Working Spouse Surcharge

Why is SCL Health making this change?

SCL Health believes that all employers should be equally responsible for paying the medical plan costs of their own employees. By continuing to provide primary healthcare coverage for working spouses, SCL Health is subsidizing other employers’ healthcare costs, which is not our intent. This surcharge is to help absorb the cost for healthcare that SCL Health is incurring instead of your spouse’s employer.

How do I know if the Working Spouse Surcharge applies to me?

The surcharge does not apply if any of the following scenarios apply to your spouse:

  • Does not work.
  • Is an SCL Health associate.
  • Is covered by Medicare, Medicaid, Tricare, Tribal health insurance, or other state assistance program.
  • Is covered under COBRA.
  • Works (full-time or part-time) but is not eligible for medical coverage through their employer.
  • Works but their employer’s medical plan charges 100% of the cost to the employee (includes self-employed individuals).
  • Works but their employer’s medical plan has an annual in-network, out-of-pocket maximum greater than $5,000 for individual coverage or $10,000 if covering dependents.
  • Works and is enrolled in his/her employer’s plan, and an SCL Health medical plan as secondary coverage.
  • Loses their job-related medical coverage

The surcharge applies when your spouse is:

  • Eligible for employer-provided medical plan coverage.
  • Gains eligibility for employer coverage during plan year.

How will you know if my spouse has other medical coverage available?

During Open Enrollment, all associates enrolled in an SCL Health medical plan and covering a spouse will be asked to indicate if their spouse has access to medical coverage through their own employer. If you are covering a spouse and do not indicate whether or not your spouse has other coverage available during Open Enrollment, the surcharge will automatically be applied.

What if my spouse also works for SCL Health and I cover them as a dependent under my medical plan election?

No, you will not be subject to the surcharge.

What if decide to cover my spouse initially, but then my spouse enrolls in their own employer’s plan in the future?

If you stop covering your spouse, the surcharge will be discontinued. To have the surcharge discontinued, contact the HR Service Center within 31 days of the date s/he enrolls in his/her own employer’s plan.

My spouse waived coverage through their own employer. Do I have to pay the surcharge?

If your spouse remains enrolled in an SCL Health medical plan, the surcharge will apply. However, your spouse will likely be able to enroll in his/her employer’s medical plan due to a qualified change in status. Your spouse should contact his/her employer for assistance.

What if my spouse’s employer’s Open Enrollment period has already passed?

Your spouse will likely be able to enroll in their employer’s medical plan due to a qualified change in status. Your spouse should contact his/her employer for assistance. If s/he remains enrolled in a SCL Health medical plan, the surcharge will apply.

What if my spouse has a different plan year than SCL Health and his/her enrollment period is over? Do I have to pay the surcharge?

IRS rules allow for your spouse to add coverage under his or her employer plan if he/she is dropping coverage under the SCL Health plan, the plan years are different, and his/her employer plan rules allow for the change. The change usually has to be made within 30 days of dropping coverage, which in this case would be January 30, 2017. Your spouse should contact his/her employer for assistance.

If your spouse’s employer plan has a different plan year (other than January – December) and does not allow for this change, then the surcharge doesn’t apply until your spouse’s new plan year begins. At that point, if you choose to continue covering your spouse, you will need to update your attestation within 30 days of the beginning of your spouse’s plan year.

My spouse isn’t working at the moment, what happens if he/she gets a new job and obtains employer coverage?

If you decide to keep him/her on the SCL Health medical plan, the surcharge would begin applying in the month he/she becomes eligible for his/her own employer coverage. You will need to contact HR Service Center to report that coverage has become available to your spouse.

What if my spouse, who is currently covered by his/her employer’s plan, loses his/her job? Or has hours reduced and loses eligibility for medical coverage?

This is a qualified event and your spouse would be eligible to enroll in the SCL Health medical plan and the surcharge would not apply to you. Contact HR Service Center to enroll your spouse within 31 days from the change.

What if my spouse is continuing coverage under their previous employer’s COBRA?

The surcharge would not apply.

What is the surcharge? When does it start?

The surcharge is $100 per month and will be prorated over 24 pay periods ($50.00 per pay period starting in January). This surcharge will be collected on a pre-tax basis through payroll deductions.

Does the Working Spouse Surcharge apply to dental or vision?

No. The Working Spouse Surcharge applies to the medical plan only.

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