It depends on your employer’s policy and the type of health insurance plan they offer. Some employers may ask you whether your spouse has access to other health insurance through their own employer and may charge you more or deny you coverage if they do.
This is called a spousal surcharge or a spousal exclusion. Other employers may not ask you about your spouse’s health insurance status or may allow you to enroll your spouse regardless of their eligibility for other coverage.
You should check with your HR department to see what your employer’s policy is and how it affects your health insurance options.
Are employers allowed to review the health insurance policies of their employees’ spouses?
No, reviewing of an employee’s spouse’s health insurance policies is not permissible for employers.
Provisions in the Affordable Care Act (ACA) prevent employers from inquiring about such information, viewing health insurance as private data beyond an employer’s reach.
However, certain exceptions do exist. An employer may need to understand the spouse’s health insurance status in cases where it impacts the employee’s eligibility for benefits, like life or disability insurance.
Also, the employer might gain knowledge about the spouse’s health insurance status if the employee willingly shares this information.
What are the advantages and disadvantages of having spousal health insurance?
Having a spouse’s health insurance might come with both positive and negative aspects, depending on the individual scenario.
Here are potential advantages:
- Cost efficiency: Merging coverage into one plan could bring substantial savings, particularly if one partner has a comprehensive employer-backed plan offering family coverage at a fair price.
- Expanded benefits: The partner’s plan may provide extra services and perks such as dental care, vision care, mental health care, or prescription drugs, thus diversifying your healthcare choices.
- Qualification: Marriage may allow you to get covered under your partner’s health insurance plan when no other options are accessible.
- Premium write-offs: Hiring your spouse in your enterprise might permit deducting company-paid premiums for their health insurance from your costs.
Despite these benefits, there could be potential disadvantages:
- Rising costs or coverage refusal: Your employer’s policy might demand higher payments or deny coverage if your spouse is eligible for other health insurance through their own employer, known as a spousal surcharge or spousal exclusion.
- Documentation obligations: Your employer might require evidence of your partner’s health insurance coverage, like a copy of an insurance card or an employer letter.
- Elevated out-of-pocket expenses: If both partners are under separate plans, each will have its own deductible and out-of-pocket limit, possibly leading to higher costs.
- Coverage cessation: If divorce, separation, job loss of your partner, or changes in their plan happen, your coverage under their health insurance might end.
What are the benefits of having health insurance through my employer?
There are many benefits to having health insurance through your employer. Some of the most common benefits include:
- Pre-tax contributions
- Employer contribution
- A wider range of plan options
- More comprehensive coverage
- No underwriting
- Lower premiums and out-of-pocket costs
What are the drawbacks of having health insurance through my employer?
Here are some of the drawbacks of having health insurance through your employer:
- Limited choices of plans, providers, and networks.
- Loss of coverage if you lose your job or change your employment status.
- Ineligibility for tax credits or subsidies if your employer offers affordable and minimum value coverage.
