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U.S. Department of Labor Seal U.S. Department of Labor

Health Benefits Advisor

Adoption - Group Health Plan Through My Spouse

If certain conditions are met, you, your adopted child (including a child placed with you for adoption) and your spouse may have the opportunity for special enrollment. In addition, other enrollment opportunities in a group health plan may be offered by your spouse's employer, employee organization (such as a union), or both, regardless of whether your spouse is presently enrolled in the plan or when the plan otherwise permits enrollment.

Qualifications for Special Enrollment

The following individuals may qualify for special enrollment in your spouse's group health plan if the plan provides coverage for dependents:

  1. Your spouse, if he or she is not already enrolled in the plan and is otherwise eligible;
  2. You, if your spouse is already enrolled in the plan or enrolls with you; and
  3. The adopted child, if your spouse's plan covers children, and your spouse is already enrolled in the plan or enrolls with the child.

Time Frame for Special Enrollment

In order to special enroll in your spouse's group health plan, you must request the enrollment within 30 days of the date of adoption or placement for adoption. If special enrollment is properly requested, the plan must make the enrollment effective on the date of adoption or placement for adoption.

Additional Enrollment Rights

In addition to the special enrollment rights just described, you and your family members may have other rights to enroll in your spouse's group health plan. Additional rights to enroll may exist under the terms of your spouse's group health plan or under state law.

To find out more about enrollment rights in your spouse's group health plan:

  1. Read the notice of special enrollment rules that the plan was required to give you when you were offered the opportunity to enroll in the plan.
  2. Review the SPD (summary plan description) of your plan for information about enrollment rights; and
  3. Contact your state insurance department to find out if state law gives you or other family members additional enrollment rights.

How to Choose Among Health Coverage Options

Depending on your circumstances, you and your family members may have health coverage options available besides your spouse's group health plan. Before making any decisions, you should carefully consider information on your spouse's plan, any group health plan offered through your job, and other coverages for which you and your family members may qualify.

In choosing among the options available to you, you should review the SPD for each available group health plan to determine which plan best meets your needs. You should also review and compare the information on the other coverages for which you are eligible. In making your decision, you may want to consider such things as:

  1. Any waiting period (or affiliation period) imposed under the plans;
  2. Types of benefits offered (Is dependent coverage available? Do the benefits cover your family's medical needs?);
  3. Cost of coverage (premiums, co-payments and deductibles for prescription drugs and doctor visits);
  4. Limitations on coverage; and
  5. Any exclusions from coverage (treatments, procedures, conditions or prescription drugs).

To find out about other kinds of health coverage for which you and your family members may qualify, return to the Childbirth/Adoption Page and select another option.

UNITED STATES
DEPARTMENT OF LABOR