Group plans generally must offer coverage to an employee’s spouse and to children up to age 26. Domestic partner coverage is optional and varies by carrier, and its value is often taxable to the employee unless the partner qualifies as a tax dependent.
If the spouse is a bona fide W-2 employee, listing them as an employee can help the group qualify (it adds an eligible employee). If they don’t actually work in the business, they’re a covered dependent (spouse).
Under the ACA, plans that cover dependent children must allow them to stay on a parent’s plan until they turn 26, regardless of whether the child is married, in school, living at home, or financially independent.
A birth, adoption, or placement for adoption is a qualifying event, so you generally have a special enrollment window, usually 30 days on an employer plan (60 days on the marketplace), to add the child, with coverage retroactive to the date of birth or placement.
Usually not. Group plans cover spouses, dependent children, and; where offered; domestic partners who meet the plan’s definition. A boyfriend or girlfriend generally doesn’t qualify unless the plan specifically offers domestic-partner coverage and the couple meets its criteria.
Submit an enrollment/change form to the carrier within the allowed window; within 30 to 60 days of a qualifying event like marriage or a new child, or during open enrollment, with any required documentation.
Usually no. Most plans cover a spouse and your children to age 26. Parents, grandchildren, and other relatives generally cannot be added unless they are your tax dependents and the plan specifically allows it.
Yes. A court order (such as a QMCSO) requiring a child to be added to a group health plan triggers a HIPAA special enrollment period, so the employee can enroll the child, and themselves if not already enrolled, outside open enrollment.