What are eligible dependents?

For a dependent to be eligible, they need to be claimed as such by the employee for tax purposes, reside in the US, and have a valid Social Security Number or equivalent.

Examples of eligible dependents can include:

  • Spouses
  • Children (under the age of 26)
  • Siblings
  • Domestic partners
    • This is subject to carrier requirements as some carriers do not consider domestic partners to be eligible dependents.
    • If carriers allow domestic partner enrollments, companies can decide whether or not they wish to allow domestic partner enrollments for their policy at Open Enrollment/Renewal.
  • Disabled parents
    • Depending on carrier rules, the disabled parent must share the same address as the employee, be disabled, and ineligible for Medicare.

Please note that ultimately it is at the carrier's discretion who is considered an eligible dependent. Dependents are subject to the same enrollment periods as employees and cannot enroll in insurance outside of an open enrollment period or qualifying life event (QLE) situation.

See IRS publication 501 for more information about qualifying dependents. While the ACA requires that spouses and children under the age of 26 are considered eligible dependents, carrier and group policies will ultimately determine if other dependent types are eligible for coverage.

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