a biological child, adopted child, stepchild or foster child. "When you get married and you're seeking to enroll that new spouse and the children, federal law requires that the employee has at least 30 days to enroll," says Rich Gisonny, senior consultant at Towers Watson in White Plains, N.Y. The federal rule states you have "at least 30 days" but an employer could give you a longer period of time, adds Gisonny. This gives employees a reasonable period of time to make a decision and complete the enrollment. "There's not a mandate in force today to offer health insurance to an employee's children," points out Gisonny.
If I am an unmarried man and get a woman pregnant, can I put the child on my employer health plan?
If a plan covers children, under federal law there cannot be restrictions on eligibility. "The employer can't require that the child reside with the employee or that the child is financially dependent on the employee," says Gisonny. The plan may require a birth certificate as proof, or verification of the dependent relationship. Some health plans are more rigorous in requiring dependent or biological verification than others. "If a plan so chooses, it has the discretion or the right to require proof that a dependent relationship actually exists," says Gisonny.
If my mother lives in my home and is claimed as a legal dependent on my taxes, but is not old enough to collect Medicare, can I add her to my health plan?
Gisonny says that health plans typically limit the definition of dependents to a spouse and children.