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Dependent Coverage 101


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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

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