There are two general types of health insurance, private and group. Individuals purchase private insurance directly from the health insurance company, and it rarely comes with any type of coverage that extends to dependents. Group plans, on the other hand, are offered by businesses as an employee benefit, and they often include dependent coverage. If an individual does not have dependent coverage with a policy, he cannot cover a spouse at all, and the option to include benefits will not be available.
With group plans that offer dependent coverage, spouses are included as dependents in most cases. This means that the individual, when progressing through employee orientation and signing up for health insurance, can sign up a spouse for the insurance at the same time he is completing the application. This can become more complex if the individual is only living with a partner or qualified domestic partner, neither of whom is covered in the same way. Qualified domestic partners can be dependents, as long as they are covered by the qualifying relative status.
If a person is not legally a spouse, she may be considered a qualifying relative and still eligible for dependent status. A qualifying relative must be a blood relative or share the same residence as the policyholder. The policyholder, as a taxpayer, must provide over half the necessary support income for the relative from their own income, and the relative cannot be able to support himself. The relative must also be a United States citizen, resident or national.
If spouses are already covered by a policy of their own, it can be difficult to be covered by two health insurance policies. Insurance companies have regulations that prevent any health insurance overlap between policies, so there may be no benefit to having cross-dependents within the family. Also, dependents may be able to use policy features such as health savings accounts, but only if they do not have any benefit-oriented savings accounts already in place.