More and more employers are seeking cost savings by discouraging or blocking employees from enrolling a spouse in the employer’s health plan. Here’s what you need to know about the growing trend of spousal carve-outs:

Employers often use one of the following four methods to reduce the number of spouses they cover:

1. Charging employees more to cover spouses who have access to employer-sponsored coverage through their own jobs.
2. Charging employees more to cover spouses whether or not they have access to other coverage.
3. Choosing not to cover any spouses who have access to their own employer-sponsored coverage.
4. Choosing not to offer coverage for any spouses under any circumstances.

Recent survey data reveals a clear trend:

• The 2018 International Foundation Employee Benefits Survey showed that 20.1% of responding health plan sponsors imposed spousal surcharges or exclusions.
• The June 2019 PWC Health and Well-being Touchstone Survey results showed that 38% of survey respondents apply a spousal surcharge if the spouse has access to coverage through another employer. The median surcharge is $100 per month.
• The December 2018 issue of AYCO Compensation & Benefits Digest reported that just over 25% of its survey participants are imposing a spousal surcharge in 2019. The most commonly used surcharge amount is $100 per month.
• The 22nd Annual Willis Towers Watson Best Practices in Health Care Employer Survey shows that 27% of companies used a spousal surcharge in 2017.

At least three factors are driving this spousal carve-outs trend:

1. Plan sponsors are looking for new ways to stem the rising tide of health care benefit costs.
2. Employees, especially those on single-only coverage, may view spousal surcharges as a more equitable way for an employer to allocate health benefit costs among single and married employees.
3. As more plans impose surcharges or exclusions, plans that cover spouses without a surcharge could be at risk for adverse selection.

In an effort to save costs, health plan sponsors are increasingly nudging (or pushing) spouses of employees to obtain coverage somewhere else.

Lois Gleason, CEBS
E-Learning/Online Course Instructional Designer at the International Foundation

The latest from Word on Benefits:

• What the Executive Order Increasing PBM Fee Transparency Means for Employers
• Working Under the Sun: Gear Up Against Skin Cancer
• GLP-1 Drug Coverage Continues to Rise in Canada 
• GLP-1 Drugs Responsible for Over Ten Percent of Annual Claims 
• Mental Health Parity: Four Compliance Documents to Reference During Period of Nonenforcement for the 2024 Final Rule