Who counts as a dependent
In health insurance, a dependent is someone other than the employee who may be covered under the employee’s plan. Which relationships qualify is set by the plan and by the laws where you live. Commonly, eligible dependents can include:
- a spouse, and in some plans a domestic partner
- the employee’s children, including biological, adopted and stepchildren, and sometimes children in foster care or under legal guardianship
- older children, up to an age limit that varies by place and plan
- in some cases, a dependent with a disability who is unable to support themselves
Plans define these terms differently, so the plan document is the source to check. This article is general information, not insurance or legal advice.
Coverage tiers
Employer plans usually price coverage in tiers. Common ones are:
- employee only
- employee plus spouse
- employee plus child or children
- employee plus family
Moving from one tier to another generally increases the payroll deduction. Whether the increase is small or large depends on how much the employer contributes toward dependents, which is covered in more detail under employer contributions. Some employers pay much less toward dependent coverage than toward the employee’s own, so the jump can be sizable. A few plans charge per child up to a limit, while others charge a single rate for any number of children.
Adding family members
Employees commonly add dependents at one of these moments:
- When first eligible. During new hire enrollment, you typically choose both your own coverage and who else to cover.
- During open enrollment. Once a year, most plans let you add or drop dependents.
- After a qualifying event. Marriage, birth, adoption and certain other changes allow a mid-year change, usually within a limited window that often runs about a month, though it varies. Adding a newborn is one example, and qualifying life events more generally are described elsewhere on this site.
If you miss the deadline, you may have to wait until the next open enrollment. Cutoffs are often strict.
Documentation
Employers commonly ask for proof that a person is an eligible dependent. This can include a marriage certificate, a birth certificate or adoption paperwork. Some employers audit dependent eligibility periodically, and covering someone who is not eligible can lead to problems such as the plan seeking repayment or removing coverage. If you are unsure whether someone qualifies, ask before enrolling them.
How costs add up
Premiums are one part of the cost. When more people are covered, you may also see:
- A higher deductible and out-of-pocket limit. Family plans often have a family deductible and a family out-of-pocket maximum in addition to individual amounts, and how they work together differs by plan. Some use an embedded structure in which an individual limit applies inside the family limit, and others do not.
- More use of the plan. More people usually means more care, which means more copay and coinsurance charges.
- Dental and vision. These are often elected separately, and their tiers can have different rules from medical.
A hypothetical illustration: if employee-only coverage costs $100 per paycheck and the family tier costs $350, adding family would cost an extra $250 per paycheck. That is $6,500 across 26 paychecks. These figures are made up, and real tiers vary widely.
Special situations
- Two employed spouses. Both may be offered coverage. Some households cover everyone on one plan, others split coverage, and some employers apply a spousal surcharge. Comparing totals, networks and benefits helps.
- Divorce. Coverage for an ex-spouse usually ends with the divorce or legal separation under the plan’s terms, with potential continuation options. Divorce and coverage changes have their own timing rules.
- Adult children. Many plans cover adult children up to a certain age. Rules differ by country and region.
- Children living apart. Court orders about medical support can affect who must provide coverage. Ask the plan administrator how such orders are handled.
Removing dependents
You can usually remove a dependent at open enrollment or after a qualifying event. Coverage normally ends on a date set by the plan, often the end of a month. If a dependent becomes ineligible, such as by aging out, it is wise to tell the plan promptly. Ask whether continuation options are offered.
Before you decide
Check the total cost by tier, the plan’s definition of an eligible dependent, the deadlines for changes and any proof you must provide. A benefits representative can confirm details for your specific plan.