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Summary

Effective July 1, 2013, a spouse/domestic partner must elect medical coverage under his/her own employer's plan, if available, to be eligible for coverage under the Fred Hutchinson Cancer Research Center and Seattle Cancer Care Alliance medical plans. All employees who cover a spouse/domestic partner must complete an Affidavit of Spouse/Domestic Partner Medical Plan Coverage Eligibility.

Background

Health care coverage is a major expense for Fred Hutch and SCCA. Because these costs continue to increase faster than our sources of income, we must constantly look for responsible ways to manage them.

Most employers provide health care coverage to employees as part of their total compensation package. When an employee elects this coverage, their employer's plan is primarily responsible for covering their medical expenses, even if they are also covered by another plan. The decision to require spouses/domestic partners to take their employer's coverage, when available, ensures the health care cost burden is more equitably distributed among employers.

FAQ

If my spouse/domestic partner has medical coverage available at his/her employer, but does not elect that coverage, can s/he be covered by our (Fred Hutch and SCCA) plan?

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No, they are not eligible for coverage under our plan. The only exception is for spouses/domestic partners whose share of the premium is over $225 per month for the lowest cost employee-only coverage option in the 2016-2017 plan year.

What do I do if my spouse/domestic partner's share of the premium is over $225 per month for the lowest cost employee-only coverage option?

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You need to complete the Affidavit of Spouse/Domestic Partner Medical Plan Coverage Eligibility and provide the name of his/her employer and the cost of coverage.

If my spouse/domestic partner currently has coverage with his/her employer, can s/he also be covered by our plan?

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Yes, when your spouse/domestic partner is covered under two plans, his/her plan will be primarily responsible for the cost of medical services and prescription drugs. Our plan may, in certain circumstances, reimburse for a portion of the expenses not covered by the other plan.

Does this change affect eligibility for the dental plan?

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No, this eligibility change applies only to the medical plan.

How much benefit do I receive when my spouse/domestic partner is covered by both his/her plan and our plan?

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When a person is covered by more than one plan, the claim is processed according to the Coordination of Benefit (COB) rules. Your spouse's/domestic partner's employer plan will pay first and the remainder is submitted to our plan for consideration.

Because COB rules are relatively complex and change from time to time, you will need to work with customer service at Premera (800.722.1471) or Kaiser Permanente WA (888.901.4636) to discuss what the plan may pay in your situation.

What should I consider when deciding whether or not to double cover my spouse/domestic partner?

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You will want to evaluate the additional premium paid vs. the additional amounts that may be covered by our plan, and whether the providers your spouse/domestic partner normally sees are considered in or out-of-network in his/her employer's plan.

Additionally, if a High Deductible Health Plan is offered to your spouse/domestic partner, please note that current tax regulations do not permit any contributions to a Health Savings Account if they are also covered by our plan, which is not classified as a High Deductible Health Plan (this restriction does not apply to Flexible Spending Accounts).

What do I need to do if my spouse/domestic partner becomes eligible for other employer coverage outside of Fred Hutch/SCCA's open enrollment period?

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S/he should sign up for his/her employer's coverage when eligible. His/her eligibility is considered a "qualifying event" and you have the option of keeping him/her on our plan or removing him/her from our plan at that time.

If my spouse/domestic partner loses his/her employer coverage, may s/he be added to our (Fred Hutch and SCCA) plan?

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Yes, his/her loss of coverage is considered a "qualifying event" and s/he may be added to our plan within 30 days of their loss of coverage.

Do I need to do anything if my spouse/domestic partner is not employed or does not currently have coverage available through his/her employer?

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Yes, you need to complete the Affidavit of Spouse/Domestic Partner Medical Plan Coverage Eligibility. Additionally, you need to be aware of this criterion if his/her coverage status changes in the future.

What if my spouse/domestic partner is retired and eligible for Medicare?

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Medicare is not considered an employer-sponsored plan. You need to complete the Affidavit of Spouse/Domestic Partner Medical Plan Coverage Eligibility indicating that your spouse/domestic partner does not have access to an employer-sponsored medical plan.