Back about a decade ago, a big company adding spousal eligibility limitations to their health plan was actually headline news. But nowadays, it’s an increasingly common practice, for several good reasons:
- Employers that add spousal eligibility limitations typically see plan savings of 4-6% or more.
- Eligibility limitations reduce the chances of adverse selection, an imbalance of high-risk members to healthier ones that may lead to spiraling costs.
The most common spousal eligibility limitations are :
- Exclusion: The most aggressive eligibility limitation, exclusion eliminates spousal coverage from the plan altogether.
- Waiver: If the member’s spouse can get coverage through their own employer, that employer’s plan must serve as primary coverage, while your plan can be used for secondary coverage. This is the most common eligibility limitation for MedBen clients.
- Surcharge: Members have to pay an extra cost to cover working spouses who have coverage available under their employer’s plan. Conversely, employers may offer members a monetary incentive for not adding spouses to their plan.
Currently, about one-third of MedBen clients have a spousal limitation in their plan. If you’re interested in exploring the options, we can help you implement a limitation strategy that best fits your benefit goals. Contact us at 888-627-8683 to learn more.