Spousal Insurance Coverage Policy

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About the Spousal Insurance Coverage Policy

The objective of the Spousal Insurance Coverage Policy is to recognize all forms of health coverage that may be available to a participating employee’s family. In the event a spouse is employed and has access to health insurance coverage through their employer, this policy positions the other employer to be the primary payer of their own employee’s medical claims if the coverage is deemed affordable according to the Affordable Care Act (ACA).

Additionally, this policy does not impact your spouse’s eligibility for dental and vision insurance, health savings and flexible spending accounts, dependent life insurance, tuition remission, or employee assistance programs.

Resources

Spousal Enrollment and Employment Verification

All employees wishing to enroll a spouse on their Wright State medical plan as primary or secondary coverage must submit a Spousal Employment Verification Form (PDF). 

The verification process determines the status of your spouse in one of three categories:

  • Spouse is employed and eligible for primary coverage through their employer-sponsored plan.

    Employed outside of Wright State: 

    If your spouse is employed and eligible for primary coverage through their employer-sponsored plan, and the coverage is affordable as deemed by the ACA, your spouse must enroll in their employer’s medical plan as primary coverage.

    You may enroll your spouse on your Wright State medical plan as secondary coverage. If enrolling your spouse, a Spousal Employment Verification Form (PDF) is required.

    Employed at Wright State: 

    If both you and your spouse are employed by Wright State, you may enroll your spouse on your Wright State medical plan as primary coverage. If enrolling jointly, the spouse with the highest annualized salary is required to be the policyholder.

  • Spouse is employed and not eligible for primary coverage through their employer-sponsored plan.

    If your spouse is employed and not eligible for primary coverage through their employer-sponsored plan (outside of Wright State), you may enroll your spouse on your Wright State medical plan as primary coverage. If enrolling your spouse, a Spousal Employment Verification Form (PDF) is required.

  • Spouse is unemployed, self-employed, retired, and eligible for or enrolled in Medicare, Medicaid, or Tricare.

    If your spouse is unemployed, self-employed, retired, and eligible for or enrolled in Medicare, Medicaid, or Tricare, you may enroll your spouse on your Wright State medical plan as primary coverage. A Spousal Employment Verification Form (PDF) is required.

Frequently Asked Questions

  • What is the Spousal Insurance Coverage Policy?

    If your spouse is employed and eligible for medical coverage through their employer-sponsored plan (outside of Wright State), and the coverage is deemed affordable by the Affordable Care Act (ACA), your spouse must enroll in their employer’s medical plan as primary coverage. You can enroll your spouse on your Wright State medical plan as secondary coverage or waive coverage for your spouse.

    Your spouse is eligible for primary coverage on a Wright State medical plan if your spouse meets any of the conditions below:

    • Not employed.
    • Self-employed.
    • Employed by Wright State. If enrolling jointly, the spouse with the highest annualized salary is required to be the policyholder.
    • Retired and no longer have employer group medical coverage.
    • Eligible for or enrolled in Medicare, Medicaid, or Tricare.
    • Not eligible for medical coverage through their employer.
    • Eligible for medical coverage through their employer, and the coverage is deemed unaffordable by the ACA.

    All employees wishing to enroll a spouse on their Wright State medical plan as primary or secondary coverage must submit a Spousal Employment Verification Form.

  • What is the effective date of the policy?

    January 1, 2025.

  • Does the policy apply to benefits other than medical?

    No. The policy does not impact your spouse’s eligibility for dental and vision insurance, health savings and flexible spending accounts, dependent life insurance, tuition remission, and the employee assistance program.

  • How is coverage deemed affordable by the Affordable Care Act?

    Using the 2026 W-2 safe harbor method, an employer-sponsored medical plan is considered “affordable” if the employee’s share of the annual premium in the lowest-cost plan (single coverage) is less than 9.96% of the employee’s household income (Form W-2, Box 1 wages). 

    To calculate, divide the employee's Form W-2 Box 1 wages by 12 to get their monthly amount, and then multiply that number by 9.96%. The employee's monthly premium for the lowest-cost, self-only coverage option cannot exceed this amount.  The spouse’s employer will verify if the coverage is affordable on the Spousal Employment Verification Form.

  • Who must complete the Spousal Employment Verification Form?

    If you plan to cover your spouse on your Wright State medical plan as primary or secondary coverage, you’re required to submit a Spousal Employment Verification Form. If you do not submit the form by the deadline, your spouse will be ineligible for Wright State medical coverage (primary/secondary).

  • How do I submit the Spousal Employment Verification Form?

    In-person: Human Resources, University Hall, Suite 203

    Email: HR-Benefits@wright.edu

    Fax: 937-775-3040

  • What’s the submission deadline for Spousal Employment Verification Form?

    During the benefits open enrollment period: November 21

    New Hires: Within 31 days of hire

    Qualifying Events: Within 31 days of the event

  • How often will I need to complete a Spousal Employment Verification Form?

    Annually, and if you experience a qualifying life event. (i.e. marriage, loss, or gain coverage through an employer-sponsored medical plan) during the calendar year.

  • What if I don’t submit the Spousal Employment Verification Form?

    Your spouse will be ineligible for Wright State medical coverage (primary/secondary).

  • If my spouse is eligible for their employer’s medical coverage and it is deemed affordable, what are the next steps?

    Your spouse must enroll in their employer’s medical plan as primary coverage. Your spouse’s employer is required by law to allow enrollment within 30 days of the loss of eligibility for primary coverage (i.e. before January 29, 2026 since the coverage will end December 31, 2025). Please email HR-Benefits@wright.edu to request a letter to provide to your spouse’s employer so that they will recognize this loss of coverage. During our open enrollment, you may enroll your spouse on your Wright State medical plan as secondary coverage or waive coverage for your spouse. Your spouse should contact their employer’s Human Resources (HR) department to learn how to enroll in medical coverage. 

  • What does it mean if my spouse has primary coverage through their employer and secondary through Wright State?

    The plan that pays first is called the Primary Plan. The Primary Plan must pay benefits according to its policy terms, regardless of the possibility that another plan may cover some expenses. The plan that pays after the Primary Plan is the Secondary Plan. The Secondary Plan may reduce the benefits it pays so that payments from all plans do not exceed 100% of the total allowable expense.

  • What if my spouse loses eligibility for medical coverage through their employer during the calendar year?

    You must provide Wright State’s HR department with documentation of your spouse’s ineligibility for coverage within 31 days of the loss. Your spouse’s coverage would become primary on Wright State’s medical plan. A Spousal Employment Verification Form is required.

  • Will the policy affect my spouse if they are not employed?

    Your spouse will not be impacted by the policy. However, if your spouse becomes eligible for an employer-sponsored medical plan during the year, you must notify Wright State’s HR department within 31 days to change your enrollment. If your spouse’s coverage is deemed affordable by the ACA, your spouse’s Wright State coverage would become secondary, or you end your spouse’s coverage. A Spousal Employment Verification Form is required.

  • What if my spouse’s employer does not offer insurance coverage?

    You can enroll your spouse on your Wright State medical plan as primary coverage. A Spousal Employment Verification Form is required.

  • What happens if my spouse is enrolled on my Wright State medical plan, but has access to affordable coverage through an employer-sponsored plan and does not elect the coverage?

    Your spouse’s Wright State coverage will be terminated. All medical claims will be denied and reversed retroactively to the effective date.

  • What happens if my spouse’s employer’s annual open enrollment period doesn’t coincide with the effective date of the policy?

    In compliance with federally mandated HIPAA requirements, your spouse’s employer’s plan must allow enrollment within 30 days of the loss of eligibility for primary coverage. Wright State’s HR department can provide documentation to verify the loss of eligibility. Please email HR-Benefits@wright.edu to request a letter. You may enroll your spouse on your Wright State medical plan as secondary coverage or waive coverage for your spouse. Your spouse should contact the HR department at their employer to learn how to enroll in medical coverage.

  • How will Wright State know if my spouse has coverage available through their employer?

    If you enroll your spouse on your medical plan, you will be required to complete a Spousal Employment Verification Form. Your spouse’s employer must certify whether coverage is available and affordable according to the ACA.

  • Whose health care plan will cover my children; Wright State’s medical plan or my spouse’s employer’s plan?

    If your spouse’s employer provides coverage for children and your children meet the eligibility requirements for both plans, you and your spouse will need to decide which employer’s plan to enroll your children. We recommend comparing the key features of both plans, including premiums, networks, deductibles, out-of-pocket maximums, copays, and coinsurance.

  • How will the pharmacy know my spouse has primary and secondary coverage?

    Your spouse will need to update their insurance information with their pharmacy by providing both primary and secondary insurance cards. This will ensure claims are submitted properly.

  • How will my medical provider know my spouse has primary and secondary coverage?

    Your spouse will need to update their medical insurance information with each medical provider by providing both primary and secondary insurance cards. This will ensure claims are submitted properly.