Question
My girlfriend, Hannah, is from (and currently living in) Wisconsin. She is 20 years old and a full-time student at the University of Wisconsin. She has health insurance through Humana, which is provided by her father's place of employment (he has a family health insurance plan). Hannah's mother has informed her that she will no longer receive health insurance in the year of 2007 because Hannah will no longer be a "dependent."
I know that the definition of a "dependent" can vary, depending on who is defining. For IRS tax purposes, Hannah probably does not meet the definition of dependent because her parents do not provide enough financial support. For financial aid purposes (for school), Hannah is considered a dependent.
How do I determine the true definition of dependent as it applies in this situation? I want to know if her mother can kick her off the policy (they are not on good terms).
Answer
My girlfriend, Hannah, is from (and currently living in) Wisconsin. She is 20 years old and a full-time student at the University of Wisconsin. She has health insurance through Humana, which is provided by her father's place of employment (he has a family health insurance plan). Hannah's mother has informed her that she will no longer receive health insurance in the year of 2007 because Hannah will no longer be a "dependent."
I know that the definition of a "dependent" can vary, depending on who is defining. For IRS tax purposes, Hannah probably does not meet the definition of dependent because her parents do not provide enough financial support. For financial aid purposes (for school), Hannah is considered a dependent.
How do I determine the true definition of dependent as it applies in this situation? I want to know if her mother can kick her off the policy (they are not on good terms).
My response:
Her mother can "kick her off" right now, if she wanted. Hannah is an adult.
IAAL
Answer
It really doesn't matter how the IRS or financial aid defines a dependent. All that matters is how the policy defines a dependent.
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As somarco says, the only definition of a dependent that counts, is the one in the insurance policy.
It is by no means unusual for an insurance carrier to have a limit on how long they will carry an adult child. Usually they will do so longer for a full time students, but even they only get a "free ride" for a limited time. If next year is when Hannah is no longer eligible, then that's that.
BTW, YOU have no standing to determine anything at all. Because of privacy laws, it is doubtful in the extreme that the insurance carrier will talk to you about this at all. The only ones with standing to do so are Hannah and her family.
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Well, Hannah can get a copy of her policy booklet (or just call customer service) and see how they define a dependant. The most common definition is a child can be covered to age 23 if they are a full time student, but it can vary a lot. HOWEVER, if her father (since it's his policy through his work) wants to drop her from the policy at the next open enrollment (for whatever reason, dependant coverage can be very expensive), he can do that. I don't think her parents are legally obligated to provide coverage just because Hannah is eligible for it. Hopefully the two of them can work it out.
IF, on the other hand, she's really NOT eligible for coverage anymore, she should still be able to get Cobra. Which is also really expensive, but at least it's an option.
Other options available in either case of her not having coverage are student health (through her school, usually just covers doctors visits and sometimes discounted prescriptions) with supplementary catastrophic coverage (in case she needs to be hospitalized) or state aid (Medicaid)if she qualifies.
Answer
Age and student status are just some of the ways carriers define an eligible dependent. "Common" definitions mean nothing in this case. Once more, all that really matters is how the plan defines a dependent.
Some plans are also now excluding dependents that are now covered by the non-custodial parent's policy.
If the person in question does not live with the father, and the father does not have custody, they may no longer be eligible under the plan.
COBRA is usually the last resort.
If the person is insurable, the best route is usually an individual policy.
Student health plans are usually way overpriced and totally inadequate in the case of a major claim.
Answer
My father works for a different company than Hannah's father. Both companies are state-owned (PBS and Mental Health provider) and both companies offer Humana. My plan with Humana says I'm a dependent up to age 26 as long as I'm single and a full-time student. My hunch is that Hannah's policy says the same thing. Her dad has family coverage at a fixed price - meaning it costs the same amount if there are 1 dependents or 10. I believe the only reason they want to drop her from the coverage is to punish her for being engaged to me. Her mother claims that she will no longer get coverage and it's my job to provide it because I'm the fiance'. The reason we're not married is because we're both in school and know we obviously cannot afford to get married until we get out of school.
You have a very good point, ecmst12, about getting the policy booklet. The strange thing is that her brother is 19 years old and in college - and they still cover him. They also say that they are not trying to get her off the insurance as a punishment, but because it's illegal/immoral to say she's a dependent when she isn't. My personal belief is that her mother is one big fat liar.
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Common reasons for a student being dropped:
1) Over age
2) Not claimed on taxes
3) Not enough credits
4) Married
5) Covered under another policy
Have your girlfriend call her insurance carrier and request a benifit booklet. She can also ask the customer service reps why or if she will be dropped.
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Just because both policies are the same ins. company does not mean that they will be in any way similar. The employer can design the plan pretty much any way they want; so there's really no way to relate your dad's plan and Hannah's, since they are through different employers.
If you WERE to get married, then she wouldn't be a dependant. Just being engaged doesn't make her not a dependant though. Maybe her mom is just confused about that?
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Just because both policies are from Humana does NOT mean that both policies have the same definition of an eligible dependent. I worked for a national insurance carrier for 5 years and have been dealing with employer-sponsored group plans for 25 - your assumption that both plans will say the same thing is not based on any factual evidence. It is QUITE common for two different plans from the same company to have different definitions.
If the eligibility requirement in the plan cuts off an adult child at age 21 (which is what it sounds like) then what do you see as "funny" that the 19 year old brother is covered? 19 is not 21.
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Besides, if he wants to just punish Hannah for being with you he has that right. It makes him a jerk but he can do it if he wants.
I guess I just don't understand how finding out what the policy says makes any difference unless you want proof that he is a jerk.
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Besides, if he wants to just punish Hannah for being with you he has that right. It makes him a jerk but he can do it if he wants.
I guess I just don't understand how finding out what the policy says makes any difference unless you want proof that he is a jerk.
Some policies will not remove a dependant untill they are no longer eligible . So in some cases the father may not be able to remove Hannah. The OP needs to get a copy of the benifit booklet.
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Some policies will not remove a dependant untill they are no longer eligible
Then those policyholders had better review ERISA and Section 125 of the IRS code. An employee has the right to remove a dependent during open enrollment and when there is an appropriate life status change; the policyholder and the insurance carrier do not have the right to demand that the dependent be left on the plan simply because they are still eligible.
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Appropriate life status change would make the dependent no longer eligible. I did however forget about open enrollment, those rules could keep a child on the policy for months against the employees wishes (which I see alot).
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A life status change does not necessarily make the dependent ineligible.
Example: Child is carried on mother's insurance. Father starts new job and becomes eligible for a better policy. Or, father remarries and is now eligible for a better plan under new wife's insurance. Suddenly becoming eligible for new insurance that was not available before can be considered a life status change. The parents decide to cover the kid on Dad's policy now. The kid is still eligible under Mom's policy, even though an appropriate status changed has moved him/her to other coverage.
While Section 125 (and ERISA) can require an employee to continue to cover a dependent beyond the date the employee wishes to remove the dependent, the insurance carrier or employer cannot require the employee to cover the dependent for the duration of eligibility.