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Insurance coverage for dependent spouse
Benefits & Compensation
Insurance coverage for dependent spouse
Exchange ideas about health plans, retirement, work/life benefits, and employee assistance.
We have an employee who has waived medical coverage due to the fact that he is currently covered under his wife's group medical plan. His wife's insurance company contacted her and wants to know what
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Forums » Topic Forums » Benefits & Compensation » Insurance coverage for dependent spouse
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Insurance coverage for dependent spouse
posted at 9/13/2010 7:05 AM EDT
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Posts: 11
First: 9/23/2008 Last: 9/14/2010 |
We have an employee who has waived medical coverage due to the fact that he is currently covered under his wife's group medical plan. His wife's insurance company contacted her and wants to know what percent that we pay on our employees coverage. Evidently they are saying that if we pay a certain percent of our employees coverage then he should be on our insurance and not theirs. We are in Texas and I have not had this issue come up before. This is also confidential information that we do not give to the employees. Is this legal? |
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Insurance coverage for dependent spouse
posted at 9/13/2010 7:58 AM EDT
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Posts: 2146
First: 2/15/2006 Last: 9/14/2011 |
Actually it is totally legal for the other company to refuse to cover spouses that have any coverage (even if they pay 100% of it personally with 0% employer paid).
So it seems that this company has a bit less strict criteria. What I would do is contact someone in HR at that company and ask what that level is and then be willing to write a letter on corporate letterhead stating that your company pays more or less % than their standard level. That way, you are answering their question, but without giving out an exact answer. It used to be that a lot of companies paid 100% of the employee only cost. But a lower percentage on dependents (spouse and/or children). The way I look at it is if the employee could be mostly paid for by their own employer, why should the spouse's employer be responsible for any portion? But then again, I wish health insurance were totally private and NOT employer driven! |
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Insurance coverage for dependent spouse
posted at 9/13/2010 8:01 AM EDT
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Posts: 2146
First: 2/15/2006 Last: 9/14/2011 |
eta: it is also legal for them to charge a surcharge if the spouse has other coverage available but chooses to be under their plan. It actually sounds like they are being reasonable in NOT doing those two things (totally deny or upcharge).
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Insurance coverage for dependent spouse
posted at 9/13/2010 9:48 AM EDT
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Posts: 2146
First: 2/15/2006 Last: 9/14/2011 |
Yes, at least so far I have not seen any employer requiring they be covered elsewhere. Usually that just comes down to a financial aspects of which has better coverage for the lessor amount. An employer who wants to incentivize dependents be covered elsewhere will set their dependent rates at 100% of the cost with no subsidizing at all.
And if both have the children covered then it usually comes down to a birthdate or something. There is a specific rule that I always forget! |
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Insurance coverage for dependent spouse
posted at 9/14/2010 5:08 AM EDT
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Posts: 1047
First: 4/11/2002 Last: 9/14/2011 |
Perhaps 15% - 20% of employers will have a surcharge for spouses jumping on their plan if they have coverage elsewhere. So while it's not common, it's out there.
I'm not sure how much benefit this approach has over the long haul, however. If a spouse has insurance through his or her employer and he's on the insurance plan of another employer, it usually means coverage is worse or contributions are lower. Forcing your employee to pay more for his or her insurance isn't exactly going to help when it comes to attraction and retention. |
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Insurance coverage for dependent spouse
posted at 9/14/2010 5:22 AM EDT
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Posts: 11
First: 9/23/2008 Last: 9/14/2010 |
Thank you for your help. I am in the process of contacting the spouses employer to get the details that they need for this decision. If they mandate that our employee cannot stay on their plan, then this will be a qualifing event and I can add him to our plan at the 1st of the month. |
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Insurance coverage for dependent spouse
posted at 9/15/2010 12:45 PM EDT
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Posts: 1
First: 9/15/2010 Last: 9/15/2010 |
So...if the end result is that the employee is no longer eligible for dependent enrollment in his spouse's plan, thus needs to enroll in his own company's plan---would that plan-based ineligibility, qualify as a Life Event that would enable him to jump into his company's plan without late enrollment penalties? |
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Insurance coverage for dependent spouse
posted at 9/15/2010 1:10 PM EDT
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Posts: 1047
First: 4/11/2002 Last: 9/14/2011 |
I don't think the company can exclude this dependent from being insured on the plan, assuming he or she meets the definition of a dependent. What the employer can do is not make a contribution to his or her insurance. A qualifying event would probably come into play here or the dependent could just wait until the next open enrollment. |
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Insurance coverage for dependent spouse
posted at 9/16/2010 8:46 AM EDT
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Posts: 2146
First: 2/15/2006 Last: 9/14/2011 |
Actually they can exclude as long as their plan document is written such that their dependents are defined that way. Unless PPACA changed that. I know that child dependents with the age cap are still eligible even if they have access elsewhere. But I haven't seen that applied to spouses.
Of course you get into the situation of asking employees to lie about spousal coverage.... |
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