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.

January 1, 2025.

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.

Using the 2025 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 9.02% of the employee’s household income (Form W-2, Box 1 wage).

To calculate, divide the employee's Form W-2 Box 1 wage by 12 to get their monthly amount, and then multiply that number by 9.02%. 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.

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).

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

Upload: Secure File Share Upload

Fax: 937-775-3040

During the benefits open enrollment period: November 21

New Hires: Within 31 days of hire

Qualifying Events: Within 31 days of the event

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.

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

Your spouse must enroll in their employer’s medical plan as primary coverage. Your spouse’s employer is legally required to allow enrollment within 30 days of the loss of eligibility for primary coverage (i.e., before January 29, 2025, since the coverage will end on December 31, 2024). 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.

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.

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.

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.

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

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

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.

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.

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.

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.

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.