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Summary

Dependent coverage is when health insurance also covers people in the insured's immediate family.

Dependent coverage usually includes the insured's spouse and children until the children reach the age of 26. It may also include significant others. (For more, click here.)

If a dependent is covered under two plans, there are established rules about  how benefits are coordinated which determine which pays first. For information, click here.

If a person is covered as a dependent who does not meet the plan's definition, you may be liable to repay premiums and possibly even health care costs paid with respect to that person. 

  • It used to be that companies took an employee's word about whether a particular person was a dependent. More and more companies are conducting audits in order to keep costs lower.
  • If you have a dependent on your health plan, it is wise to check the exact wording of your plan to be sure any named people are "dependents" within the definition of your particular plan. 
    • A good place to start is your summary plan description. 
    • If you still have questions, contact your employer's human resources department.
    • If you have Medicare, call 1.800.MEDICARE
    • If you have Medicaid, contact your local office.
  • If a dependent has another health plan as well, the other plan may be considered to the "primary" coverage and have to pay first.
  • To learn what to do if you receive notice about a dependent audit, click here

Who is Considered To Be A "Dependent" For Health Insurance Purposes

Following are the people who can be considered to be a dependent for health insurance purposes:

  • Husband/Wife
    • Divorced and/or separated spouses may be covered under COBRA
  • Children. 
    • Children generally includes children born to the insured and to children who are legally adopted by the insured.
    • Children born to, or adopted by, the insured during the policy term are generally automatically covered.
    • There is usually a cut off age beyond which a person is no longer considered to be a "dependent" for health insurance purposes. 
      • The exact age depends on the particular policy. Some policies extend coverage beyond the threshhold age so long as the child is in school, including through the college level. Even policies which cover through college, generally have a cut off age, such as 21. 
      • Children under age 26 are eligible for dependent coverage regardless of their educational status - provided they do not have a job that offers health insurance.
    • Children who become disabled while a dependent under a parent's group health plan can usually remain covered even after they reach the age when they would normally be dropped from coverage. Generally the insurance company has to be provided proof of disability.
  • Significant others
    • More and more policies, particularly group health insurance policies, cover significant others. The definition of significant other varies from policy to policy.




To Learn More

More Information

COBRA

When A Dependent Is Covered By Two Health Plans: "Primary" and "Secondary" Coverage

If a dependent also has access on his or her own to health insurance, such as through a job or because of eligibility for Medicare:

  • Some companies require that dependents with access to their own health insurance rely on that policy as their primary coverage. This means that if there is a claim, the other plan pays first. If more money is owed, the dependent coverage pays next. For more information, see the documents in "To Learn More."
  • An employer that discovers the existence of other primary coverage through an audit may stop paying all or part of a beneficiary's bills. The employer may also insist that the insured return the money that was paid incorrectly. 

For more information, see:

What To Do If You Receive Notice About A Dependent Audit

As a general matter, when companies do an audit of dependents:

  • A written notice and request for information is generally sent to the insured.
  • The insured usually has 30 - 45 days to respond to the request for information.
    • If you do not respond within the stated period, your dependent may lose health coverage even if he or she fits within the definition of "dependent" in your health plan.
  • Most companies offer an amnesty period. If someone is being covered through you as a dependent who should not be covered, you will generally not be held liable for any overpayment up to that date. If you do not declare a person who is a dependent who should not be during the amnesty period, you may be held liable to pay back premiums, and possibly medical expenses, paid with respect to that person.