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Adding Dependents to Your Benefits

It’s time, they’re here! You are now eligible for your health benefits. It’s an exciting moment when you are able to access your employer sponsored health benefits. It means improved health and well-being for you and your family and a weight of worry off your shoulders as the health bills are now covered.

But with this new coverage can come a slew of new questions, like who is covered? When can I add them? For how long are they covered? These questions and more are often asked, and we are here to answer them and take some of the mystery out of the process. In this newsletter we will cover:

 

  • Who is considered a dependent.
  • What is a life event.
  • How long a dependent can be on your insurance.
  • The cost of adding a dependent.
  • Adding the dependent to your insurance.

For answers to these questions and more, please
continue reading the rest of our newsletter. We will provide general information on these topics that can be applied to most insurance carriers, however some differences will apply.

Who Is Considered A Dependent For Health Insurance
It varies from plan to plan, but usually for health insurance, a “dependent” is defined as a person, especially a family member, who relies on another for financial support. This typically means your spouse and children. Your dependents are covered under your plan, which means they could be entitled to benefits under your workplace coverage or a personal benefit plan you have.
Definition of Spouse

Your spouse can be your legal married partner, or common law partner with whom you publicly present as your partner and with whom you have resided with for a specific period of time. Each insurance company defines common-law spouse differently, so consult your plan administrator for the exact definition.

Definition of Dependent Children

For most health benefits plans, a child is considered a dependent within your family group. This means that your or your spouses’ children can be added to your coverage. Your children may be adopted by you or your spouse, your natural children or stepchildren.
They must be unmarried and usually under the age of 21 to be eligible for most health benefit plans.

Other Family Members

Typically group health insurance plans don’t consider siblings or parents of the insured to be dependents, and therefore they are not eligible for coverage under your group health benefits plan.

What Is A Life Event
A life event refers to an event that causes change in your personal situation that allows you to change your individual/family coverage easily without the requirement to provide evidence of good health.
Most events that are considered life events are:
  • Marriage.
  • Entering a common-law relationship.
  • Divorce.
  • Ending a common-law relationship.
  • Having a child.
  • Adopting a child.
  • The death of your spouse.
  • The death of your child.
  • Your spouse gaining or losing insurance  coverage.
  • Your dependent gaining or losing insurance coverage.
  • Your province of residence changing.

It is important that you notify your insurer of any of these life events immediately, usually withing 30 days of them happening, to keep your policy and coverage up to date for you and your family.

How Long A Dependent Can Be On Your Insurance
There are a few different factors that dictate how long a dependent can stay on your health insurance plan and it varies per policy. For your spouse, they can usually remain covered under your plan for as long as your relationship lasts.
For children, the length of which they can remain on your insurance is different for each policy. However, the most common rules are that so long as the child is unmarried and under the age of 21 they can remain under your coverage. Though, there are sometimes exceptions to certain policies.

For instance, some plans allow your child to remain covered so long as they are attending post secondary school and are under 25. Others can allow for dependent children to remain on their parent’s plan if they are over 21 and have a disability. It is best to check with your specific health benefits provider
to see what their policy is.

The Cost Of Adding Dependents To Your Insurance

The cost implications of adding a dependent to your health insurance plan will vary from insurer to insurer, as well as different factors like your dependents health and age. For more information, check the premiums information of your insurer’s website or brochure, or contact us to speak to one of our plan member service representatives to learn more.

Adding The Dependent To Your Insurance

Once you have taken out the policy or you are eligible for workplace group benefits plan your dependents are also eligible. Each dependent is eligible to be added based on certain criteria: For a spouse or common-law partner, they are eligible from the date of marriage or according to the common-law definition of the insurance company. For a child, they are eligible from the date of birth, adoption, or assemblage of the relationship between you and your spouse.

Remember to gather the necessary information and documentation for each dependent, like the birthdate of each person to be included on the application and their medical information (name and addresses of the family doctors and details of prescription drugs). The documents that are sometimes needed to prove the relationship between the insured and the dependent differs per insurer but could be the following:

  • Personal Health Number (PHN) for everyone.
  • For a spouse, marriage certificate or documentation that you are in a common-law relationship (utility bills, etc.).
  • For newborn children, birth certificate.
  • For adopted children, a copy of the Notice of Placement from the adoption agency is required.

For indigenous applicants to some group benefits plans provided through a First Nations organization (such as First Nations Health authority) you may also need the following:

  • Indian Status Number (register with ISC as soon as possible as the wait can be up to two years).

Note, for a newborn dependent who has been registered with ISC, and has a PHN number, they could be covered under your account for up to two years while they wait for their Indian Status Number. Once the documentation has been provided to the insurer, processing times will vary.

Removing A Dependent From Your Insurance

Being able to remove a dependent from your insurance will be different per policy. Typically, in personal health insurance policies you can remove a dependent at anytime. However, with group benefit policies you may only be able to remove a dependent because of a life event happening. For example:

  • You get divorced or separated from your spouse.
  • A child reaches maximum age of eligibility (turns 26 or is no longer enrolled
    in a post-secondary school).
  • A dependent passes away.

You must notify your insurer of any life events or changes to your dependents as soon as possible in order to keep your coverage current. If you are unsure of something or need help notifying your insurer of a life event, contact us to speak with one of our plan member service representatives and they will help you.

If you have any questions or would like to review how your dependents are covered under your workplace or individual plan please
don’t hesitate to get in touch with our Plan Member Service Representatives. You can connect with them here using this link. We
are here to help!

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