How do most self-funded plans define dependent child eligibility particularly where a child or step-child does not live with the employee? Do plans cover step-children not living with the employee? We have our plan defined as primarily dependent upon the employee for support. Can we say that must be declared as a dependent on their tax return? Do other plans exclude step-children not living with the employee?

When it comes to dependent child eligibility, you can define it any way you'd like. Sorry to be so general, but it differs from company to company. What I've seen most often is exactly the way you have it - primarily dependent upon the employee for support.

For a biological or adopted child, you can't condition enrollment on whether or not the child is claimed as a dependent on the federal income tax form, whether the child resides with the parent, or whether the child was born out of wedlock. Step-children are another matter. We see plans do different things. Our more generous plans will enroll step-children living in the home if the custodial parent (new spouse of the employee) has a QMCSO that requires the custodial parent to maintain coverage.

In our health plan the step-child must live with the employee, the employee or the employee's legal spouse must have legal custody of the step-child and the step-child must reliant upon the employee for support.