Does my health insurance cover my domestic partner?

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Within a company health insurance, the first-degree relatives of the worker are also usually covered or given the possibility of making this extension, mainly to include the spouse and children. However, there are particularities, exceptions, and limitations that may apply to the different types of policy. Neither the company nor the insurer is obliged to admit their family members to a worker’s health policy; this is, in any case, an added value.

Many companies offer their workers health insurance. The tax advantages for the company and for the employee himself are among the main reasons for this type of business initiative. However, it is a voluntary and totally private resource, so each company offers the health insurance that it prefers or that it considers most appropriate and/or advantageous.

There is no stipulated rule on what a company health insurance has or does not have to cover and there are as many varieties as there are companies. However, regarding the issue of including beneficiaries in the policy, you can find different types of options.

1. Fully personal company health insurance.

There are companies that hire and pay the health insurance premiums for their employees, but they are personal and individual policies on which the company agrees on conditions and assistance, and the employee cannot change them in any way. In this case, the possibility for workers to include anyone in this insurance is completely closed, regardless of the degree of kinship or relationship that unites them with the owner. This type of insurance is more common in companies or in groups of workers with activities that are especially risky or extreme for health. 

2. The company’s health insurance is familiar.

One of the most common cases is that companies offer their employees the possibility of enjoying health insurance contracted through the company – which can cover all or part of the premium. In this case, the worker enjoys better conditions than he would have if he freely contracted the same insurance. It is usually a relatively closed insurance policy in terms of conditions, assistance, and coverage. In the case of the extension of beneficiaries, however, it is usual that there is the possibility of including additional beneficiaries, although it is usually limited to the spouse – legally married – and the children, under 25 years of age.

3. Company health insurance is flexible.

There are cases in which the company offers its employees to contract and design health insurance with a specific insurer. In general, the company does not pay the insurance premium but simply makes it possible for the company’s employees to be hired under more advantageous conditions, but it is the worker who pays. As the premium would vary depending on what each employee contracts within their health policy, the possibilities in terms of coverage, services, and assistance are much broader and more flexible. Insurers, if they usually allow the inclusion of different relatives of the owner and common-law couples are no exception. Although in each case, particular conditions and costs may be contemplated.

The reality is that there is no standard applicable to all company health insurance, so you may find different cases and possibilities. However, it is true that even if you are not married, there are currently other possibilities for a couple to certify their cohabitation and stable and de facto relationship for legal and administrative purposes. Insurance companies can allow this type of circumstance if there is no specific exception in the policy offered by your company.

Remember that individual and private health insurance is chosen by each holder, according to their needs and priorities, the inclusion of beneficiaries is a personal decision, although it is always subject to the admission and approval of the insurance company. Meanwhile, company health insurance is usually a more closed and limited product, since it is the company that negotiates with the insurer and offers it to its workers.

If your company’s health insurance does not have specifications or limitations regarding its beneficiaries, you can request the inclusion of new insurable persons in the policy. The insurer will have to give you the pertinent reasons for the admission or rejection of your proposal, as well as indicate the specific conditions -if any- in case the new beneficiary is admitted. The change in your insurance premium with the new incorporation will also have to be reported in your case.

A company’s health insurance is usually advantageous, so it is always interesting to study this proposal if you are lucky enough that your company offers you that possibility. Evaluate what they offer you and consult all your particular circumstances, such as the possibility of including your partner and children. There are many options to suit the circumstances and needs of each person.

By aamritri

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