Just found out he's a Dad.

[Guest hankinbc]

Today, an employee approached us stating that he recently found out that he's the father of a 3 year-old and he wants to add her to our group health plan.

This isn't a birth or adoption, so I don't think this would be considered a special enrollment opportunity under HIPAA, but it may be a change in the number of dependents and we could sneak it in under the revised CIS rules.

Does anyone have any advice on whether we should allow this or not? If so, what would you require for documentation - an affidavit?

[david rigby]

Is the child a dependent?

Does your plan (or administrative proecedures) require some documentation of that status?

[Guest hankinbc]

In the event of a birth, we'd ask the employee to furnish a birth certificate. Per the father, the parents have made a "friendly agreement" regarding visitation rights, etc. I see where you are going. Should we hold out for a child support order or adoption?

[GBurns]

Since there does not seem to be any paternity litigation, the only source for verification of "visitation right's" would be from the father. In any case, Since when is "visitation" a condition for being a dependent?

A child support order would only be derived from a dispute over support. If he has accepted responsibility and has been meeting any criteria set by the child's mother there would be no dispute or litigation, hence no child support order should be forthcoming.

You expect him to adopt his own child?? How?

The only thing that you will most likely ever get is the child's birth certificate. If this shows this employee as the father, then he is the father and the child could be a dependent. What definition of dependent does your plan use? Will he be getting a Custodial Release or Joint Custody form (I cannot recall the IRS Form#) from the mother so that he can claim the child as a dependent on his tax return?

[jsb]

Since the qualifying event (birth) occurred well in the past, I think you need some other type of event to justify adding the child mid-year. If the "new" father can wait, enroll the child at your next annual enrollment. If he found out he was a father due to some court proceeding by the mother, a copy of the court order should work, even if they have to go back and amend it to cover his obligation for medical support. If this is an amicable discovery, and the father is trying to voluntarily provide the coverage, suggest he establish his parental rights through proper legal channels (amended birth certificate, court orders, ets) and ask for an order from the court that would qualify as a medical support order to permit (or compel) the employer to add the child to the plan.

[david rigby]

... to permit (or compel) the employer to add the child to the plan.

Can the court compel? Is the plan/employer a party to the determination of parental rights? support? dependency?