Common use of Spouse Coverage Clause in Contracts

Spouse Coverage. (A) When both the husband and wife are Members, either one family plan or two single plans shall be available. The type of policy shall be decided by the Members. (B) A Member’s spouse who is eligible to receive health insurance coverage through his/her employer must enroll in such plan on at least a single enrollment basis. A spouse is considered to be eligible for his/her employer’s health insurance plan if: ● The access is continuous (i.e., non-seasonal) and reasonable group coverage is available, and ● The spouse works more than twenty (20) hours in an average work week, and ● The spouse is not required to pay more than forty-five percent (45%) of the premiums (C) A spouse shall not be required to enroll in his/her employer provided health insurance plan if the only plan available is a High Deductible Health Plan with a Health Savings Account (HDHP with HSA) (which per IRS rules does not allow for secondary coverage) or the IRS does not allow for secondary coverage for any plan(s) offered by the spouse’s employer. When the spouse has enrolled in a health insurance plan maintained by his/her employer, coverage for the spouse under the Board provided plan shall be limited to secondary coverage when the Member carries a family plan. The Member shall provide all information required to administer this provision through the enrollment form/process or by completion of the Spousal Determination Form distributed by the Board by August of each year. Failure to provide accurate information may result in the Member having to repay any contributions, premiums, premium reimbursements or claims paid by the Board. (D) Any Member who is an employee prior to the 2016-17 school year, shall be reimbursed up to $2,000 annually for the difference in net premium payments from that required of his/her spouse’s employer and the payment amounts required by the Board’s plan. See addendum.