If an employee is the grandparent and legal guardian of a minor child, does the employee's health plan have to provide medical coverage for the child?

An answer is going to depend on what state you are located in, if the benefits are provided by health insurance or by a self-funded benefits plan. For example, federal govt employees may cover grandchildren in certain instances provided the employees hiring office approves. In Ohio, an insurance company does not have to cover children who are not legally adopted by the enrollee. There is also a distinction between legal custody and legal guardianship. As a first step, check the language of the plan covering the enrollee to see if the plan allows it. If it is a true insurance policy, you can get your state's department of insurance to interpret whether the child should be covered if there is any question of eligibility.

Assume it is a self-funded plan and the plan does not currently allow coverage.

kredlin:

If the plan is self-insured it can determine who is covered as a dependent. Even if it is insured I don't think a state insurance department can force an employer to cover grandchildren even if the covered employee is legal gardian.

I agree with Kip--no coverage in self-funded unless plan language specifically allows it. Just not sure on state law, although I've been surprised enough times on what some states allow/mandate, usually those liberal leaning states.

What about any federal laws relating to this issue? Are there any that may require coverage?

If the employee is the legal guardian under a fully insured plan, coverage is allowed. How long would they have to enroll the child?

kredlin:

Check with the carrier and see if it is allowed or if it is self-insured as you indicated, check your plan documents. There's no reason why this couldn't be covered since most carriers allow children to be covered if there is a court-order document indicating legal guardianship.

matt