Dependent Definition

[Guest calcu]

We have a health plan that simply defines dependent as a child until age 19 (23 if full-time student) and the parent provides over 50% of his or her support. The WFTRA, however, broke the definition of dependent into two categories. My question is whether it is necessary to amend our definition to include the age, support and residency requirement for a "qualifying child?" We only cover children who get more than 50% of their support from their parents, so the way I see it we will always satisfy at least the "qualifying relative" definition. Any thoughts?

[Guest grafals]

It depends.

What kind of health plan? What kind of coverage? For what purposes?

If it is just a group health plan that provides insured coverage, the insurer can provide coverage to anyone as defined in the policy. Likewise, if you are referring to insured coverage in a cafeteria plan, eligibility can be whatever the plan/policy/policies provide. Just clearly set forth the definition in the plan.

For COBRA, you can generally extend continuation rights more liberally than required by law. Again, just clearly set forth the def in the plan.

But, for HIPAA, the dependent will need to default to the legal definition. I'd just cite the code section in the plan and leave it at that.

For an FSA, IRB 2004-49 clarifies that the WFTRA definition does not apply. So, the 105 and 106 definitions are the same. I'd just cite the code here to. (I just found this out today! )

The problem with using conflicting definitions is having the administrator keep it straight in administering the plan. I tend to favor a uniform definition. So, I tend to favor just incorporating the legal def into the plan by reference where possible.