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Health insurance - am I covered as a dependent

Health insurance - am I covered as a dependent

Old Jan 14th 2016, 5:54 pm
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Default Health insurance - am I covered as a dependent

Hi all,

My husband is looking at several jobs in New York where he already has his New York Bar to practice as an in-house attorney at various financial firms. He's senior management - senior v-p I think in US. I have a pre-existing inherited kidney disease, which is currently being managed by medication but will in time need a transplant. I know there's no hard and fast, but I wonder if anyone has experience of something similar and if so, do you think I'm likely to be covered as a dependent under the employer's health insurance plans?

Thanks so much

Y
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Old Jan 14th 2016, 6:03 pm
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Default Re: Health insurance - am I covered as a dependent

I have never heard of anyone, or their dependant being turned down for employment-linked health insurance. There isn't even a medical questionnaire - you just need to be one of the defined dependants - spouse or child. Given that employer schemes have to be ACA compliant, and the ACA prevents discriminate based on pre-existing conditions, I don't see how an employment-linked scheme could reject a dependant.

Last edited by Pulaski; Jan 14th 2016 at 6:06 pm.
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Old Jan 14th 2016, 6:08 pm
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Default Re: Health insurance - am I covered as a dependent

I've got zero experience so that helps, as we had only heard of pre-existing conditions being rejected so were worried. Thanks
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Old Jan 14th 2016, 6:09 pm
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Default Re: Health insurance - am I covered as a dependent

Provided you pay the premiums, yes you will get coverage from your husband's group medical plan.

Pre-existing conditions are now no longer a restriction to getting medical cover in the US.

However, transplants are a very special situation and I know that in my previous group medical insurance there were some very specific conditions which had to be met before such a procedure could be approved or undertaken.

Indeed, most plans have procedures which need to be undertaken for many treatments i.e notification and approval from medical insurance company prior to treatment/procedure.

So, while you will undoubtedly get general coverage from your husband's group insurance you should look at the fine details.
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Old Jan 14th 2016, 6:36 pm
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Default Re: Health insurance - am I covered as a dependent

Ok thanks! Lastly - in your experience is this something that can be seen before one signs the employment contract? There's no point us moving out there and my having to come home when I get sick.
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Old Jan 14th 2016, 6:49 pm
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Default Re: Health insurance - am I covered as a dependent

Hi ask for a copy of the summary of the plan. I got mine prior to coming here to see the restrictions, co-pays and deductibles.

As others said its the total level of coverage that you pay for that can determine the need for medicals. As a lot of policies are fairly "basic" and you can add extra coverage, its usually the extras you have to qualify for and pay for.

Most prescriptions are covered but again what you co-pay as a percentage is down to the policy. Even though a figure of 20% you pay, 80% insurance pays can seem attractive, you really need to find out how much your meds cost and if you can get generics.


Luckily my prescriptions are generic so 20% is similar to what I pay in the UK on the NHS.
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Old Jan 14th 2016, 6:50 pm
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Default Re: Health insurance - am I covered as a dependent

Yes, you should be able to obtain a copy of the insurance policy with its conditions etc prior to signing any contracts.
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Old Jan 14th 2016, 6:54 pm
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Default Re: Health insurance - am I covered as a dependent

Originally Posted by Pulaski View Post
I have never heard of anyone, or their dependant being turned down for employment-linked health insurance.
There's no legal requirement that employer-provider insurance cover a spouse. Having said that, I think it's extremely unlikely that the OP's spouse's likely insurance wouldn't. I would certainly be asking though.

"This guidance does not include spouses in the definition of "dependents." Therefore, employers do not have to extend health insurance to an employee’s spouse."

For large employers, “pay or play” extends to dependent children

Last edited by Giantaxe; Jan 14th 2016 at 6:56 pm.
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Old Jan 14th 2016, 7:01 pm
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Default Re: Health insurance - am I covered as a dependent

Originally Posted by Giantaxe View Post
There's no legal requirement that employer-provider insurance cover a spouse. Having said that, I think it's extremely unlikely that the OP's spouse's likely insurance wouldn't. I would certainly be asking though.

"This guidance does not include spouses in the definition of "dependents." Therefore, employers do not have to extend health insurance to an employee’s spouse."

For large employers, “pay or play” extends to dependent children
A good point..... some folks on this forum have said that their spouse's policy did not cover them and/or the premiums, where they are able to be covered, are exorbitant.

However, this OP's hubby is looking at jobs as senior VP in financial firms in NYC so I think policies at that level would cover the spouse.
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Old Jan 14th 2016, 7:18 pm
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Default Re: Health insurance - am I covered as a dependent

Presumably if the employer scheme did not cover a spouse that spouse could apply for Obamacare?
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Old Jan 14th 2016, 7:41 pm
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Default Re: Health insurance - am I covered as a dependent

Originally Posted by MidAtlantic View Post
Presumably if the employer scheme did not cover a spouse that spouse could apply for Obamacare?
Yes
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Old Jan 14th 2016, 7:47 pm
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Default Re: Health insurance - am I covered as a dependent

Originally Posted by SanDiegogirl View Post
A good point..... some folks on this forum have said that their spouse's policy did not cover them and/or the premiums, where they are able to be covered, are exorbitant.
Often the employer will subsidize the employee's premium say 50% but the employee has to pay 100% of the premium for any dependents.

Originally Posted by MidAtlantic View Post
Presumably if the employer scheme did not cover a spouse that spouse could apply for Obamacare?
I think dependents can opt for the Obamacare exchange either way.
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Old Jan 14th 2016, 8:58 pm
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Default Re: Health insurance - am I covered as a dependent

i work for a major bank. Each year i have to chose my coverage in the medical scheme - there are varying levels of deductibles and plans etc. I also have to state whom is covered - and pay the associated cost - ie if i chose just me - then my contributions would be lower than the whole family.

So i would think for MOST normal large employers - dependants would be covered if wanted. You may have to provide periodic proof you are a dependant - i have to send in copies of marriage and birth certs for the kids every few years.

Just be aware also that not all health insurance is the same- and depending on the company policy and generosity - you may still be on the hook to pay significant co pays or deductibles - depending on what plans they chose to offer.
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Old Jan 14th 2016, 11:42 pm
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Default Re: Health insurance - am I covered as a dependent

It is up to the employer. As previously noted, the employer must pay for at least 50% coverage for the employee (some of my staff are fully funded). There is no requirement to provide insurance for a spouse. I don't know why they wouldn't as typically the spouse pays 100% of the premium, and the clerical work needed to add them is minimal.
We even go so far, as allowed by our carrier, to extend it to domestic partners. It costs us nothing, but is of huge benefit to the employee.
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Old Jan 15th 2016, 11:44 am
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Default Re: Health insurance - am I covered as a dependent

I'm not offered health insurance by my spouse's employer. You should check. It's not common but it does happen.
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