REQUIREMENTS FOR EMPLOYED SPOUSES OF ELIGIBLE EMPLOYEES. In order to be eligible for coverage under the District’s health insurance plan, any spouse of an eligible bargaining unit member who has coverage available through an employer- sponsored group health plan must join that plan, at least on a single enrollment basis, at the first (1st) open enrollment opportunity with his/her employer. A spouse of a bargain- ing unit member is considered to have coverage available if he/she meets the following criteria:
1. The spouse has access to continuous group coverage through employment;
2. The spouse works more than twenty (20) hours in an average work week;
3. The spouse is not required to make a contribution or is not required to pay more than thirty-five (35) percent of the cost of the premium. (Effective July 1, 2016 forty (40) percent of the cost of the premium) When the spouse has enrolled in a plan maintained by his/her employer, coverage for the spouse under the District’s plan will be secondary to the coverage provided by the spouse’s employer’s plan. The bargaining unit member will provide all information required to administer this pro- vision through the initial enrollment form or through a Coordination of Benefits Questionnaire form. If a spouse of a bargaining unit member has coverage available through his/her employ- ment in accord with the conditions stated above but fails to enroll for such coverage, spouse benefits paid by the District’s plan retroactive to the date on which the spouse became eligible for coverage through his/her employment will be recovered one hundred (100) percent. It is the responsibility of the bargaining unit member to keep Human Resources current about changes in family circumstances that could impact enrollment information for the health insurance plan. Information that is provided is considered to be truthful and cur- rent. Exceptions: Bargaining unit members who are married and both employed by the District and both eligible for health insurance benefits are not governed by the language of the above provisions.
