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My work covers health insurance for me and my spouse, but recently we had a baby and I was told by HR that our baby would not be covered by insurance. I was told that covering the baby would be too costly for the company (it's a small company) and that I would need to take out an insurance policy on my own. Had we already had a baby when I started working there, all 3 of us would have been covered, but because the baby came after I started working there, they don't want to take on the added cost.

Now, I don't make very much as it is (am actually underpaid for my position), and the idea of paying a monthly health insurance premium is daunting financially (but we would gladly do it, of course, for the sake of our baby). From a purely financial perspective, I'd need a bump in income just to cover the cost of the insurance premium, but if HR isn't going to cover our baby on its insurance policy because of the extra cost, it doesn't seem likely I would be given a raise even if I asked.

My first question is, Is this normal for a company to cover health insurance of spouse but not subsequent dependents born after the hire date? And specific to my situation, do I have a bargaining chip to ask for a raise to help offset the cost of the premium?

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  • this will almost certainly fall into legal advice so I suppose the OP is off-topic. Personally speaking though (US based comment), I have often see various 'levels' of coverage and employer / employee contribution. Self, Self + Spouse, and Self + Family. So that in itself isn't terribly odd. You should definitely check the HR paperwork / benefits info you received when hired (and honestly should be getting every year at renewal time) to see if there is a family option. Then yeah, as others have said, call a lawyer.
    – NKCampbell
    Apr 4, 2017 at 15:59

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Is this normal for a company to cover health insurance of spouse but not subsequent dependents born after the hire date?

No, it most certainly is not normal. IANAL or healthcare expert, but I believe under the ACA most employer insurance plans are required to offer coverage (not for free though1) for dependents up to age 262. A newborn child should most certainly be able to fall under your plan, but you might be responsible for the premium. What doesn't seem right to me is that they would offer dependent coverage for some employees but not others, which appears to be banned outright3.

The health insurance laws are all very complicated with lots of exceptions, particularly for companies with less than 50 employees2, so I definitely recommend talking to a professional about this. Try calling your insurer directly, as they will definitely have a good understanding of the applicable laws. If they don't know the answer to your question, you should really talk to a lawyer.

And specific to my situation, do I have a bargaining chip to ask for a raise to help offset the cost of the premium?

I don't think this a chip you want to play, and may not need to if the law is on your side. Hopefully they will do what is ethical (and likely legally required) and cover your child. If they don't, I would look for a new company. If they are penny-pinching enough that they won't cover a newborn's health insurance, I can't imagine the company is in a good financial state.

1: "businesses with 50 or more full time-equivalent employees to offer health insurance to their full-time employees and those employees’ children. But while the coverage must be considered affordable for the employees, there is no requirement that the employer fund any portion of the premiums for dependents"

2: "group insurance plans are required to extend coverage to adult dependents through age 26"

3: "An employer cannot discriminate by extending coverage to some employees’ family members but not to others."

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    This is a mess, and needs research. Coverage must be offered, not necessarily provided. The employee may still need to pay for it. It didn't apply to small business at first. The rules are very different for businesses with fewer than 50 employees. The rules for companies with fewer than 50 employees change radically this year, and I don't even pretend to know everything about it. With what I have read, the worst part for small businesses kicks in this year. Competent legal advice may be necessary, here.
    – Wesley Long
    Apr 4, 2017 at 15:51
  • @WesleyLong Yes, it's all very complicated and I don't claim to be an expert, which is why my primary advice is to talk to professionals, not accuse the company of breaking the law. Regardless of what the company is legally required to do, it is certainly not standard company policy for them to cover existing children but not new children.
    – David K
    Apr 4, 2017 at 16:16
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    Yes, agreeing. Just filling in some details as to what may need to be mentioned.
    – Wesley Long
    Apr 4, 2017 at 16:33
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    The second sentence is entirely incorrect in this context. The ACA requires that insurers allow subscribers to keep their children on their policies until age 26. It does not require that employers foot the bill for that coverage or that an existing policy extend it at no extra charge. I don't think I've ever run across an employer health plan that wouldn't let you add spouses and children for a higher premium.
    – Blrfl
    Apr 4, 2017 at 18:14
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    The terms you want to use when talking to the insurance company are "life-changing event' or "qualifying life events". Generally you can only adjust insurance through the workplace during the annual open season or if you have a life changing event such as new spouse, a new child, etc. I have never heard of any insurance company that did not allow changes for these events. You should have gotten paperwork on your insurance plan at the time you signed up for it, look to see if this is included in the policy. If your policy says you can add them, I am not sure the company can prevent it.
    – HLGEM
    Apr 5, 2017 at 18:19

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