Common use of Spousal Exclusion Clause in Contracts

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 action.

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-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 action.