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.
Tags: DEA, Dependent Eligibility Audits