Can an employer sponsored health plan provider require that personal/private documents be submitted in order to provide dependent coverage?

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Can an employer sponsored health plan provider require that personal/private documents be submitted in order to provide dependent coverage?

Employer sponsored health care insurer is requiring proof of marital status (current year Federal or state tax return or marriage certificate and mortgage statement, credit card statement, auto insurance statement which shows both employee and spouse listed/joint ownership), proof of parent/child relationship (child’s birth certificate), proof of financial support of child (federal or state tax return showing child as dependent

Asked on April 22, 2011 under Employment Labor Law, Texas

Answers:

SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 10 years ago | Contributor

The plan can definitely require these things. They are requiring nothing more than the employee prove that he has the family members or dependents that he or she claims he is. Insurance is a contract; insurers (including self-insured employers) may put pretty much any terms they want on buying or receiving insurance, and those terms can include proving eligibility. The insurer does not need to take a would-be-insured at their word that someone else is a spouse, for example, and therefore covered: they can can ask for proof. It's no different than having to provide proof of the value of a car being insured, or a house being appraised to prove value, or taking a medical test before receiving life insurance.


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