Common use of Spousal Insurance Clause in Contracts

Spousal Insurance. If an employee’s spouse is eligible to participate, as a current employee or retiree in group health insurance and/or prescription drug insurance sponsored by his/her employer or any public retirement plan, the spouse must enroll in such employer or public retirement plan sponsored group insurance coverage(s). This requirement does not apply to any spouse who works less than thirty (30) hours per week AND is required to pay more than fifty percent (50%) of the single premium to participate in his/her employer’s group health insurance coverage and/or prescription drug insurance coverage. This requirement also does not apply to any spouse who is a retiree under a public retirement plan and enrolled in Medicare coverage. Upon the spouse’s enrollment in any such employer or public retirement plan sponsored group insurance coverage, that coverage will become the primary payor of benefits and the coverage sponsored by the Board of Education will become the secondary payor of benefits. If an employee’s spouse enrolls in his/her employer’s health insurance, the employee shall not be required to enroll in single coverage offered by the Board of Education, provided the employee is eligible for family coverage. Any spouse who fails to enroll in any group insurance coverage sponsored by his/her employer or any public retirement plan, as required by this Section, shall be ineligible for benefits under such group insurance coverage sponsored by the Board of Education. Every employee whose spouse participates in the Board of Education’s group health insurance coverage and/or prescription drug insurance coverage shall complete and submit to the Board of Education, upon request, a written certification verifying whether his/her spouse is eligible to participate in group health insurance coverage and/or prescription drug insurance coverage sponsored by the spouse’s employer or any public retirement plan. If any employee fails to complete and submit the certification form by the required date, such employee’s spouse will be removed immediately from all health and prescription drug insurance coverages sponsored by the Board of Education. Additional documentation may be required. If you submit false information or fail to timely advise the Plan of a change in your spouse’s eligibility for employer or public retirement plan sponsored group health insurance and/or prescription drug insurance, and such false information or such failure by you results in the Plan providing benefits to which your spouse is not entitled, you will be personally liable to the Plan for reimbursement of benefits and expenses, including attorneys’ fees and costs, incurred by the Plan. Any amount to be reimbursed by you may be deducted from the benefits to which you would otherwise be entitled. In addition, your spouse will be terminated immediately from group health insurance and/or prescription drug insurance coverage under the Plan. If you submit false information, you may be subject to disciplinary action by your school district, up to and including termination of employment.

Spousal Insurance. This provision becomes effective March 1, 2013. If an employee’s spouse is eligible to participate, as a current employee or retiree in group health insurance and/or prescription drug insurance insurance, sponsored by his/her employer or any public retirement plan, the spouse must enroll in such employer (or public retirement plan plan) sponsored group insurance coverage(s)) OR in lieu of the employer (or public retirement plan) sponsored group insurance coverage(s) may secure his/her own individual health insurance policy. This requirement does not apply to any spouse who is also employed by the Garfield Heights City Schools. This requirement also does not apply to any spouse who works less than thirty (30) hours per week AND is required to pay more than fifty percent (50%) of the single premium to participate in his/her employer’s group health insurance coverage and/or prescription drug insurance coverage. This requirement also does not apply to any spouse who is a retiree under a public retirement plan and enrolled in Medicare coverage. This requirement also does not apply to any spouse if an Health Savings Account (“HSA”) is the only option that spouse has for health insurance. Upon the spouse’s enrollment in any such employer (or public retirement plan plan) sponsored group insurance coverage, that coverage will become the primary payor of benefits and the coverage sponsored by the Board of Education will become the secondary payor of benefits. If an employee’s spouse enrolls in his/her employer’s health insurance, the employee shall not be required to enroll in single coverage offered by the Board of Education, provided the employee is eligible for family coverage. Any spouse who fails to enroll in any group insurance coverage sponsored by his/her employer or any public retirement plan, as required by this Sectionrequired, shall be ineligible for benefits under such group insurance coverage sponsored by the Board of Education. Every employee whose spouse participates in the Board of Education’s group health insurance coverage and/or prescription drug insurance coverage shall complete and submit to the Board of Education, upon request, a written certification verifying whether his/her spouse is eligible to participate in group health insurance coverage and/or prescription drug insurance coverage sponsored by the spouse’s employer or any public retirement plan. If any employee fails to complete and submit the certification form by the required date, such employee’s spouse will be removed immediately from all health and prescription drug insurance coverages sponsored by the Board of Education. Additional documentation may be required. If you submit an employee submits false information or fail fails to timely advise the Plan Board of a change in your Education of his/her spouse’s eligibility for employer (or public retirement plan plan) sponsored group health insurance and/or prescription drug insurance, and such false information or such failure by you the employee results in the Board of Education Plan providing benefits to which your the employee’s spouse is not entitled, you the employee will be personally liable to the Board of Education Plan for reimbursement of benefits and expenses, including attorneys’ fees and costs, incurred by the Board of Education Plan. Any amount to be reimbursed by you may be deducted from the benefits to which you the employee would otherwise be entitled. In addition, your spouse will be terminated removed immediately from group all health insurance and/or and prescription drug insurance coverage under coverages sponsored by the PlanBoard of Education. If you submit Any employee submitting false information, you may information will be subject to disciplinary action by your school districtaction, up to and including termination of employment. For employee spouses who are enrolled in their employer’s insurance plan or in lieu of enrolling in their employer’s plan secured his/her own individual health insurance policy, the Board agrees to reimburse employees up to One Hundred Twenty-Five Dollars ($125.00) per month of actual documented premium costs paid by the employees spouse to his/her employer for single and prescription drug medical coverage. Such reimbursement shall be tax-free. Requests for reimbursement with attached documentation demonstrated that such premium contributions were made shall be submitted to the Treasurer’s office.

Spousal Insurance. If an employee’s 's spouse is eligible to participate, as a current employee or retiree in group health insurance and/or prescription drug insurance sponsored by his/her employer or any public retirement plan, the spouse must enroll in such employer (or public retirement plan plan) sponsored group insurance coverage(s). This requirement does not apply to any spouse who works less than thirty (30) hours per week AND is required to pay more than fifty percent (50%) of the single premium to participate in his/her employer’s 's group health insurance coverage and/or prescription drug insurance coverage. This requirement also does not apply to any spouse who is a retiree under a public retirement plan and enrolled in Medicare coverage. Upon the spouse’s 's enrollment in any such employer (or public retirement plan plan) sponsored group insurance coverage, that coverage will become the primary payor of benefits and the coverage sponsored by the Board of Education will become the secondary payor of benefits. If an employee’s 's spouse enrolls in his/her employer’s 's health insurance, the employee shall not be required to enroll in single coverage offered by the Board of Education, provided the employee is eligible for family coverage. Any spouse who fails to enroll in any group insurance coverage sponsored by his/her employer or any public retirement plan, as required by this Sectionrequired, shall be ineligible for benefits under such group insurance coverage sponsored by the Board of Education. Every employee whose spouse participates in the Board of Education’s 's group health insurance coverage and/or prescription drug insurance coverage shall complete and submit to the Board of Education, upon request, a written certification verifying whether his/her spouse is eligible to participate in group health insurance coverage and/or prescription drug insurance coverage sponsored by the spouse’s 's employer or any public retirement plan. If any employee fails to complete and submit the certification form by the required date, such employee’s 's spouse will be removed immediately from all health and prescription drug insurance coverages sponsored by the Board of Education. Additional documentation may be required. If you submit an employee submits false information or fail fails to timely advise the Plan Board of a change in your Education of his/her spouse’s 's eligibility for employer (or public retirement plan plan) sponsored group health insurance and/or prescription drug insurance, and such false information or such failure by you the employee results in the Board of Education Plan providing benefits to which your the employee's spouse is not entitled, you the employee will be personally liable to the Board of Education Plan for reimbursement of benefits and expenses, including attorneys’ ' fees and costs, incurred by the Board of Education Plan. Any amount to be reimbursed by you may be deducted from the benefits to which you the employee would otherwise be entitled. In addition, your the employee's spouse will be terminated removed immediately from group all health insurance and/or and prescription drug insurance coverage under coverages sponsored by the PlanBoard of Education. If you submit Any employee submitting false information, you may information will be subject to disciplinary action by your school districtaction, up to and including termination of employment. For employee spouses who are enrolled in their employer's insurance plan or in lieu of enrolling in their employer's plan secured his/her own individual health insurance policy, the Board agrees to reimburse employees up to One Hundred Twenty-Five Dollars ($125.00) per month of actual documented premium costs paid by the employee's spouse to his/her employer for single and prescription drug medical coverage. Such reimbursement shall be tax-free. Requests for reimbursement with attached documentation demonstrated that such premium contributions were made shall be submitted to the Treasurer's office.

Spousal Insurance. If an employee’s spouse is eligible to participate, as a current employee or retiree in group health insurance and/or prescription drug insurance sponsored by his/her employer or any public retirement plan, the spouse must enroll in such employer or public retirement plan sponsored group insurance coverage(s). This requirement does not apply to any spouse who works less than thirty (30) hours per week AND is required to pay more than fifty percent (50%) of the single premium to participate in his/her employer’s group health insurance coverage and/or prescription drug insurance coverage. This requirement also does not apply to any spouse who is a retiree under a public retirement plan and enrolled in Medicare coverage. Upon the spouse’s enrollment in any such employer or public retirement plan sponsored group insurance coverage, that coverage will become the primary payor of benefits and the coverage sponsored by the Board of Education will become the secondary payor of benefits. If an employee’s spouse enrolls in his/her employer’s health insurance, the employee shall not be required to enroll in single coverage offered by the Board of Education, provided the employee is eligible for family coverage. Any spouse who fails to enroll in any group insurance coverage sponsored by his/her employer or any public retirement plan, as required by this Section, shall be ineligible for benefits under such group insurance coverage sponsored by the Board of Education. Every employee whose spouse participates in the Board of Education’s group health insurance coverage and/or prescription drug insurance coverage shall complete and submit to the Board of Education, upon request, a written certification verifying whether his/her spouse is eligible to participate in group health insurance coverage and/or prescription drug insurance coverage sponsored by the spouse’s employer or any public retirement plan. If any employee fails to complete and submit the certification form by the required date, such employee’s spouse will be removed immediately from all health and prescription drug insurance coverages sponsored by the Board of Education. Additional documentation may be required. If you submit false information or fail to timely advise the Plan of a change in your spouse’s eligibility for employer (or public retirement plan plan) sponsored group health insurance and/or prescription drug insurance, and such false information or such failure by you results in the Plan providing benefits to which your spouse is not entitled, you will be personally liable to the Plan for reimbursement of benefits and expenses, including attorneys’ fees and costs, incurred by the Plan. Any amount to be reimbursed by you may be deducted from the benefits to which you would otherwise be entitled. In addition, your spouse will be terminated immediately from group health insurance and/or prescription drug insurance coverage under the Plan. If you submit false information, you may be subject to disciplinary action by your school district, up to and including termination of employment.

Spousal Insurance. See the end of the contract for an example of the Spouse Eligibility/Reimbursement Certification form A. If an employee’s spouse is eligible to participate, participate (as a current employee or retiree retiree) in group health insurance and/or prescription drug insurance sponsored by his/her employer or any public retirement planemployer, the spouse must enroll in such employer or public retirement plan employer-sponsored group insurance coverage(s). The spouse may enroll in single employer-sponsored group insurance coverage(s); the spouse is not required to enroll in family coverage. B. This requirement does not apply to any spouse who works less than thirty (30) hours per week AND is required to pay more than fifty percent (50%) of the single premium to participate in his/her employer’s group health insurance coverage and/or prescription drug insurance coverage. This requirement also does not apply to any spouse who is a retiree under a public retirement plan and enrolled in Medicare coverage. . C. Upon the spouse’s enrollment in any such employer or public retirement plan employer-sponsored group insurance coverage, that coverage will become the primary payor payer of the spouse’s benefits and the coverage sponsored by the Board of Education will become the secondary payor payer of the spouse’s benefits. If an employee’s spouse enrolls in his/her employer’s health insurance, the employee shall not be required to enroll in single coverage offered by the Board of Education, provided the employee is eligible for family coverage. . D. Any spouse who fails to enroll in any group insurance coverage sponsored by his/her employer or any public retirement planemployer, as required by this Section, shall be ineligible for benefits under such the group insurance coverage sponsored by the Board of Education. Board. E. Every employee whose spouse participates in the Board of EducationBoard’s group health insurance coverage and/or prescription drug insurance coverage shall complete and submit to the Board of EducationBoard, upon request, a written certification declaration verifying whether his/her spouse is eligible to participate in group health insurance coverage and/or prescription drug insurance coverage sponsored by the spouse’s employer or any public retirement plan. employer. F. If any an employee fails to complete and submit the certification form by the required date, such employee’s spouse will be removed immediately from all health and prescription drug insurance coverages sponsored by the Board of Education. Additional documentation may be required. If you submit submits false information or fail fails to timely advise the Plan Board of a change in your his/her spouse’s eligibility for employer or public retirement plan employer-sponsored group health insurance and/or prescription drug insurance, and such false information or such failure by you the employee results in the Plan Board providing benefits to which your the spouse is not entitled, you the employee will be personally liable to the Plan Board for reimbursement of benefits and expenses, including attorneys’ fees and costs, incurred by the PlanBoard. 1. Any amount to be reimbursed by you the employee may be deducted from the benefits to which you would otherwise be entitled. 2. In addition, your the employee’s spouse will be terminated immediately from the Board’s group health insurance and/or prescription drug insurance coverage under the Plan. If you submit false information, you may be subject to disciplinary action by your school district, up to and including termination of employmentcoverage.

Spousal Insurance. A. If an employee’s spouse is eligible to participate, as a current employee employee, self- employed individual (other than a sole proprietor) in a business or organization (e.g., partner, member), or retiree in group health insurance and/or prescription drug insurance sponsored by his/her employer employer, business, organization, or any public retirement plan, the spouse must enroll for coverage in such employer employer, business, organization, or public retirement plan sponsored group insurance coverage(s). . B. This requirement does not apply to any spouse who works who: 1. Works less than thirty twenty (3020) hours per week AND is required to pay more than fifty percent (50%) of the single premium to participate in his/her employer’s, business’s, organization’s or retirement plan’s group health insurance coverage and/or prescription drug insurance. 2. Is employed by another Huron-Erie School Employee Insurance Association (HESE) district, provided the spouse does not receive any available payment (or any other form of remuneration) from that HESE district for waiving health insurance and/or prescription drug insurance coverage. This requirement also does not apply to any spouse who is a retiree under a public retirement plan and enrolled in Medicare coverage. . C. Upon the spouse’s enrollment in any such employer employer, business, organization, or public retirement plan sponsored group insurance coverage, that coverage will become the primary payor of benefits and the coverage sponsored by the Board of Education HESE will become the secondary payor of benefits. If an employeebenefits according to the primary plan’s spouse enrolls in his/her employer’s health insurance, the employee shall not be required to enroll in single coverage offered by the Board Coordination of Education, provided the employee is eligible for family coverage. Benefits and participation rules. D. Any spouse who fails to enroll in any group insurance coverage sponsored by his/her employer employer, business, organization, or any public retirement plan, as required by this Section, shall be ineligible for benefits under such group insurance coverage sponsored by HESE. E. It is the Board of Educationemployee’s responsibility to advise the HESE Health Benefit Plan (the “Plan”) immediately (and not later than thirty (30) days after any change in eligibility) if the employee’s spouse becomes eligible to participate in group health insurance and/or prescription drug insurance sponsored by his/her employer, business, organization, or retirement plan. Upon becoming eligible, the employee’s spouse must enroll in any group health insurance and/or prescription drug insurance sponsored by his/her employer, business, organization, or retirement plan unless he/she is exempt from this requirement in accordance with the exemptions stated in this Section. F. Every employee whose spouse participates in the Board of EducationHESE’s group health insurance coverage and/or prescription drug insurance coverage shall complete and submit to the Board of EducationPlan, upon request, a written certification verifying whether his/her spouse is eligible to participate in group health insurance coverage and/or prescription drug insurance coverage sponsored by the spouse’s employer spouses’ employer, business, organization, or any public retirement plan. If any employee fails to complete and submit the certification form by the required date, such employee’s spouse will be removed immediately from all group health and insurance and/or prescription drug insurance coverages sponsored by the Board of EducationHESE. Additional documentation may be required. . G. If you submit an employee submits false information information, or fail fails to timely advise the Plan of a change in your his/her spouse’s eligibility for employer (or public business, organization, or retirement plan plan) sponsored group health insurance and/or prescription drug insurance, and such false information or such failure by you the employee results in the Plan providing benefits to which your his/her spouse is not entitled, you the employee will be personally liable to the Plan for reimbursement of benefits and expenses, including attorneys’ fees and costs, incurred by the Plan. Any amount to be reimbursed by you the employee may be deducted from the benefits to which you he/she would otherwise be entitled. In addition, your the employee’s spouse will be terminated immediately from group health insurance and/or prescription drug insurance coverage under the Plan. If you submit an employee submits false information, you he/she may be subject to disciplinary action by your school districtaction, up to and including termination of employment.