Employer not paying for minor child ins. if spouse has insurance?

[janicepetrin]

What is the name of your state (only U.S. law)? Ohio.

Many employers have Affidavits of Spousal Eligibility for health insurance coverage. Meaning, if a spouse is offered health insurance through their employer, they cannot be covered on their spouse's insurance plan. However, a certain employer (a non-profit), includes dependent children in this affidavit as well. So if spouse 1 has insurance offered through their work, spouse 2's employer will not pay for any insurance for the kids. The only way spouse 2's employer will cover the children, is if spouse 2 pays the full cost of the insurance ($1,000 per month).

What if both spouse's employers had a similar policy? Is the only option for the family to either forgo coverage for the kids, or pay $1,000+ monthly to have them covered?

Didn't the ACA mandate that employers have to cover children until the age of 26? The kids in question are middle school age. Also, as healthcare is a benefit often considered when deciding to work somewhere, how can spouse 2's employer essentially cut out this benefit based on the benefits offered by spouse 1's employer? Why is it any of spouse 2's employer's business what benefits spouse 1 receives through their employment?

 

[FlyingRon]

No, I do not believe that this is right under the ACA. If the employer is subject to the employer mandate, he must extend a coverage option to the spouse and children unless they qualify on their own coverage. That means that if your spouse has employer-sponsored coverage, your employer need not offer a coverage option for her. However, that doesn't remove the requirement to cover the children (unless the children are working and have the availability of insurance through their employer).

Are you sure you are reading the statement in that affidavit correctly?

 

[janicepetrin]

No, I do not believe that this is right under the ACA. If the employer is subject to the employer mandate, he must extend a coverage option to the spouse and children unless they qualify on their own coverage. That means that if your spouse has employer-sponsored coverage, your employer need not offer a coverage option for her. However, that doesn't remove the requirement to cover the children (unless the children are working and have the availability of insurance through their employer).

Are you sure you are reading the statement in that affidavit correctly?

The employer said that "technically" they are covering them... just not paying anything for them to be covered. Family coverage is $75 per month, unless your spouse's employer offers family coverage, in which case they will make you pay for the full cost of the insurance, which is $1000 per month.

 

[PayrollHRGuy]

Let's make one thing clear here. While the ACA requires that an ALE employers to offer coverage to employees, spouses and dependants. It doesn't require that the employer pay one cent towards the coverage for spouses and dependants.

 

[cbg]

OP, what is the size of the employer?

 

[janicepetrin]

OP, what is the size of the employer?

Around 6,000 employees.

 

[cbg]

Then the employer must have a provision to cover children, including step and adopted children, until they reach the age of 26. They need not contribute any part of the premium, but they must allow them to be covered.

 

[janicepetrin]

How is 1000 a month affordable, especially when it is only 75 if the spouse's employer didn't offer coverage? What if both employers have that policy? I know spouses aren't required, but I thought dependents were? All the ACA information I can find talks about shared responsibility for dependents.

 

[FlyingRon]

How is 1000 a month affordable.

Because if you had to buy coverage for them on the open market it would be worse.

 

[cbg]

https://www.healthinsurance.org/faqs/my-employer-covers-me-but-not-my-children-can-i-buy-individual-policies-for-my-children/

 

[ecmst12]

For kids you can most likely get private coverage much cheaper than $1000 a month.