Whether you have coverage through your job or the government's Health Insurance Marketplace, the process of adding a dependent to insurance is relatively simple. Begin by asking questions. You must determine if your intended dependent is eligible, when your plan accepts new enrollments, and what procedures and policies you must follow.
The Affordable Care Act, or ACA, defines dependents as biological and adopted children and stepchildren. Under ACA, children can stay on your health insurance through the end of the month in which they turn 26 even if they marry, move out of your house, go to school or get a job. All providers must comply with this mandate, although employers can elect to include foster children and stepchildren.
Although you may consider your spouse, domestic partner or domestic partner's children to be dependents, the ACA doesn't. Nor does it require insurers to cover them. However, plan providers generally count legal spouses as eligible dependents, and some have provisions to cover domestic partners and their children. Even when a plan considers legal spouses dependents, it may require them to accept any benefits for which they are eligible at work regardless of cost. This means that your spouse would use your plan as secondary coverage. Some states, such as California, mandate that health plans covering spouses also cover domestic partners and their children.
Confirm with your human resources office or plan's customer service department that your dependent is eligible to be added to your insurance. Adding a child who lives outside of your plan's service area may require you to switch plans.
Timing is Everything
The Internal Revenue Tax Code gives pre-tax status to exclude any costs you pay toward medical insurance from your taxable income. In return, it limits when you can add dependents -- annual open enrollment periods and what the Health Insurance Portability and Accountability Act, HIPAA, calls "special enrollments." Special enrollments require a qualifying life event, according to Healthcare.gov.
Accepted qualifying events are:
- Child adoption
- Becoming a foster parent
- Loss of coverage
- Change in income
- Change in job status, such as being a new hire or completing probation
- Becoming a U.S. citizen or legal resident
- Release from prison
You must take advantage of this enrollment opportunity within 60 days of the qualifying event happening, or for newborns, 30 days of the birth date. If you miss the deadline, you won't be able to add your dependent until open enrollment. Watching the calendar can save you money: The effective date you elect for your dependent's enrollment to begin may trigger retro charges when you backdate, or when you use an earlier date than the day you submit your request. If you haven't incurred any medical expenses since the date of the qualifying event, you should elect a current effective date.
Open enrollment is your only option if you don't have a qualifying event. Coverage for dependents added during open enrollment doesn't take effect until your plan's new benefit year begins.
If you belong to an Indian tribe recognized by the U.S. government, or are a shareholder under the Alaska Native Claims Settlement Act, however, you can enroll a dependent once every month except during open enrollment.
Complete Required Documentation
In addition to obtaining the appropriate enrollment forms, get your dependent's Social Security number, birth date and address. Also gather any supporting documents your plan provider requires to verify your relationship to the dependent. To add a child, present an official birth certificate, court document that assigns you guardianship or foster care responsibility, or an adoption decree. Your marriage certificate, or an affidavit of marriage if you wed in a country that doesn't issue certificates, prove your spouse's legal status, although some plans also request a copy of your federal tax return and a bank statement or other proof of joint ownership. You also may need proof that your spouse lost health benefits, information about her employer-sponsored insurance, or a copy of her Medicare card.
Adding a domestic partner may require a notarized affidavit confirming your relationship plus several types of proof that the partnership has existed for a set period of time, such as six months, and that the two of you depend on each other financially. Examples of documentary proof include a lease or mortgage, car title and bank statements carrying both of your names. Your domestic partner's name must appear on her child's birth certificate for you to add the child to your insurance.
Enrollments on the Health Insurance Marketplace also require financial information for each dependent you add.
- Office of Personnel Management: Healthcare; Family Members Eligible for Coverage
- Small Business Majority: Enrollment Options and Procedures
- Pennsylvania Employees Benefit Trust Fund: Summary Plan Description
- U.S. Department of Labor: Protections for Newborns, Adopted Children, and New Parents
- Healthcare.gov: Getting 2015 coverage with a Special Enrollment Period
- CIRI: Shareholder Responsibilities
- Northwestern University: Office of Human Resources; How Do I Verify My Dependents?
- City of New York: Instructions for Completing a Health Benefits Application
- GLAD.org: Domestic Partnership Benefits