Employer Medical and Health Coverage of Stepchildren

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UPDATED: Jun 29, 2022

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Written By: Jeffrey JohnsonUPDATED: Jun 29, 2022Fact Checked

Unfortunately, there is ever increasing confusion as to the meaning of “step parenting” in today’s culture. These misunderstandings often lead to unnecessary pain and hurt, based upon a series of false, albeit understandable, legal assumptions. In discussing the roles of step-parents, always consider whether we are discussing a legal relationship — with obligations and duties — or a more casual definition, implying a third-party relationship. 

Nevertheless, there are some insurance policies, and certain factual situations, where step-parents (meaning non-legally related) may insure step-children. 

Modern “family” relationships can, obviously, be very complex to define. However, how we provide health insurance has not caught up with that complexity, since it is based on older definitions of “family.” As a result, employer-provided health insurance does not always have to cover step children, even though it will cover biological and adopted children. When someone pays for “family coverage,” that coverage was once based almost exclusively on a definition of “family” that only takes in legal relationships, such as those of blood, marriage, or adoption. 

Insurance is a contract, and that includes employer-provided health insurance. This means the insurer (acting through an agent) will negotiate the policy with an insured. However, the parties are not truly 100% free to contract as they choose, since states also pass laws to regulate insurance practices. 

Domestic Partnership Arrangements 

Not all (not even most) states have recognized, or allow, legal protections for, a variety of non-marital, but important (familial) cohabitation or quasi-contractual relationships. There are distinctions, however between when a state allows for domestic partnerships, somewhere along a continuum of associated rights, and compelling insurance companies to allow “step-parents” to add “step-children” to their insurance. Virginia, for one, does not recognize domestic partnerships….but allows step-parents (in the casual sense) to add step-children to employer insurance policies. 

It’s vital, therefore, to check your state’s specific laws on the subject, to see if whether you are in a state—like Virginia—that does allow step-parents to cover their step-children. 

Legal Adoption Distinguished 

Since a step-child is not legally a child of the step parent, that step-parent’s health insurance family coverage does not, absent some specific contractual clause or state law, have to cover the step-child, any more than an employee’s health insurance has to cover the children of boyfriends, girlfriends, or affianced. 

This uncertainty comes into play most acutely for stepchildren. While the step parent/step child relationship is a venerable one, recognized by society for centuries, there is actually not always legal force to it. When a man marries a child’s mother (or woman marries a father), he becomes that child’s step father only in a casual sense; but as a step-father, he does not have the same legal connection to that child that a biological or adopted father would. A relationship between two adults does not automatically create a legally cognizable relationship between one of those adults and the children of the other, no matter that the community and the children themselves may recognize the relationship. 

Of course, if the step-parent also adopts the children of his spouse, that changes everything. Adoption is in all respects the same, legally, as a biological parent-child relationship; adopted children are the children, in the eyes of the law, of the adopting parent. After adoption, the children would be eligible for health insurance under the adoptive parent’s plan. 


1. It’s always worth pursuing whether the step-parent and children could be covered under the other spouse’s insurance. That is, the spouse who is biologically related to the  children can clearly cover his or her own children under their health insurance; and the step parent s/he married is now his or her wife/husband, so s/he can be covered, too. 

2. State laws may require insurance based on cohabitation, domestic partnerships, or even a common law marriage, or a court order. Given that traditional marriage confers over 1,000 rights, it’s important to seek professional advice about how a state’s particular laws affect insurance rights and obligations between non-legally related individuals.

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Jeffrey Johnson is a legal writer with a focus on personal injury. He has worked on personal injury and sovereign immunity litigation in addition to experience in family, estate, and criminal law. He earned a J.D. from the University of Baltimore and has worked in legal offices and non-profits in Maryland, Texas, and North Carolina. He has also earned an MFA in screenwriting from Chapman Univer...

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Written by Jeffrey Johnson
Insurance Lawyer Jeffrey Johnson

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