Who can benefit from Health Insurance for dependents?

Including dependents in health insurance is one of the situations that causes the most doubts for people. Many people do not know if it is possible to include their stable partner, mother-in-law, grandfather or even adopted child.
If this is your case, don’t worry! There is a law (9.656/98, from 1998 ) (1), which establishes rules and conduct for health plans and insurance. To simplify things, we have written this post with everything you need to know about the subject.
Follow us and find out who could be your dependent!
Health Insurance for Dependents: Find Out Who to Include in Individual Insurance
Firstly, it is important to understand that there are differences in the rules for individual or family health insurance (those in which the consumer signs a contract directly with the operator) and collective health insurance (which is brokered by legal entities).
In the first case, the rules must be stipulated in the contract. Some carriers offer the option of including dependents in the future, while others do not. Therefore, it is necessary to read what is written carefully and make comparisons between companies.
Let’s say you have just married, but your insurance does not have entry for new persons. You will have to talk this over with your insurance company so that they may change their contract. Be warned, though: according to the Consumer Protection Institute, Idec, in these cases, only the grace periods are obligatory for new beneficiaries.
Therefore, insurance companies are prohibited from requiring the recurrence of deadlines and waiting periods that have already been met by the policyholder. In any case, it is worth trying to negotiate with the broker in order to reduce or eliminate the deadlines for new dependents.
Understand how group insurance works
The rules for group insurance — that is, those intended for company employees, members of associations and unions, etc. — are slightly different. In this case, the law guarantees that “blood” relatives ( children , grandchildren, etc.) up to the third degree and those up to the second degree by affinity (in-laws) can be dependents.
Basically, the following people can be included:
Relatives up to the third degree
- children;
- grandchildren;
- great-grandchildren;
- country;
- grandparents;
- great-grandparents;
- uncles;
- nephews;
- brothers.
Relatives up to the second degree by affinity
- parents in law;
- spouse;
- couples in a stable union;
- same-sex couples.
Newborns
In the case of newborns, the legislation (9.656/98) states that the inclusion of a child (biological or adopted) is mandatory when the insurance offers obstetric coverage — this rule applies to both individual and family contracts as well as collective ones.
To ensure inclusion, the baby’s father and mother must contact the insurance company within 30 days of the birth. Ideally, the initial contact should be made in person, by email or telephone (remember to write down the protocol number).
The broker will probably ask for some documents to prove kinship, such as a copy of the birth certificate, ID and CPF. In any case, it is worth remembering that the baby cannot fulfill any waiting period. This is prohibited by law .
Furthermore, parents must be aware that operators cannot establish special conditions, increase monthly fees or refuse to include a child born with any special need — even if the child requires procedures, care, treatments or hospitalizations that are expensive.
Homosexual couples
Since 2010 (3), homosexual couples have been able to be included in health insurance plans. Despite this, many still have doubts about how the legislation works. It is important to note that the rules here are the same for heterosexual couples who are not civilly married. Therefore, it will only be necessary to prove the stable union.
Parents and grandparents
You should be aware that not all insurance companies recognize up to the third degree of affinity, and because of the age of relatives, it can significantly increase the value of the contract. Therefore, careful analysis must be done to know whether it is advantageous to have them included, in addition to knowledge of the law.
See what happens when a relative is fired from the company
When an employee (or member of an association, board, etc.) leaves the group (by resigning or leaving the company), their health insurance contract will be terminated and dependents will no longer be entitled to the service. However, there are cases in which relatives will be allowed to remain. Check out:
- unfair dismissal of the policyholder who made a fixed contribution to the cost of the plan: in this situation, the policyholder and dependents are guaranteed the right to maintain the insurance coverage. However, they must assume full payment;
- retiree who made a fixed contribution to the cost of the plan: if the employment relationship was for at least 10 years, he/she can continue with the insurance, as long as he/she assumes payment;
- death of the holder, if remission in the event of death is provided for in the contract.
Know the legislation well
It is indispensable to know the rules just to stay out of the hands of insurance companies, and it is necessary for analyzing what is said in the contract. Besides, this approach will also help in finding a brokerage firm with good market prestige and reliability. Hence, do some research and acquaint yourself with the legislation, understand your rights and duties in full.
Below, check out some tips before taking out the ideal insurance:
- check whether the contract allows the inclusion of dependents and see which relatives are permitted;
- in the case of insurance that authorizes the future inclusion of dependents, pay attention to the values and waiting periods;
- Whenever you request the inclusion of a new person, make the request in writing so that you can later prove what was done;
- if you want to include a relative, but your contract does not allow it, negotiate with the operator to change the type of insurance;
- If your contract was signed before January 1999 (when the current legislation came into force), you can ask for the document to be modified.
In any case, remember to always read carefully what is written at the time of signing. If there are any discrepancies with the law, do not sign and seek legal assistance.