Working Spouse Provision Verification

Save when spouses on your health plan have other coverage.

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Employees’ spouses on your plan who have access to their own coverage from a job or other source cost you, on average, $3,000 to $3,500 a year, each. You can dramatically reduce or eliminate this cost with a Working Spouse Provision Verification from HMS.

An HMS Working Spouse Provision Verification gives you the information you need to implement cost-saving options, including directing spouses to the benefits offered by their own employers, or by paying an additional premium.

In our experience, approximately seven percent to 12 percent of covered spouses have access to other coverage, but typically don’t voluntarily disclose their covered status. This financial burden can be quickly and efficiently removed from your health plan. Working Spouse Provision Verification is an effective cost-saving measure for all health plans, whether commercial or government. It begins when you contact HMS.

Upon completion of the verification, you can save money with one of the following options:

  • In a Spousal Carve-out Provision Verification, spouses with coverage available from their own employers are removed from your plan. HMS conducted a carve-out verification for a global business process solutions company, identifying 72 spouses with other coverage. Removing these spouses saved the company $216,000 in a single year.
  • A Spousal Surcharge Provision Verification offers identified spouses the option to stay on your plan if they pay a monthly amount to help offset your direct costs. HMS conducted a verification for an international oil and gas company, finding 114 spouses who opted to pay the $200 a month surcharge, resulting in $273,600 in additional premiums. Fifty-seven spouses left the plan saving $171,000, for a net reduction of $444,600 in plan costs in a single year.

Almost 30 percent of employers currently implement spousal surcharges. More businesses are beginning to use the Working Spouse Provision Verification as an effective method to control plan costs.

HMS has deep experience in Working Spouse Provision Verification, as a component of full Dependent Eligibility Verification, as a stand-alone process for verifying spouses currently covered on health plans and when employees enroll new spouses.

Throughout the process, employees receive sensitive communications explaining the reasons for verification, necessary steps for plan compliance, and what will happen if other coverage is identified.

Contact us today to learn how our Working Spouse Provision Verification can immediately improve your bottom line.

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