A common question for those with insurance is, can I add someone to my plan? Luckily the answer is yes, you can! There are rules and exceptions when it comes to dependents, but you absolutely can add people to your insurance plan.
What is a Dependent?
First, let’s define what a dependent is. A dependent is a person that you can claim as a personal exemption on your taxes. It should also be noted that it is required to provide health insurance for those you claim as a dependent on your taxes. Dependents can be your spouse, domestic partner, newborn, adopted child, or adult child under the age of 26. Once added on to your plan, your dependent will reap all the benefits of your insurance plan.
Who Can Be Added to a Health Insurance Plan?
Eligibility to be classified as a dependent can be broken into three main categories. Those that fall into these categories can look into taking the next steps to be added as a dependent on the primary holder’s insurance plan.
Newborns are a lucky category, as they are automatically covered under the family insurance plan for their first 31 days. After this initial month, they’ll have to be manually added on to the plan through an enrollment application or your company’s HR division. You will have a total of 60 days after the birth of the baby to enroll the baby in your plan. To do so you will need to fill out an enrollment/change form, and present a copy of the baby’s birth certificate and Social Security card. Additionally, having a baby counts as a Qualifying Life Event (QLE) that makes you eligible for a Special Enrollment Period. This means that in the case you didn’t have insurance already, you can now sign up outside of the typical yearly Open Enrollment Period.
If what you are considering is the eligibility of a child older than two months, yes, they can be enrolled in your plan and claimed as a dependent until the age of 26. Children count as dependents as long as they are biologically your child, a stepchild, adopted child, or a foster child. Another qualifier requires that the child has lived with you for a minimum of six months prior to the claim. This does not mean they have to reside with you when the claim is made, but those prior six months are necessary. Additionally, if the child does have an income, they cannot make enough to be their own primary source of support.
When it comes to your partner and creating a new life together, health insurance can definitely be a joint benefit. After getting legally married, usually there is a 60 day window to enroll in a new plan or add the dependent to an existing plan. If you let these 60 days go by, you will unfortunately have to wait for the next Open Enrollment Period to add them. The following documentation is necessary for enrollment: enrollment/change forms, optional life enrollment form, a copy of the marriage certificate, social security cards, and birth certificates. For this situation it is usually a requirement that the couple file taxes jointly.
Timeframe to Add Dependents to an Insurance Plan
If within the past 60 days you have gotten married, had a baby, adopted a child, or taken in a foster child, you may qualify for a Special Enrollment Period. This opens up the opportunity to enroll in a new health insurance plan or add dependents onto the plan. In the case that you have recently gotten married, you must pick a plan by the last of the month. In the cases that regard children, coverage begins on the day of the event (like the day the newborn was born, for example). Although coverage begins on the very first day, you have 60 days after the event to enroll. Generally speaking, it is best to enroll or add your dependent as soon as you can to avoid later hassles and coverage problems.
Adding/Removing a Dependent From Health Insurance
We briefly mentioned a qualifying life event (QLE) earlier, but what exactly is that and are there more qualifications? A QLE is defined as a change in your situation that can make you eligible for a Special Enrollment Period. Now, what is a Special Enrollment Period? A SEP is a flexible special period of time granted to some to enroll in health insurance plans outside of the normal, yearly Open Enrollment Period everyone else has. The following will touch upon several situations that qualify as QLEs.
Health Insurance Loss
In the case that you lose your existing health insurance coverage, especially in the case that it was job-based, an individual plan, or a student plan, you may qualify for a SEP. This situation also extends to those that lose their eligibility to Medicare, Medicaid, or CHIP. Lastly, if you were a dependent that aged out of your parent’s plan at 26, you do fall into this category. If any of these situations reflect your current situation, you are eligible for a Special Enrollment Period to find new health insurance.
Household changes refers to the state of those within the home, and those enrolled or looking to be enrolled. In the case that you got married, divorced, or legally separated, you qualify for a SEP. As previously stated, having a child, adopting a child, or fostering a child will also qualify you. The saddest qualifying life event is a death in the family. In this case, a Special Enrollment Period is allowed if needed.
At first glance this category seems pretty self-explanatory, but it does include a mix of situations. The most obvious situation is moving to a different zip code or a different county. In the case that a student were to move to or from where they attend school they would find themselves eligible. Eligibility would also be extended to seasonal workers moving to or from where they live and work. Lastly, SEP eligibility is extended to those moving into or out of a shelter or other transitional housing.
Unique Qualifying Life Events
Unique Qualifying Life Events cover a variety of situations that don’t fall into the above stated categories. In the case that there was a change in your income that affected the coverage you qualify for, you can apply for SEP to change your plan. SEP eligibility is extended to those gaining membership into a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder. Similarly, if you were made a U.S. citizen within 60 days prior you can apply for SEP. Lastly, if you recently left incarceration in either a jail or a prison you can apply for SEP to find coverage.
So You’ve Added Your Dependent – Now What?
After going through the appropriate channels and filing to have a dependent added to your plan, what benefits can be expected? Typically, dependents will have access to the same plan benefits and limitations as you, the plan holder. If you are eligible for more than one type of plan, your dependent will be as well and can take their pick. Although, this does depend on your insurance company and how things were already previously set up.