Coordinating Benefit Coverage with a Spouse

You and your spouse both have group benefits at work… what happens? 

Understanding group benefits for yourself can be complicated. Throw another person's benefits into the mix and it can be overwhelming.

Let's look at your different options when your spouse also has group benefits.  

Waive health and dental

  • You can waive heath and dental coverage from your company plan and remain under your spouse's health and dental benefit plan.
  • You still get the other benefits, including dependent life.
  • You can’t opt back into health and dental unless there is a life event (a child is born, your spouse loses coverage, you lose your spouse, etc).
  • If you want to opt back into health and dental without a life event, medical underwriting will be required.

Single coverage

  • Both spouses take single coverage.
  • No coordination of benefits, you and your spouse have separate group coverage.

Family coverage - coordinate benefits!

  • Both spouses take family coverage.
  • You each submit to your own benefit plan first, then send the claim to the spouse’s carrier for consideration of additional payment.
  • Children's claims are submitted to the plan of the parent whose birthday is earlier in the year.

Important Note: You cannot insure some dependents and not others.

  • If you choose family coverage, it’s all or nothing. You cannot cover two out of three kids, or only your children and not your spouse. The cost is the same for one or 27 dependents.
  • If your policy allows for couple coverage, it can only be used when the family unit is exactly two people.

 

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