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healt Insurance for yourself, your spouse, and your dependents

Senin, 07 September 2009 by noesaja

The following list includes some of the issues I get asked about regarding how best to cover family members — and my recommendations:

* Double-covering a spouse. The question of whether to cover a spouse under your health insurance plan as well as under your spouse’s comes up most often when each spouse has coverage paid entirely by their own employer and one of the two employers also pays all or most of the spouse’s and dependents’ coverage.
Covering children when both spouses have a group health insurance plan. Where to cover the children — under your plan or your spouse’s? In this situation, you weigh out-of-pocket costs in premiums, copayments, and deductibles against the coverage of each plan. These out-of-pocket costs can be dramatically different. But again, choose the plan that covers the five criteria best. Price should be the least important part of the decision. (Use the Health Insurance Comparison Form in the Forms Directory to compare your choices.)
Avoiding the single parent penalty. The most equitable group plans charge a price per head. So if you’re a single parent, you don’t pay for a nonexistent spouse. Or if you’re childless, you don’t pay for nonexistent children. But it doesn’t always work that way. Sometimes group insurance offers only two choices — individual and family. Family includes husband, wife, and all children for one price. But family also includes single parent families and childless families. If your family is small, you pay the same amount as a person with a very large family.
To cover a person under your health insurance plan, that person must be considered a dependent. The definition of dependent is based on your plan’s legal requirements concerning financial support. (In an employer-sponsored plan, the employer may also have input into the definition of dependent.) Some plans consider a child a dependent only if the child meets all of the following very specific criteria:
- The child is your responsibility by birth or legal adoption, or the child is a stepchild or a foster child.
- The policyholder provides more than 50 percent of financial support and maintenance for this child.
- The policyholder can claim the child as an exemption on his or her federal income tax return.
A child is considered a dependent if a legal court order mandates that the policyholder must provide coverage for the child. Other individuals may be considered dependents if they satisfy IRS requirements.
health insurance plans’ regulations regarding coverage for children and/or other dependents may vary greatly, so check out the plans carefully. To make administration simple and consistent, some companies use some variation of the birthday rule, in which the primary coverage for eligible children is through the plan of the parent whose birthday falls in the earlier month of the year. For example, a parent born in May 1954 would assume coverage for the children, even though the spouse born in September 1950 is older.

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