What Is a Qualified Beneficiary?

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  • Written By: Malcolm Tatum
  • Edited By: Bronwyn Harris
  • Last Modified Date: 13 September 2019
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A qualified beneficiary is an individual who is entitled to some sort of insurance coverage by way of a relationship with someone who is eligible to participate in a group health insurance plan. The range of individuals who may be classed in this manner vary somewhat from one jurisdiction to another, although most providers do allow for spouses and dependent children to be considered qualified for purposes of extending insurance benefits. In areas where some sort of ongoing insurance benefits are offered after the termination of employment, a qualified beneficiary is also often extended coverage as part of the arrangement.

In many jurisdictions, the legal spouse or civil partner of the covered party can be included as a qualified beneficiary on the health insurance arrangement. Any minor children that are living in the same residence as the covered party are also eligible for this status. With situations in which the covered party is a non-custodial parent, it is not unusual for any minor children living with the former spouse to also be eligible for coverage as a qualified beneficiary. This is especially true when the child support arrangement between the former spouses calls for the non-custodial parent to provide health insurance for the children up to a certain age, normally 18 or 22.


Once the coverage is in place, there is the possibility of adding a qualified beneficiary to the plan. For example, if the covered party should marry or enter into a civil union, the new spouse or partner can be covered under the health insurance plan as a qualified beneficiary. In addition, should the couple choose to adopt a minor child, that child can also be enrolled in the plan and receive the same level of benefits as afforded to everyone else participating in the family coverage.

The status of a qualified beneficiary is very important, especially if the employment of the covered party is severed for some reason. In some nations, former employees are eligible for state sponsored insurance plans for a period of time after the severance. Typically, if a beneficiary qualified under the employer’s group plan, that same beneficiary will also qualify under the new plan, although there may be some restrictions in terms of adding beneficiaries to this short term coverage. Since these types of contingency insurance arrangements vary somewhat from one country to the next, seeking counsel from qualified insurance professionals to weigh options and decide how to go about securing the best possible insurance arrangements for the interim period is always a good idea.


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