How Do I Add My Spouse to My Health Insurance in Maine?

Life is full of changes, and if you want to add your spouse to your health insurance plan, you likely have lots of questions. Having proper health insurance coverage can help protect you and your loved ones from high medical costs.

 

Why You May or May Not Want to Add Your Spouse to Your Health Insurance

When deciding whether or not to add your spouse to your health insurance plan, there are a variety of factors that you should be thinking of. Below are a couple of examples.

• The cost of coverage. The premium cost may be cheaper or more expensive than your spouse’s current health insurance. Be sure to review the cost of coverage before making any definitive decisions.
• The benefits and coverage offered on your plan. The plan you are enrolled in may have better benefits, like a lower deductible and out of pocket maximum, than your spouse’s plan. Switching plans for a better benefit may be more cost effective for your family. Alternatively, the benefits and coverage offered on your plan may be worse than your spouse’s current benefits. Be sure to review your plan documents before you decide whether or not to add your spouse to your health insurance plan.

When Can I Add My Spouse to My Health Insurance?

Whether you are enrolled in an individual marketplace plan or an employer sponsored health insurance plan, typically enrollments and changes can only be made during open enrollment or if there was a qualifying life event. Keep reading to learn about each.

Open Enrollment and Marketplace Coverage in Maine

You usually can add your spouse to your health insurance plan at open enrollment. Open enrollment is a specific designated time each year when you may be able to make changes to your health insurance plan.

Regarding marketplace coverage, in Maine, the open enrollment is typically early November through Mid-January. For further information on Maine marketplace coverage, visit CoverME.gov.

For employer sponsored coverage, open enrollment periods are specific to every employer. For further information on your employer sponsored coverage, contact your plan administrator, which is usually a member of your employer’s HR or administration staff.

What Is a Qualifying Life Event for Health Insurance?

Qualifying life events are situational changes that may make you eligible for a special enrollment period. A special enrollment period is a specific time frame where you can make changes to your health insurance coverage, even if you are not in an open enrollment period. There are many different potential qualifying life events that could enable you to add a spouse to your coverage. Below is a partial list of common qualifying life events, although each health insurance plan will specify what counts as a qualifying life event for that plan. If you have experienced any of the below life events, whether you are on an individual plan or an employer sponsored plan, your spouse may be eligible to join your plan.

• If you and your spouse just recently got married.
• Spousal loss of coverage.
• Change in residence.

If you have experienced any of the above life events, be sure to contact your plan administrator within your special enrollment period in order to make any necessary plan changes. Typically, you have 60 days from the day of the qualifying life event to make any insurance changes, although plan requirements can vary. Be sure to promptly check with your plan administrator to verify the time requirements that apply to your specific plan.  

What Is Needed to Add My Spouse to My Health Insurance?

In order to add your spouse to your health insurance, you will first want to connect with your plan administrator to obtain the proper paperwork and necessary information needed to enroll. You will need to complete and return the required paperwork and other information, which could include marriage certificates, termination letters, etc. The necessary paperwork needed for health insurance enrollment varies from carrier to carrier. Different carriers have different carrier specific paperwork that they require for enrollments or changes. You can connect with your plan administrator to obtain the necessary paperwork needed for your specific health insurance plan.

Is My Employer Allowed to Deny My Spouse’s Enrollment?

In simple terms, yes, your employer may be able to deny your spouse’s enrollment. However, in order to do so, your employer must have implemented a spousal carveout.

What is a Spousal Carve Out?

A spousal carveout is a plan provision that employers can implement that excludes or restricts any spouses, who are eligible or enrolled in their own employer sponsored health insurance plan, from enrolling in the health insurance plan. The Affordable Care Act (ACA) typically requires employers with 50 or more employees to offer health insurance coverage to employees and their dependent children. However, employers are allowed to implement spousal carveout. A spousal carve out must consistently apply to all employees and their spouses in order to be ACA compliant. If you have questions about spousal carve outs, contact your plan administrator.

Health Insurance Quotes for Maine Businesses

If you are an employer interested in learning more about offering an employer sponsored health insurance plan or an individual looking or an individual health insurance plan, our team at Cross Insurance is here to help. To find out more, contact your local Maine Cross Insurance today. 

 

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This article is for general informational purposes only and is not to be relied upon or used for any particular purpose. Cross Insurance shall not be held responsible in any way for, and specifically disclaims any liability arising out of or in any way connected to, reliance on or use of any of the information contained in this article. The information contained or referenced in this article is not intended to constitute and should not be considered legal, insurance, accounting or other professional advice, nor shall it serve as a substitute for the recipient obtaining such advice. The views expressed in this article are that of its author and do not necessarily represent the views of Cross Financial Corp. and its subsidiaries and affiliates (“Cross Insurance”) or Cross Insurance’s management or shareholders.