Spouse Coverage. Effective September 1, 2018, if the spouse of a Staff Member is not an employee of the District, and is eligible for group health insurance coverage through his/her employer’s medical/health insurance plan, then he/she is not eligible to participate in the group medical/health insurance plan offered by the District to Staff Members. Children and/or qualified dependents of the Staff Member are eligible to participate in the group medical/health insurance plan offered by the District to Staff Members.
Spouse Coverage. 1. If a spouse of a covered employee is eligible for his/her employer’s health insurance plan, for which the employer pays a minimum of 50% of the insurance premium or an equivalent amount in cash or contribution to Internal Revenue Code Section 125 (cafeteria plan), the Health Insurance Plans will only pay claims as if it were secondary to the spouse’s employer’s plan.
2. A spouse covered by his/her employer’s insurance plan may remain as a participant in the Health Insurance Plans, but coordination of benefits shall apply and the employer’s plan will be primary.
3. If the insurance coverage available to the spouse through his/her employer is limited by a pre-existing condition, the Health Insurance Plans will act as primary for the pre-existing condition until the spouse has satisfied the pre-existing condition limitation. The spouse must present a declination of coverage due to the pre-existing condition limitation. The information must be from the employer’s health insurance carrier or the spouse’s physician.
4. If a spouse currently under the Health Insurance Plans is ineligible for his/her employer’s health insurance as outlined in paragraph one, or due to medical conditions is unable to become eligible under his/her employer’s plan, he/she may remain solely on the Health Insurance Plans.
5. If a spouse becomes ineligible for his/her employer’s plan, he/she may enroll as a dependent in one of the Health Insurance Plans during the open enrollment period, and a spouse can enroll outside the enrollment period if one of the three qualifying events listed in the Plan document occurs. In such an event, any pre-existing conditions limitations of the Health Insurance Plans shall be waived.
Spouse Coverage. (A) When both the husband and wife are Members, either one family plan or two single plans shall be available. The type of policy shall be decided by the Members.
(B) A Member’s spouse who is eligible to receive health insurance coverage through his/her employer must enroll in such plan on at least a single enrollment basis. A spouse is considered to be eligible for his/her employer’s health insurance plan if: ● The access is continuous (i.e., non-seasonal) and reasonable group coverage is available, and ● The spouse works more than twenty (20) hours in an average work week, and ● The spouse is not required to pay more than forty-five percent (45%) of the premiums
(C) A spouse shall not be required to enroll in his/her employer provided health insurance plan if the only plan available is a High Deductible Health Plan with a Health Savings Account (HDHP with HSA) (which per IRS rules does not allow for secondary coverage) or the IRS does not allow for secondary coverage for any plan(s) offered by the spouse’s employer. When the spouse has enrolled in a health insurance plan maintained by his/her employer, coverage for the spouse under the Board provided plan shall be limited to secondary coverage when the Member carries a family plan. The Member shall provide all information required to administer this provision through the enrollment form/process or by completion of the Spousal Determination Form distributed by the Board by August of each year. Failure to provide accurate information may result in the Member having to repay any contributions, premiums, premium reimbursements or claims paid by the Board.
(D) Any Member who is an employee prior to the 2016-17 school year, shall be reimbursed up to $2,000 annually for the difference in net premium payments from that required of his/her spouse’s employer and the payment amounts required by the Board’s plan. See addendum.
Spouse Coverage. An eligible employee may include health insurance coverage for his spouse under the following conditions:
(1) From the date of the employee's eligibility for paid health insurance up until the annual open enrollment period for group health coverage, the County will pay 50% of the premium difference required to include the spouse with the employee paying the remaining 50% of the premium difference.
(2) For the next twelve month period, the County will pay for 60% of the premium difference required to include the spouse with the employee paying the remaining 40% of the premium difference.
(3) For the next twelve month period the County will be responsible for paying 70% of the premium difference required to include the spouse with the employee paying the remaining 30% of the premium difference.
(4) For the next twelve month period the County will be responsible for paying 80% of the premium difference required to include the spouse with the employee paying the remaining 20% of the premium difference.
(5) For the next twelve month period the County will pay 90% of the premium difference required to include the spouse with the employee paying 10% of the premium difference.
(6) The County will be responsible for the entire premium payments made thereafter. For all employees hired after October 1, 2000, spouses may continue to be covered by the Employer’s health insurance plan at the employee’s expense. In the event of the employee's death the spouse (at time of retirement) may continue coverage as described in this Section at the County's expense. (For all employees hired after October 1, 2001, the coverage shall be provided at the spouse’s expense). In the event of the death or divorce of the employee's spouse (the person married to the employee at the time of his retirement) and if the employee remarries, that new spouse may be covered at the employee's expense. If an employee is single at the time of retirement and later marries, that new spouse may be covered at the employee's expense.
Spouse Coverage. In the event a husband and wife are both employees of the County, or any of the Courts of Xxxxxx County, the payment provisions in lieu of health insurance coverage as stated under Section 6 shall be mandatory. Those employees shall not be permitted to have double health insurance coverage from the same or different options noted in this Article. Employees losing medical coverage from their spouse shall notify the Financial Services Department in time so that the employee may re-enroll in a health care plan beginning the first day of the month following the loss of alternate coverage. For employees participating in the waiver plan prior to January 1, 2007, the spouse receiving the waiver payment will receive $106.09 per month as taxable compensation. For newly formed couples either through marriage or new employment on or after January 1, 2007, there will be no eligibility for health waiver payments.
Spouse Coverage. (1) An eligible employee may include health insurance coverage for his spouse under the following conditions:
(i) From the date of the employee's eligibility for paid health insurance up for the initial twelve (12) month period the Employer will pay 50% of the premium difference required to include the spouse with the employee paying the remaining 50% of the premium difference.
(ii) For the next twelve-month period, the Employer will be responsible for paying 60% of the premium difference required to include the spouse with the employee paying the remaining 40% of the premium difference.
(iii) For the next twelve-month period the Employer will be responsible for paying 70% of the premium difference required to include the spouse with the employee paying the remaining 30% of the premium difference.
(iv) For the next twelve-month period the Employer will be responsible for paying 80% of the premium difference to include the spouse with the employee paying the remaining 20% of the premium difference.
(v) For the next twelve-month period the Employer will pay 90% of the premium difference required to include the spouse with the employee paying 10% of the premium difference.
(vi) The Employer will be responsible for the entire premium payments made thereafter.
(2) An employee whose spouse is not immediately covered from the date of the employee's eligibility for paid health insurance because of alternate coverage as specified in (c) above, and who subsequently becomes eligible shall enter the Employer's payment schedule based on the date of the employee's eligibility for paid health insurance.
(3) For all employees hired after October 1, 2000, spouses may continue to be covered by the Employer’s health insurance plan at the employee’s expense.
(4) In the event of the employee's death, the spouse (at time of retirement) may continue coverage as described in this Section at the Employer's expense. For all employees hired after October 1, 2000, the coverage shall be provided at the spouse’s expense.
(5) If an employee acquires a spouse after the effective date of retirement, this spouse may secure County health insurance coverage at the employee's expense. It is the intent of the parties that this option apply only to the first new spouse after retirement.
Spouse Coverage. 1. If a spouse of an employee with a family plan has dependents and is eligible for family coverage under a noncontributory program, the spouse must take family coverage with his/her employer to be eligible for coverage for himself/herself, and those dependents for whom the spouse’s employer would be primary, under this plan.
2. The Board reserves the right to pay the spouse’s share of either a single or family plan, and such payment shall result in payment under coordination of benefits with said plan regardless of whether or not the spouse takes coverage under said plan.
Spouse Coverage. Effective for employees hired on or after July 1, 2013, if an employee wishes to enroll his or her spouse in a STATE SYSTEM health plan, and that spouse is eligible for coverage under his or her own employer’s plan, the spouse shall be required to enroll in that other employer’s plan (which shall be his or her primary coverage), as a condition of eligibility for secondary coverage under the STATE SYSTEM plan, without regard to the amount of the cost-sharing required under the spouse’s plan, and without regard to any incentive the spouse’s plan may offer to the spouse not to enroll. In the event that the spouse loses coverage through his/her employer, the spouse’s coverage under the STATE SYSTEM plan shall immediately become primary.
Spouse Coverage. If a Contractholder wishes to terminate a spouse’s coverage, the required forms must be submitted to us prior to the requested termination date; or in the case of a divorce, within ten days after the date a divorce is final.
Spouse Coverage. If a spouse (as defined by law) of a covered employee has health insurance available and his/her employer pays any percentage of the premium, the spouse must enroll in the health insurance plan of his/her employer as their primary carrier. However, nothing prohibits the spouse (as defined by law) from using Harlem’s Plan as secondary coverage.
