SPOUSAL SURCHARGES AND DEPENDENT ELIGIBILITY AUDITS ...
嚜澦EALTH WEALTH CAREER
SPOUSAL SURCHARGES AND
DEPENDENT ELIGIBILITY AUDITS:
S T R AT E G I E S T O M A N A G E
D E P E N D E N T P O P U L AT I O N S
A P R E S E N TAT I O N T O T H E
E M P L O Y E R S * H E ALT H C O AL I T I O N
OF IDAHO
SEPTEMBER 17, 2015
Sean White
Principal, Boise
SPOUSAL SURCHARGE
W H AT I S I T ?
? An additional monthly contribution required by an employer for employees who
choose to cover a spouse who has access to health coverage through his or her
own employer
? Sometimes referred to as a ※working spouse charge§
? Amount of the surcharge generally varies between $25 to $150+ per month, with a
median amount of $100 in 2014 for large employers?
1. From the 2014 Mercer National Survey of Employer-Sponsored Health Plans; ※large employer§ is defined as an employer with 500 or more employees
? MERCER 2015
1
SPOUSAL SURCHARGE
VARY I N G AP P R O A C H E S
? Most common approach:
每 If enrolling for spouse coverage, employee attests at open enrollment whether
his or her spouse has access to coverage through his or her own employer
每 Surcharge applies if
- Employee enrolls the spouse
- The spouse declines enrollment through his or her own employer
每 Surcharge does not apply if spouse is enrolled in both plans (so coverage
through the employee is secondary)
每 Some employers have not applied a surcharge in cases where the coverage
through the other employer is catastrophic or limited in nature (e.g. very high
deductible and out-of-pocket maximum, mini-med plan) or if the cost of coverage
on the spouse*s plan is excessive (e.g. >50% of premium cost)
? MERCER 2015
2
SPOUSAL SURCHARGE
VARY I N G AP P R O A C H E S C O N T I N U E D
? Other approaches:
每 Apply to all spouse coverage
- Surcharge is essentially buried in the employee contribution, spread across all
employees enrolling for spouse coverage
- Not common, questions of effectiveness due to the surcharge not being visible
and questions of equity
每 Exclude spouses from coverage entirely
- Allows spouses to access public exchange subsidies
- Very uncommon, and obviously could create employee relations, attraction,
and retention issues
? MERCER 2015
3
SPOUSAL SURCHARGE
VARY I N G AP P R O A C H E S C O N T I N U E D
? Other approaches:
每 Exclude spouses with access to other employer coverage from eligibility
- More effective at removing spouses from coverage, but more disruptive than a
surcharge
- Some employers modify this approach by allowing spouse enrollment only if
the other employer coverage is also taken
- Some large employers have taken this approach and made headlines#
※Since the Affordable Care Act requires employers to provide affordable coverage,
we believe your spouse should be covered by their own employer 每 just as UPS
has a responsibility to offer coverage to you.§?
1. From UPS Working Spouse Eligibility FAQ dated 7/15/2013;
? MERCER 2015
4
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