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Spousal Eligibility


There is no requirement that self-funded ERISA plans must offer spousal coverage. Plans that are subject to ERISA currently have flexibility when it comes to defining a spouse under their health plan as ERISA does not define this term. This holds true even with the Supreme Court's ruling on June 26, 2015 requiring states to recognize same sex marriages. While every state must recognize these marriages, there have been no regulatory changes to ERISA requiring same sex spouses to be covered by a self-funded group health plan. Groups should, however, be cautioned about the risk of not recognizing same-sex marriages under their plan (if spousal coverage is offered) as it is possible there are state employment laws they may be violating by not providing such coverage.

 

Non-ERISA plans will always need to defer to state law when determining who is eligible to participate under their plan.

 

Spousal eligibility should be clearly defined in the groups plan document.

 

Please note that spousal coverage and domestic partner coverage are not one in the same.

 

The content described on this page is current as of 2018 and is not intended to be legal or tax advice and should not be construed as such. The intent is to provide information only. Meritain encourages plans to consult with their own legal counsel and tax experts for legal and tax advice.