Spousal Coverage

[NWBenefitProvider]

They have not issued anything in writing, but each time I ask the reps they say we can't do that (or they won't allow it).

There is one carrier that is allowing, but the others say no.

Any chance you can direct me to the section of PPACA that talks about this? My next question is can they legally provide coverage for ONLY employees and NOT offer it to spouses and children? I though I heard somewhere that they have to offer it to kids. Not sure what is true anymore.

You seem to have a great handle on this and I appreciate your input.

 

[leevena]

They have not issued anything in writing, but each time I ask the reps they say we can't do that (or they won't allow it).

There is one carrier that is allowing, but the others say no.

Any chance you can direct me to the section of PPACA that talks about this? My next question is can they legally provide coverage for ONLY employees and NOT offer it to spouses and children? I though I heard somewhere that they have to offer it to kids. Not sure what is true anymore.

You seem to have a great handle on this and I appreciate your input.

Believe I may have figured this out. It appears to be in the wording you are using. Keep in mind, I am not very detailed oriented to begin with, so I may have been able to answer this better.

You are actually asking two different things in your post, the first being can the employer deny spousal coverage and the other dependent. My answer about the first; categorizing spouses as ineligible is correct. An employer can either state that; 1) no spouse is eligible to participate, or, 2) no spouse with coveage elsewhere is eligible to participate.

Now comes the 2nd part. Your post mentions that the carriers will not issue a plan without DEPENDENT available. This is correct because the employer must offer (PPACA) to dependent kids to age 26.

Check this out with your carriers.

 

[NWBenefitProvider]

I see. So they could flat out decline to offer spousal coverage, but would be required to offer it to dependents.

I'm trying to find the best option for groups to decline to offer spousal coverage in order to allow that spouse to be eligible for a subsidized health plan. However, it seems that the best result would be employees covered by the group, spouses eligible for a subsidy (if they qualify) and kids would NOT be eligible for a subsidy since they could join the group plan.

Does this sound right to you? Of course I will also follow up with the carriers, but they are not always as reliable. Go figure!

 

[leevena]

I see. So they could flat out decline to offer spousal coverage, but would be required to offer it to dependents. Yes, there is not legal requirement, and never has there been a legal requirement, for an employer to offer spousal coverage. Yes, the employer is required to offer "dependent" coverage because of the PPACA requirement to cover the kids.

I'm trying to find the best option for groups to decline to offer spousal coverage in order to allow that spouse to be eligible for a subsidized health plan. However, it seems that the best result would be employees covered by the group, spouses eligible for a subsidy (if they qualify) and kids would NOT be eligible for a subsidy since they could join the group plan. I have not thought this all the way through, but I doubt if you could develop a strategy that would make everyone happy. You will need to pick the least offensive option.

Does this sound right to you? Of course I will also follow up with the carriers, but they are not always as reliable. Go figure!

-agree.


See my comments above, I believe it's easier to read.

 

[NWBenefitProvider]

Thank you. Very helpful.

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Sorry to keep bringing this up. I looked online ofr a resonable overview of the PPACA and could not locate anyhting that adressed the ability of a company to not offer coverage to spouses. Do you have a source where I can read this, or do you happen to know what section of the law contains such text?

 

[thebig_j]

So if a spouse is not eligable on the group plan they can get a subsidy? Has anyone gotten through this process? heard it was a nightmare.

 

[Happy Texan]

So if a spouse is not eligable on the group plan they can get a subsidy? Has anyone gotten through this process? heard it was a nightmare.

Yes, they are eligible for subsidies if coverage is deemed unaffordable - which exceeds 8% of household income.
Employers receive penalties only if the employee is eligible for subsidies on the exchange.
Spouses are not deemed as dependents.
See healthaffairs.org Parts 1 and 2 posted by Timothy Yost on the latest Treasury regulations regarding this issue and others, including transitional issues and what detrmines full-time status.
He has 2 posts the last 2 days.
Don Levit