Improving and expanding employee health benefits has been top of mind for employers across all industries, especially over the last few years as worker demand for better, more comprehensive health benefits has increased. At the same time, many organizations are also putting substantial effort into implementing diversity, equity, and inclusion strategies that help them attract and retain top talent. As companies look to foster a more inclusive and diverse workplace, offering family-friendly health benefits—and adjusting their criteria of who counts as family—is becoming an increasingly critical component of their DEI strategy.

In honor of Pride Month, we’ll learn more about non-traditional families, the criteria to be covered under a family health plan, which family health benefits are in high demand, and the advantages for organizations that offer diverse, inclusive family-friendly health benefits.

What are Non-Traditional Family Structures?

The nuclear family, defined as “a social unit of two parents and their children,”1 is what most people think of as a traditional family. Historically, the two parents in this context were assumed to be straight, cisgender and, most often, married. But in 2020, the number of children living with two parents reached an all-time low of 70%, according to the Census Bureau’s 2020 survey.2 The rest live in a variety of alternative family structures, including:

  • Blended families—stepparents, stepchildren, and/or half-siblings
  • Large, extended family structures— multiple generations living in one household
  • Families with cohabiting parents—unmarried parents living together with their children as a family
  • Same-sex partner families—two partners of the same-sex, regardless of marital status, with or without children
  • Single-parent families—one divorced, widowed, or single parent raising their children on their own
  • Family by choice—not blood relatives necessarily, but people who make up a family unit together

Even within these nontraditional family structures, there are many possible combinations that create unique, diverse families. While the Affordable Care Act (ACA) offers some protection to same-sex couples,3 not all families are given the same rights or access to employer-sponsored health benefits.

Who Currently Qualifies for Coverage Under Family Health Benefits?

Employees are required by law to provide health coverage for anyone they claim as a tax dependent.4 The most common tax dependents are spouses and children, though many employees also claim domestic partners, parents, siblings, and other relatives on their taxes—provided they meet the qualifications provided by the IRS.6 Even if an employee can claim someone as a dependent, there’s no guarantee that the dependent will also be covered under an employer-sponsored health plan. Here are some common guidelines for different groups of people.

Children are covered by a family health plan under the employee if:

  • They are under the age of 26.
  • They lived with the employee for at least six months.
  • They’re the employee’s biological child, stepchild, adopted child, or foster child.
  • No one else has claimed them as a dependent.
  • The employee provides more than half the financial support they rely on.
  • The child is not filing a joint tax return.

Employer-sponsored health plans can cover relatives other than children and spouses if:

  • No one else has named them as a dependent.
  • Their gross annual income is less than $3,000.
  • The employee provides more than half the financial support they rely on.

In addition to relatives, some employers offer health plan coverage for others who have lived in the employee’s house for at least a year and meet all of the criteria above.4

Health coverage criteria for domestic partners varies

The general criteria to be identified as domestic partners (or cohabitating parents) is that the employee and their partner are in a committed relationship, living together, but not married or joined in a civil union.

However, since federal law doesn’t require employers to offer health coverage to domestic partners, even if they offer spousal health benefits, states, cities, and companies create their own parameters for who is—and who is not—included in family plans.6

Same-sex couples are protected by the ACA

The ACA stipulates that all insurance companies are required to offer the same individual and group health plans to legally married gay and lesbian couples as they offer to married heterosexual couples.3 Self-funded employers that outsource insurance coverage to payers have operated under the same rules7 since a 2013 Supreme Court ruling.8

In 2020, the U.S. Supreme Court ruled9 that the Civil Rights Act “protects LGBTQ individuals from being fired due to their sexual orientation or gender identity.” However, this law doesn’t protect LGBTQ+ Americans who live in states where it’s still legal to be fired from your job for being gay and lesbian. So, requiring LGBTQ+ couples to get married to have health coverage exposes them to risk under state law. Even states, cities, and companies that do cover domestic partners under family health benefits may offer this coverage only to heterosexual couples.

Which Inclusive Family Health Benefits Do Employees Want Most?

Family-friendly benefits are those that support employees in balancing and integrating work and family responsibilities, across all life stages. Willis Towers Watson’s 2020 Emerging Trends in US Health Care Survey10 reported that employees would like their employer to offer family-related benefits that include expanded family leave (47%), bereavement leave or assistance (42%), and additional maternity leave (33%).

The same survey shared how employers are prioritizing family-friendly benefits. Some of the family health benefits offered include:10

  • Paid caregiving leave for employees caring for a spouse (20%), a child (not including parental leave) (19%), a parent (19%), a same-sex domestic partner (16%), and an opposite-sex domestic partner (15%).
  • Paid bereavement leave for the death of a spouse, child, grandparent, or sibling (90%), same-sex (77%) and opposite-sex (76% domestic partners), an extended family member (51%), a loved one (21%), or pregnancy loss (35%).
  • Fertility services beyond an infertility diagnosis (50%) including services for LGBTQ+ employees and single parents by choice. However, some employers require different populations to demonstrate infertility before covering fertility services.
  • Paid parental leave after birth or placement of a child through adoption or fostering to birth mothers (73%), birth fathers (64%), non-biological parents including opposite-sex and same-sex couples (58%), and adoptive parents (64%).
  • Other benefits and resources employers offer to assist caregivers including child care (34%), elder care (36%), legal assistance (69%), financial planning and support (45%), mental health support services for caregivers (44%), a flexible work schedule (77%) and location (75%), applied behavioral analysis (49%), emotional support for postpartum depression (28%), and gender transition support (26%).

Why Should Employers Offer Diverse, Inclusive Family Health Benefits?

There are a range of advantages gained by employers who cover family health benefits for all family structures. Employees feel more supported in balancing and integrating work and family responsibilities, they’re more present and productive at work, and their stress levels are reduced knowing that their family will be cared for under their benefits.

According to the Willis Towers Watson Emerging Trends in US Healthcare Survey, 65% of employers report providing family-friendly benefits because they align with their corporate mission and support the company’s DEI goals and objectives. 44% of employers offer family health benefits to achieve external recognition, while 30% cite environmental, social, and governance (ESG) commitments as a top reason for doing so.10

At Uprise Health, we prioritize diversity, equity, and inclusion internally and externally. We have a robust and diverse provider population and extend all our services wherever possible to any person living with a member’s household. Prioritizing individual health means prioritizing family health—and family means different things to different people.

We’re excited to see more companies talking about DEI and mental health. If you’re interested in learning more, check out this article on the role of mental health in DEI.