Should You Offer Spousal Health Care Coverage?

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17 Aug Should You Offer Spousal Health Care Coverage?

When looking to manage benefits costs, employers have many ideas to consider. One in particular is whether and how to offer health care insurance to their employees’ spouses.

The Affordable Care Act does not require spousal coverage. It only requires coverage for dependent children. But many employees may frown on seeing spousal coverage suddenly become expensive or vanish entirely. So, this is a question warranting careful forethought.

Two established ways

Essentially, there are two established ways of saving money on spousal coverage:

  1. Rationalizing the expense through a cost-sharing surcharge
  2. Eliminating coverage altogether through a ‘spousal carve-out’ policy

Few employers appear willing to lower the boom on spousal coverage by eliminating it (also known as an ‘absolute carve-out’) — especially when spouses lack access to coverage through their own employers. Forcing workers’ spouses to seek coverage on the individual market, possibly at a very high cost, would likely embitter the affected employees, potentially increasing turnover.

Potential variations

But it does not have to be an all-or-nothing proposition. One variation on the surcharge approach is to give a monetary award to employees whose spouses switch from your plan to the spouse’s employer’s plan.

You could have a spousal carve-out program with an escape hatch. Such an arrangement would allow the spouse to remain on your plan if the price the spouse would have to pay for coverage under his or her own employer’s plan exceeds a specified threshold.

Still another approach is to require employed spouses whose own employers offer coverage to enroll in those plans in order to receive benefits under your plan. This way, yours becomes the secondary plan, incurring only the portion of claims not covered by the spouse’s employer’s plan (the primary plan).

Worthy contemplation

Unfortunately, there are no quick and easy ways to keep health care plan costs in check, but policies that ensure you are not paying the medical bills of employee spouses who could be getting coverage through their own employers are certainly worth contemplating.

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