Feb. 22, 2013, 9:20 a.m. EST
Companies are dropping health coverage for spouses to cut costs
By Jen Wieczner
Companies have a new solution to rising health-insurance costs: Break up their employees’ marriages.
By denying coverage to spouses, employers not only save the annual premiums, but also the new fees that went into effect as part of the Affordable Care Act. This year, companies have to pay $1 or $2 “per life” covered on their plans, a sum that jumps to $65 in 2014. And health law guidelines proposed recently mandate coverage of employees’ dependent children (up to age 26), but husbands and wives are optional. “The question about whether it’s obligatory to cover the family of the employee is being thought through more than ever before,” says Helen Darling, president of the National Business Group on Health. See: When your boss doesn’t trust your doctor.
While surcharges for spousal coverage are more common, last year, 6% of large employers excluded spouses, up from 5% in 2010, as did 4% of huge companies with at least 20,000 employees, twice as many as in 2010, according to human resources firm Mercer. These “spousal carve-outs,” or “working spouse provisions,” generally prohibit only people who could get coverage through their own job from enrolling in their spouse’s plan.
Such exclusions barely existed three years ago, but experts expect an increasing number of employers to adopt them: “That’s the next step,” Darling says. HMS, a company that audits plans for employers, estimates that nearly a third of companies might have such policies now. Holdouts say they feel under pressure to follow suit. “We’re the last domino,” says Duke Bennett, mayor of Terre Haute, Ind., which is instituting a spousal carve-out for the city’s health plan, effective July 2013, after nearly all major employers in the area dropped spouses.
But when employers drop spouses, they often lose more than just the one individual, when couples choose instead to seek coverage together under the other partner’s employer. Terre Haute, which pays $6 million annually to insure nearly 1,200 people including employees and their family members, received more than 20 new plan members when a local university, bank and county government stopped insuring spouses, according to Bennett. “We have a great plan, so they want to be on ours. All we’re trying to do is level the playing field here,” he says.
While couples generally prefer to be on the same health plan, companies often find that spouses are more expensive to insure than their own employees. That’s because, say benefits experts, covered spouses tend to be women, who as a group not only spend more on health care, but also have more free time to go to the doctor if they don’t work. Indeed, JetBlue’s covered spouses cost 50% more than crewmembers themselves, according to the airline’s online Q&A about its health plan, which this year extended wellness incentives to spouses for the first time. See: Selling health insurance by the pound.
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About a fifth of companies had policies to discourage spouses from joining their health plan in 2012, according to Mercer, though most just charged extra—$100 a month, on average—to cover spouses who could get insurance elsewhere, rather than deny coverage entirely. Indeed, large firms including generics maker Teva and supply chain manager Intermec have spousal surcharges costing $100 a month, or $1,200 annually, while Xerox charges $1,000 for the year. See: 10 things your office won’t say.
But experts say more firms are likely to drop spouses altogether, whether they work or not—especially when the new federal health-care exchanges open in 2014, providing an alternative for spouses left out in the cold. “When there’s a place for people to go, employers won’t feel as beholden or compelled to cover the spouse,” says Joan Smyth, an employee benefits consultant with Mercer.
Firms that recently decided to drop spouses from their plans range from private insurance agencies to school systems and universities like Ball State, as well as large companies like pump and valve manufacturer Flowserve. Wisconsin-based furniture company KI carved out spouses this year when couples flocked to its plan for the first time during open enrollment. “Now, each employer is responsible for its own employee,” says Timothy Van Severen, corporate risk manager for KI, which insures about 1,700 employees in its health plan. “We were going to see a higher claim cost if we didn’t do that, because of the migration coming back to us.”