Spousal Exclusion Sample Clauses
A Spousal Exclusion clause is a provision that specifically excludes a spouse from receiving certain benefits, rights, or coverage under an agreement or policy. For example, in insurance contracts, this clause may prevent a policyholder’s spouse from being eligible for coverage or from making claims under the policy. The core function of this clause is to clearly define and limit the parties who are entitled to benefits, thereby preventing disputes or unintended obligations related to spousal claims.
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Spousal Exclusion. If an employee’s spouse is eligible to participate, as a current employee or retiree in group health insurance and/or prescription drug insurance sponsored by his/her employer or any public retirement plan, the spouse must enroll in such employer (or public retirement plan) sponsored group insurance coverage(s). This requirement does not apply to any working spouse who works less than 30 hours per week AND is required to pay more than 50% of the single premium to participate in his/her employer’s group health insurance coverage and/or prescription drug insurance coverage, or a retired spouse who is required to pay more than 50% of the single premium in his/her public retirement health insurance and/or prescription drug coverage. Upon the spouse’s enrollment in any such employer (or public retirement plan) sponsored group insurance coverage, that coverage will become the primary payor of benefits and the coverage sponsored by the Board will become the secondary payor of benefits. Any employee’s spouse who fails to enroll in any group insurance coverage sponsored by his/her employer or any public retirement plan, at least on a single enrollment basis at the first open enrollment opportunity with such spouse’s employer as required by this Section, shall be ineligible for benefits under such group insurance coverage sponsored by the Board. Every employee whose spouse participates in the Board of Education’s group health insurance coverage and/or prescription drug insurance coverage shall complete and submit to the Board, upon request, a written certification verifying whether his/her spouse is eligible to participate in group health insurance coverage and/or prescription drug insurance coverage sponsored by the spouse’s employer or any public retirement plan. If any employee fails to complete and submit the certification form by the required date, such employee’s spouse will be removed immediately from all health and prescription drug insurance coverages sponsored by the Board. Additional documentation may be required. A change in the employee’s spouse’s circumstances i.e., termination of spouse’s employment; or disqualification or change in spouse’s eligibility for medical benefits, the spouse will be returned to the District health insurance plan upon appropriate notification to the Treasurer’s office without a gap in coverage. If an employee submits false information or fails to timely advise the Plan of a change in the employee spouse’s eligibility for emp...
Spousal Exclusion. Beginning January 1, 2008, the spouse of an employee must enroll in his or her employer’s health care plan unless one of the following applies:
1. The spouse does not work outside the home
2. The spouse’s employer does not offer health care benefits
3. The spouse is retired
4. The spouse’s employer pays less than 50% of the coverage
5. The spouse’s insurance plan costs the spouse more than $5000 (in premiums only) for a single plan. If none of these exemptions apply, the spouse must enroll in at least a single-coverage (individual) plan with their employer. The spouse’s employer will be responsible as the first (primary) payer of health care claims, and if the spouse is also covered under our plan, we will then apply the coordination of benefits feature to whatever the spouse’s employer does not pay. A Spouse Insurance Verification Form will be provided to each employee, for their spouse’s employer to complete (unless the spouse also works for the District). If one of the exemptions listed above apply to the spouse, employees can use the same form to document that exemption. This form is to be submitted annually before the end of the Open Enrollment period. If the spouse’s employer has a different Open Enrollment period, we will extend the deadline until the spouse can join his or her employer’s plan. If the spouse loses medical benefits through their employer or retires, the District’s plan would then become primary, until such time as the spouse may become re-eligible under this section. To make this plan work fairly for everyone, there will be penalties for misrepresenting information regarding a spouse’s insurance status. Those penalties include loss of coverage and the recovery of improper payments and the expenses of that recovery.
Spousal Exclusion. 1. In the event a Bargaining Unit Member’s spouse is employed and eligible for healthcare coverage from his/her employer, then he/she is no longer eligible to participate in the District’s health benefit program, which includes but is not limited to the underlying healthcare program and prescription coverage, unless the spouse’s monthly payroll contribution to obtain the spouse’s employer’s single coverage is more than 55% of the COBRA rate for the medical and prescription plan.
2. If a Bargaining Unit Member’s spouse is not employed, is self-employed and does not have access to group health coverage, or is not eligible for coverage through their employer, then he/she would be eligible to participate in the District’s health benefit plan. In the event a Bargaining Unit Member’s spouse must complete a waiting period to enroll for coverage under his/her employer’s health plan, during that waiting period, he/she will be eligible to participate in the District’s health plan.
3. In the event a Bargaining Unit Member’s spouse has a change in his/her employment status and becomes eligible for group health coverage, he/she must enroll in that coverage as soon as he/she is eligible. The Bargaining Unit Member is responsible for notifying the District’s Human Resources Department within 31 days in order to enroll their spouse mid-plan year.
4. A form developed by the Human Resources Department will be issued annually to Members of the Bargaining Unit seeking to obtain spousal insurance. Failure to complete the form and submit it on or before the deadline will result in automatic spousal ineligibility for the plan year.
5. The form will require the member of the bargaining unit to certify that his/her spouse has health coverage and to provide information about that coverage or to certify that his/her employer does not offer health coverage. The form will also require the spouse’s employer to certify the monthly payroll contribution for single coverage and the monthly COBRA rate for that coverage. In the event a Bargaining Unit Member does not respond, provides false information, or fails to notify Human Resources of any required information, the Bargaining Unit Member will become personally liable for any benefits paid by the District’s health benefit program on behalf of the Bargaining Unit Member’s spouse that would not have been paid had the District’s health benefit plan had accurate information. In addition, the Bargaining Unit Member may face disciplinary actio...
Spousal Exclusion. If the spouse of a bargaining unit member is employed and eligible for medical insurance at his/her own place of employment, regardless of the level of benefits provided and/or the extent of the employee contribution, the spouse of the bargaining unit member will not enroll in the SMSD plan for primary coverage, but they may elect secondary coverage. If such election is made, the bargaining unit member will be charged the amount of either husband/wife category or family category as appropriate. Secondary coverage shall be subject to coordination of benefits described in the SMSD Plan document. For the 2017-2018 school year, if the spouse is excluded completely or maintained only on secondary coverage, SMSD shall pay $750 to the bargaining unit member, payable in two lump sum installments of $375, payable on the first pay in December and the first pay in June of the school year. For the 2018-2019 school year, if the spouse is excluded completely or maintained only on secondary coverage, SMSD shall pay $375 to the bargaining unit member, payable in two lump sum installments of $187.50, payable on the first pay in December and the first pay in June of the school year. Beginning in the 2019-2020 school year, the employee shall no longer to eligible for any such payment. If the spouse does have coverage available, the bargaining unit member may obtain primary coverage for such spouse from SMSD. The bargaining unit member may choose to purchase such coverage for the spouse through the school district coverage at the cost of $3,500 per school year. Payment shall be made by prorated payroll deduction.
Spousal Exclusion. If an employee’s spouse is eligible to participate, as a current employee, self-employed individual (other than a sole proprietor) in a business or organization (e.g., partner, member), or retiree in group health insurance and/or prescription drug insurance sponsored by his/her employer, business, organization, or any retirement plan, the spouse must enroll for coverage in such employer, business, organization, or retirement plan sponsored group insurance coverage(s) no later than July 1, 2014. This requirement does not apply to any spouse who: • Works less than 20 hours per week AND is required to pay more than 50% of the single premium to participate in his/her employer’s, business’s, organization’s or retirement plan’s group health insurance coverage and/or prescription drug insurance. • Is employed by another Huron-Erie School Employee Insurance Association (HESE) district, provided the spouse does not receive any available payment (or any other form of remuneration) from that HESE district for waiving health insurance and/or prescription drug insurance coverage. Upon the spouse’s enrollment in any such employer, business, organization, or retirement plan sponsored group insurance coverage, that coverage will become the primary payor of benefits and the coverage sponsored by HESE will become the secondary payor of benefits according to the primary plan’s Coordination of Benefits and participation rules. Any spouse who fails to enroll in any group insurance coverage sponsored by his/her employer, business, organization, or any retirement plan, as required by this Section, shall be ineligible for benefits under such group insurance coverage sponsored by HESE. It is the employee’s responsibility to advise the HESE Health Benefit Plan (the “Plan”) immediately (and not later than 30 days after any change in eligibility) if the employee’s spouse becomes eligible to participate in group health insurance and/or prescription drug insurance sponsored by his/her employer, business, organization, or retirement plan after July 1, 2014. Upon becoming eligible, the employee’s spouse must enroll in any group health insurance and/or prescription drug insurance sponsored by his/her employer, business, organization, or retirement plan unless he/she is exempt from this requirement in accordance with the exemptions stated in this Section. Every employee whose spouse participates in HESE’s group health insurance coverage and/or prescription drug insurance coverage shall com...
Spousal Exclusion. If an eligible bargaining unit member’s spouse is working, self-employed or is retired and has healthcare, prescription drug, and/or dental insurance available to him/her, that spouse is not eligible for such coverage under the District’s insurance plan (healthcare, prescription drug, and/or dental). Each bargaining unit member shall complete and submit the necessary documentation to the Board annually by October 15th relating to the working/retired spouse’s coverage. Failure of the bargaining unit member to do so shall result in the immediate loss of insurance benefits eligibility for the bargaining unit member’s spouse for healthcare, prescription drug, and/or dental insurance coverage. Note: This provision shall be effective January 1, 2022 with the required notice due to the Board by October 15, 2021.