What is a Working Spouse Rule?

Rising benefit costs and healthcare reform compliance have employers exploring different approaches to cost containment. One growing trend is the implementation of a Working Spouse Rule.

The Working Spouse Rule limits spousal coverage under your plan if that spouse has adequate coverage with their employer. Typically, this rule falls under three categories:

Spousal Surcharge

A working spouse is eligible for coverage under their employer’s plan, but elects to be a dependent under their spouse’s plan at your company. Under the spousal surcharge, your employee would pay, on average, an additional $1,200 ($100/month) in their annual contribution.

Mandatory Enrollment

A working spouse is required to purchase insurance through their employer’s plan first before also purchasing from your plan. Your organization would be come the secondary insurer.

Spousal Carve-Out

If the working spouse is offered equal to or better healthcare coverage by his or her employer, he or she is excluded from participating in your plan.

 While each type of Working Spouse Rule has its benefits, adopting one or more can save your company approximately $5,000 per non-employee spouse each year. This results in significant overall benefit savings for your company.