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Guest richeyke
Posted

We are a small company with a self funded health plan. Management would like to change some of the employee contributions for eligble spouse participation. For a spouse who works part time, the employee contribution would be less. For a spouse that has full time employment the contribution would be higher. Are there any tiered plans set up this way? Is this a legal option? Any feedbacck will be appreciated.

Posted

This wouldn't be illegal, however, it would be extremely hard to enforce. What if on January 1st a spouse is working part-time and on February 1st he or she's working full-time? Do you expect the employee to pop into your office and say please charge me more for medical insurance? The factor that you should be looking for is whether or not the spouse is eligible for medical benefits from the company he or she is working for. If he or she she is eligible and doesn't want to take the medical insurance then go ahead and charge that employee more. If he or she is not eligible then treat it the same way as you would treat an employee with a househusband or housewife. Either way, there is going to be some administration involved, however, focusing on the issue of eligibility for medical insurance is a better way since you have Section 125 on your side then.

You've indicated that you're a small company and self-insured. How many lives does your company have?

Guest richeyke
Posted

We currently insure 45 employees.

Posted

I think Proctor & Gamble does something similar based on if coverage is available to the working spouse and at what price. I've had to provide many letters to spouses of P&G employees stating what we charge for single and family coverage. Maybe someone familiar with P&G's policy can fill us on in what it is.

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