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Zirkelres

Spouse Health Coverage Surcharge

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My employer is now going to implement a 'Working spouse surcharge ($100 monthly) for a spouse/domestic partner who has medical coverage available through their employer but then remains on my employer health coverage plan.  Is this even legal? is it not discrimination to pay more for the same family coverage plan against the person who has a non-working spouse?  heck, why not now add a multi-child surcharge, should not the family of 4, 5 or more be charged more for their potential medical claims? 

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Your employer is legally entitled to provide individual coverage for the employers only, or to provide family coverage, or spousal coverage, or no coverage at all.  As long as the coverage and charges are not unfairly designed to reward the owner or top management, the employer or the insurer can set such terms as they feel appropriate.  I would hardly consider $100 per month for health care insurance as being unfair.  My wife's employer offered spousal coverage for $900 per month. 

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Not sure I completely understand the situation.

 

At my employer, for example, employees pay one rate if only the employee is covered, a higher rate, if both the employee and the employee's spouse are covered, and an even higher rate if additional family members are included.  Are you saying that employees who want employee-plus-spouse coverage are charged $X if the spouse either is not employed or is employed by an employer who does not offer medical coverage and $X+100 if the spouse is employed and has medical coverage available?

 

If so, yes, that's discrimination, but most discrimination is legal, and I see no reason why this wouldn't be legal.

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It is becoming more and more common for employers to either refuse to cover spouses altogether if the spouse has access to coverage through their own employment, or to charge a surcharge for doing so. Neither is illegal. Yes, it is discrimination, but not all or even most discrimination is illegal and this is the legal kind. 

 

Why shouldn't someone who is adding to the company claims ratio pay more than someone who isn't?

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yes, employees who want employee-plus-spouse coverage are charged $X if the spouse either is not employed or is employed by an employer who does not offer medical coverage and $X+$100 if the spouse is employed and has medical coverage available but chooses to remain on my employer family plan. 

 

How is that adding to the company claims ratio more so than a family with a non-working spouse and/or the addition of multiple children. I'd be willing to wager that the working partner has fewer claims than a no-working one and as I stated earlier, why not start surcharging for families with more than 1 or 2 dependents? 

 

So I suppose we just put the extra burden on those trying earn more and now we'll have to deal with 2 different healthcare plans, providers, drug plans, and have to fulfill separate deductibles to work this additional expenditure within our budget to have coverage within our already overpriced/burdened healthcare system.

 

Thanks for the answer I was seeking of legality, seems it is so.

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There's no logical reason why a working spouse who has medical coverage available through his/her employer would have more or less claims than a working spouse who does not have medical coverage available through his/her employer.  I have no idea whether a working spouse is more or less likely to have claims than a non-working spouse, but none of that is particularly relevant.  What is relevant is that employers who offer spousal coverage incur additional premium.  They pass a portion (but typically not all) of that additional premium on to the employees who obtain such coverage.  A working spouse has more ability to shoulder a larger share of the premium than a non-working spouse, and a working spouse who doesn't have coverage available through his/her employer has no other (good) choice.

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The more people who are included on the policy, the higher the likelihood of claims, or so it is thought in some circles. It has nothing to do with whether they are a working spouse or a non-working spouse. Or, for that matter, a dependent at all.

 

But this is how some employers see it: Jack and Joe both work for Company A, Jack's wife Susan works for Company B, and Joe's wife Lisa doesn't work at all. Both Company A and Company B offer health insurance to their employees. Company A will willingly cover Lisa since she has no access to other health insurance, but would rather that Susan be covered on Company B's plan since she has that option, rather than be covered on Company A's coverage. They would rather not cover spouses who have access to their own coverage so they provide a financial dis-incentive to include spouses who have other access.

 

I am not saying I necessarily subscribe to this school of thought. I personally think that the broader a base, the better for everyone. But as I have indicated before, the law does not much care what I think.

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