Eligible Dependent?

[Guest ybahti]

An employee has legal guardianship over a sibling who is diabled and over age 25. Is this dependent eligible to be covered under the employees medical and dental coverage?

[papogi]

What is the plan's definition of dependent? That's the place to check, as the answer to this question might vary. My guess is that this person is an eligible dependent.

[Guest bmaverick2]

I agree, you must check plan document definition.

however, in general check IRC Section 152 for definition of dependent. Should she live with employee, and employee provides more than half of her support; whe will be a dependent for tax purposes.

[Guest ybahti]

Section 152 seems pretty broad in terms of dependents. Is a plan able to be more restrictive than 152?

[papogi]

Absolutely. Check the plan doc. That's where the answer is.

[jsb]

I think that your 125 Plan would have to allow it (you can be as liberal or conservative in your plan language as you want as long as you do not exceed 125 parameters), and then your contract with the health carrier would have to permit it.

Under our plan, the sibling would not be an eligible dependent under any circumstance.

[Guest kwong98]

jsb is correct stating the sibling isn't considered an eligible dependent under any circumstance. The insurance companies recognize dependents as spouse and/or kids.

[papogi]

The original post did not say that this plan was through an insurer. You might be right that no insurer would cover a sibling, but I know of some self-insured plans that do. The answer will be in the plan doc.

[jsb]

A coworker of mine used to work with a plan that had an eligibility definition that included "...any legally domiciled adult...". The purpose was to skirt the issue of "domestic partners", but in this case the sibling could be a covered dependent if they were the only other adult in the household covered by the employee's plan.