Health coverage different for employee than for dependent

Is anyone else aware that the benefits of a health plan can be different for the enrolled employee versus the dependent?  How is this even legal in any state?  And disclosure is not required either.  This was a work-related injury.

Fuming and Hurt

Dear Fuming and Hurt,

I  think what you have found is that a dependent’s work-related injuries  are not covered by the parent’s (or spouse’s) health insurance.  This is  standard language for health insurance contracts, though some insurers  are not diligent about refusing to pay these claims.

With  the right wording, the insurer could refuse to pay the claim even if  the dependent did not have workers compensation coverage from the  employer.  Thus, a self-employed person who does not have to have workers compensation coverage could be left to pay for his/her own injury.

The disclosure would be in the certificate of coverage, though they may or may not refer to workers compensation specifically.  They would simply state that the plan would not cover care that could be covered by another liable party (such as an employer).


Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.