Married coworkers working at same company prohibited from receiving opt out insurance money for not utilizing one Spouse's Healthcare plan because we are married

Hello,

I was wondering if it is unlawful for a company to deny opt out money that they offer to all eligible employees to married couples that both work for the company? As individual employees we each receive a benefit plan that includes Healthcare. We choose one family plan through the wife's benefit package, therefore not using the husband's benefit package. Yet, we are denied the opt out insurance money for not using the husband's Healthcare plan. Could this be considered discrimination based on marital status?

Thank you in advance!

No, that's a common plan design structure I've seen.

The purpose of opt-out money is to encourage married employees to sign up for coverage under the plan of a different company where the employee's spouse can obtain family coverage. That purpose isn't served if both spouses work for the same company.

Are there many situations in which both spouses’ employers offer this sort of adjustment?

If both spouses are presented with offers of this kind (and the health coverage offered to each is the same), do spouses select between or among employers’ offers based on the $$?

3 hours ago, Peter Gulia said:

Are there many situations in which both spouses’ employers offer this sort of adjustment?

If both spouses are presented with offers of this kind (and the health coverage offered to each is the same), do spouses select between or among employers’ offers based on the $$?

Yes, it is fairly common.  I cannot speak to others' incentives for choosing, but they should choose based on their perceived needs and OOPs. 

 Some companies also have a policy that makes dependents ineligible if their dependent has access to coverage elsewhere.  

If a health plan provides a worker’s spouse is ineligible if the spouse has another employer’s offer of health coverage,

what methods does an employer use to detect that its worker falsely stated that the spouse lacked another employer’s offer of health coverage?

24 minutes ago, Peter Gulia said:

what methods does an employer use to detect that its worker falsely stated that the spouse lacked another employer’s offer of health coverage?

These are often structured as spousal surcharges.  As you noted Peter, they are close to unenforceable.  It is nearly impossible to verify whether an employee’s spouse has access to other coverage.  Without the teeth of any effective audit potential, these generally need to be run on the honor system—which can lead to employee fraud issues.

• More discussion: https://www.newfront.com/blog/conditional-offer-coverage-spouses-2

That's part of the reason spousal incentive HRAs (SIHRAs) have become a more popular alternative lately.  That carrot of that approach is instead to reimburse employees for cost-sharing amounts incurred under the spouse's plan.  I consider it a superior approach.

• More discussion: https://www.newfront.com/blog/ten-spousal-incentive-hra-compliance-considerations

I agree with Brian that it is difficult but not impossible.  1. At enrollment, the employee is required to attest whether the dependents have access elsewhere.  There is a warning about providing false info.  2. The employee with dependent coverage can be asked to provide proof that the dependent does not have access to coverage.  A letter from the other employer is often used.  3.  Check your COB information.  I am sure there may be other ways, but these are what I am familiar with now.

If I may ask one more: How often does an employer’s health plan provide no coverage for a worker’s spouse, even if the spouse has no opportunity for any group health coverage?

Almost never.  Pretty much all plans offer coverage to spouses/children (and sometimes domestic partners).  But the ACA does not require offering coverage to a spouse (it requires only the full-time employee and children).  So it can be done without penalty exposure.

29 minutes ago, Peter Gulia said:

If I may ask one more: How often does an employer’s health plan provide no coverage for a worker’s spouse, even if the spouse has no opportunity for any group health coverage?

No idea, but I would assume not often.  I am on the wholesale side (42 years) of the group business, and since ACA I have quoted in excess of 5,000 groups.  Believe I have seen it 2 or 3 times.