Personal Eligibility Question

[Tyler Durden]

I don't know if this is appropriate for this forum, I apologize if not, but I have a personal question regarding health insurance eligibility and figured you guys could help me out.

Say there is a husband and wife whom work for the same employer (public school). They have good health insurance through their employer, and the policy is in the wife's name (not sure why) and covers her, the husband, her son from a previous marriage, and his daughter from a previous marriage.

The wife and step daughter cannot get along, to the point the step daughter moves out to live with another family member (older brother) for her senior year of high school (17 years old). Should the step daughter still be eligible to be on her step mother and fathers health insurance plan? I am unfamiliar with the laws and regulations but when I heard she was no longer covered something smelt fishy to me (ie: step mother being vindictive). Is it likely the insurance company found out she doesn't live under their roof anymore and refused to cover her, or am I being overly cynical? How does this differ from a college student being covered until age 24 when he/she is living at school?

Thanks for your input!

[Abused Student]

She should still be able to be covered provided she is a student although the insurance company might say that college students still have their permanent address with the parents and that this girl doesn't.

[hotdime]

Looks like under our policies here (which may or may not be pretty standard), her no longer being covered makes sense.

Your children include your natural children, your stepchildren residing in your household, your legally adopted children, and children placed for adoption with you. The term “children” also includes any other never-married child of whom you have permanent legal custody and who regularly and permanently lives with you in a parentchild relationship. In any event, to be a dependent child, the child must be dependent on you for at least 50% of his or her support.

Once she moved out, her definition as a dependent probably got much iffier in general.

[Take 2]

Possibly relevant: When our teenage son ran/moved out, the IRS took away our dependent deduction.

[ajstudies]

If the noncustodial parent has to provide the child with health insurance through a divorce decree, then yes.

[Maine-iac]

They need a legal opinion and/or a tax accountant's opinion. On the surface, an employer's "family" policy not covering a step child of the primary insured who does not reside in the home and is not a student with legal address in the home would be a reasonable position. But it gets complicated by whatever the divorce settlement states about who is responsible for the girl's health insurance while she is a minor, as ajsuties said. (I am assuming that this situation wasn't severe enough for a court to have made the girl an "emancipated minor".)

You shouldn't rely on my hunches, but if the dad is required to provide health insurance, and is paying to support the girl at her brother's, my hunch is that the couple may need to switch their coverage around so that he is the primary insured and the step-mom is the spouse. Which may be do-able immediately if it qualifies as a "life changing event" or may have to wait until the next open enrollment.