Although every effort has been made to compile this information to ensure that its content is completely accurate, neither the publisher nor the author can accept any responsibility for any inaccuracy or change in circumstances of the information contained herein or for the consequences of reliance on it. This publication is distributed on the condition that the publisher does not provide any legal, accounting or other professional advice or service. Readers should always seek professional advice before making commitments. No, spousal supplements are not added in the middle of the year. You must submit a specific choice of spousal supplement during the next open registration period beginning on January 1 of the following year. Code § 152 (f) (1) defines “child” as “a son, daughter, son-in-law or daughter-in-law of the taxpayer or. an eligible foster child of the taxpayer. The Plan has no obligation to include in the definition of a dependant person person person who does not fall within the definition of “child” under paragraph 152(f)(1), such as the niece, nephew or grandchild of a legal guardian; And if the plan decides to include these people in the definition, it may impose additional restrictions. See FAQ under www.dol.gov/sites/default/files/ebsa/about-ebsa/our-activities/resource-center/faqs/aca-part-i.pdf (Q&A #14). When it comes to spousal supplements and all the consequences of such a move, employers have a variety of options to choose from. It is understandable that employers are looking for ways to expel spouses from their plans, or at least limit availability to specific individuals.
The average spouse can cost up to $1,179 more than the actual health plan holder, according to an in-depth study by the Institute for Employee Benefits Research (EBRI). CFOs who are considering adding a spousal supplement or placing a burden on their own health care services are certainly in good company. A recent employee benefits survey conducted by the International Foundation of Employee Benefit Plans (IFEBP) found that nearly a quarter (21%) of employers have introduced some form of spousal supplement or exception. Another 13% said they planned to do so by 2014. These types of supplements typically range from $500 per year to $3,000. Since exclusions for dependent children are generally only available to small employers and that dependent child coverage supplements tend to be an issue among the requirements of the ACA for employers of all sizes, the design and management considerations described below focus on exclusions and spousal supplements. In the context of a fully insured plan, while supplements are generally not an issue, keep in mind that some airlines do not allow exclusions. Employers implementing a supplement for spin-offs or spouses must update the plan documents and the plan summary description to reflect the new registration rules. Employers should also carefully and clearly describe the eligibility criteria, as well as the review procedures and possible consequences. You should also ensure that these elements are communicated to employees, usually as part of the registration process.
A spousal supplement is an additional fee or premium that an employee must pay if their spouse has another source of health insurance through their own employer but chooses to be added to the employee`s plan. A joint supplement only applies if the spouse has other health insurance options. Employers are not required to provide coverage to spouses. Employers who choose to offer spousal coverage have the option to charge a supplement on spouses who register or completely separate from the spouse`s eligibility without violating benefit compliance rules. A spousal split does not trigger COBRA continuation rights for spouses currently covered by the employer`s plan. Loss of eligibility resulting from a plan change is not a COBRA qualification event for the spouse. While some employers may be tempted to offer COBRA in this situation, an insurance company or stop-loss provider may not provide coverage because it is not an actual COBRA event. As I wrote in my Next Avenue article, “Divorce is a Painful Blow to Women`s Insurance,” Sociology graduate Bridget Lavelle, and Pamela J. Smock, director of the university`s Population Studies Center, noted in the Journal of Health and Social Behavior that many women between the ages of 50 and 64 have to opt for spousal coverage because they are inactive, work part-time, or are employed by small businesses or nonprofits that don`t offer health insurance.