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Spouse / Partner

A spouse or partner is the person legally married to or living in a committed relationship with the insured plan member or policyholder. In insurance terms, a spouse includes both legally married and common-law partners who meet the eligibility requirements defined by the insurer. Common-law partners are generally recognized after living together continuously for a specific period, often 12 months or longer, in a relationship similar to marriage.

Spouses or partners are considered eligible dependents under most health, dental, and life insurance plans. They may share coverage with the plan member and can also coordinate benefits if both partners have separate insurance plans through their employers. Adding a spouse or partner to a plan typically requires proof of the relationship, such as a marriage certificate or signed declaration of common-law status.

Example:

If you and your partner have lived together for over one year and you are enrolled in a group benefits plan through your employer, you can add your partner as a dependent to extend health and dental coverage to them.

What to Watch For:

Check your insurer’s definition of spouse or partner, as the required cohabitation period for common-law eligibility may vary. Notify your employer or insurer promptly about life events such as marriage, separation, or divorce, since these changes can affect dependent eligibility and benefit coordination. If both partners have coverage, coordinate claims to maximize reimbursement while avoiding overpayment.

Related Terms

Coordination of Benefits

Coordination of benefits (COB) is the process used by insurance companies to determine the order in which multiple plans will pay for the same claim when a person is covered under more than one policy. The goal is to ensure that combined reimbursements do not exceed 100 percent of the eligible expense, while allowing the insured to receive the maximum possible coverage across all plans.

Dependent

A dependent is a person, usually a family member, who qualifies for coverage under someone else’s insurance plan. Dependents are typically the spouse or children of the primary insured person, also known as the plan member or policyholder. Some plans may also cover other individuals who rely on the plan member for financial support, such as a common-law partner or a child with a permanent disability.

Insured Person

An insured person is the individual covered under an insurance policy who is entitled to receive benefits for eligible claims. In a personal policy, the insured person is typically the policyholder who owns the coverage. In a group insurance plan, the insured person is the employee or member enrolled in the plan, and their eligible dependents may also be covered under the same contract.

Plan Member

A plan member is an individual who is enrolled in and eligible to receive benefits under a group insurance plan. Typically, the plan member is an employee of a company or a member of an organization that sponsors the group policy. The plan member is covered for the benefits outlined in the plan - such as health, dental, life, and disability insurance - and may also extend coverage to eligible dependents, including a spouse or children.

Member

A member is an individual who is enrolled and covered under a group insurance plan, typically through their employer, association, or organization. The member is often referred to as the insured employee or plan participant and receives coverage for benefits such as health, dental, life, and disability insurance. The member may also extend coverage to eligible dependents, such as a spouse or children, under the same plan.

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