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Is my wife considered a dependent on my health insurance?

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The lowdown...
  • You must prove your relationship to your spouse before adding them as a dependent
  • A marriage certificate is the most common form of such verification
  • Special enrollment periods allow you to apply for immediate coverage

The issue of adding dependents to your health insurance is certainly a complicated one.

There are numerous rules and regulations about who is eligible to be considered a dependent on your health insurance and who is not eligible for such consideration.

That being said, there are general guidelines that can help you figure out if you can claim someone as your dependent on your health insurance.

Your health insurance also determines who may be claimed as a dependent in the insurance contract and if your health insurance is part of a group health insurance plan, the question can become yet more difficult to answer.

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What is a Dependent?

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Before we discuss who you may claim as a dependent on your health insurance, it is important that we clarify the precise definition of a dependent.

A dependent in this context is someone who receives benefits from your insurance but does not pay for the insurance. Typically, this is the child of an insurance policyholder as described by dependents.

However, a dependent is not necessarily the child of the policyholder. Sometimes, it is even possible for a policyholder to include their parent as a dependent on their health insurance policy.

What is a Group Health Insurance Plan?

Group health insurance plans were mentioned earlier. It is important to know what those are since they have different standards for claiming dependents than individual health insurance plans.

A group health insurance plan gives coverage to a certain group of people.

Employers often offer such plans as benefits to their employees, which is supported by group health insurance plan.

Such plans are also standardized and provide identical benefits to the employees or other individuals who make up the group in question. They also typically cost less compared to individual plans with the same benefits.

What is an Individual Health Insurance Plan?

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Now that we have defined group health insurance plans, we must also address the definition of an individual health insurance plan.

Individual health insurance plans are insurance policies that someone purchases for themselves and their families, a statement supported by individual health insurance plans.

Such plans are usually obtained by the individual who receives help from an expert in the insurance industry, such as an insurance agent.

There are only certain periods in which someone can enroll in such plans. These periods are known as open enrollment periods.

Types of Individual Health Insurance

Different levels of individual health insurance exist in the marketplace. These levels are provided with a tier that corresponds with the benefits that the plan provides. The amount of any medical expenses that each tier of plan pays for varies depending upon the tier in question.

  • The bronze tier is the lowest and pays the least amount of expenses, roughly amounting to sixty percent of said expenses.
  • Plans in the silver tier pay for seventy percent of medical expenses.
  • Gold tier plans are more expensive and pay for eighty percent of medical expenses.
  • Platinum tier plans are the most expensive plans available and thus pay for the majority of medical expenses which equals ninety percent of the costs.

Catastrophic Plans

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Catastrophic plans are another variety of an individual health insurance plan. These plans are only made for worst-case scenarios like severe injury or serious illness.

Only those under 30 years of age or those who have a hardship exemption in addition to those with an affordability exemption can purchase these plans.

These plans typically have low monthly premiums, but the deductibles are very high. Catastrophic plans also cover specific preventative services completely. They are much less common than traditional individual health insurance plans, however.

How to Determine a Premium Rate

Premium rates for plans that are on the marketplace and off the marketplace are usually determined according to the age of each person who will be insured by a plan. This is shown in premium rates.

Where the insured person lives and the level that the plan they select belongs to are also factors in the premium rate.

Benefits Covered by an Individual Health Care Plan

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The so-called essential health benefits integrated into a health insurance plan will remain the same regardless of whether the plan was put up in the insurance exchange or not.

The following services are included as part of the essential health benefits:

  • hospitalization
  • emergency services
  • prescription drugs
  • pediatric services
  • ambulance services for patients
  • newborn care
  • maternity services

Services relating to mental health and substance abuse disorders are also included. Preventative services in addition to wellness services are also part of the essential health benefits offered by insurance plans.

Eligible Dependents

Eligible dependents include those who are allowed to be claimed as dependents under your insurance. Biological children and stepchildren are eligible dependents as long as they are under the age of 26. Spouses are also eligible dependents.

Adopted children are eligible dependents once the adoption is finalized or when the child is put up for adoption with the policyholder. Whichever happens first is the date that is used.

Legal wards who became wards of the policyholder prior to age 26 are in a similar situation and their coverage begins when permanent guardianship is given to the policyholder.

Adding a Dependent or Spouse to Your Policy

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Certain restrictions exist when you decide to add a dependent or spouse to your policy. Immediate coverage can begin if you apply to add them during a special enrollment period.

Otherwise, you must apply to add them during the annual open enrollment term.

If you add them during a special enrollment period, it is important to know what classifies as a special enrollment event. Birth, adoption, marriage, divorce, and termination of other coverage are all special enrollment events.

These events allow you to apply for the dependent or spouse to get immediate coverage.

Filling out Necessary Paperwork

Filling out necessary paperwork is an integral part of adding a dependent to your health insurance. Your dependent’s Social Security number, date of birth, and address are pieces of information you need to submit to add them.

Supporting documents that verify the relationship you and the dependent share are also required for this process.

To add a spouse, you will need your marriage certificate or an affidavit of marriage if you were married in a country which does not issue certificates.

You might also require evidence that your spouse lost their health benefits or information regarding the health insurance they have sponsored by their employer.

Spouses and Dependency

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Generally speaking, spouses are considered dependents on your health insurance. This is not always the case and certain plans might have exceptions.

However, generally, it is not particularly difficult to add your spouse as a dependent on your health insurance.

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