What You Need to Know About Spousal Surcharge Programs

Posted on: December 1st, 2010 by hmshealthcare

To help employers manage costs, spousal surcharges are becoming a popular feature among group health plans. Employees whose spouses are employed and eligible for other “employer-sponsored insurance” (ESI), are required to pay a fee in order to keep their spouses on the plan.

With this surcharge, an employer is able to continue offering affordable health benefits, while allowing for the extra dependents.

A dependent eligibility audit (DEA) is a critical element in administering such a program. DEAs identify spouses eligible for other ESI, while ensuring employees are complying with company rules regarding dependents.

Under a plan with a spousal surcharge program, employees retain the option of listing their spouse as a dependent for a surcharge, and can choose the plan which best suits both their budget and healthcare needs.

The Society for Human Resource Management (SHRM) conducted a survey and found:

  • 11 percent of survey respondents  impose a spousal surcharge
  • 2 percent automatically exclude spouses eligible for other ESI
  • The average surcharge is $156.

To view the full survey results download the presentation from SHRM, click below.


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