Spousal Eligibility Q&A
What is changing for 2027?
Beginning January 1, 2027, spouses who are eligible for health care coverage under another employer-sponsored group plan will no longer be eligible for coverage under St. Olaf’s medical plan.
If they do not have access to another employer-sponsored group plan, they may continue to be eligible for St. Olaf medical coverage.
Does my spouse have to actually enroll in the other plan to become ineligible for St. Olaf coverage?
No. The new provision is based on whether your spouse is eligible for another employer-sponsored group plan, rather than whether they choose to enroll in that coverage.
This means that if your spouse has access to another employer-sponsored group plan but chooses not to enroll, they would no longer be eligible for St. Olaf medical coverage beginning January 1, 2027.
What if my spouse’s other coverage is much more expensive than St. Olaf’s?
We recognize that the cost of coverage can vary considerably from one employer to another, and that this change may result in higher costs for some families.
The new eligibility requirement, however, is based on whether your spouse has access to another employer-sponsored group plan rather than the cost of that coverage. We encourage families affected by the change to review the coverage and contribution options available through the spouse’s employer during Open Enrollment.
What if the other coverage is considered unaffordable under the Affordable Care Act?
The Affordable Care Act has an affordability standard that is used for certain purposes, including determining whether someone may qualify for financial assistance through the Health Insurance Marketplace.
That affordability standard is separate from St. Olaf’s eligibility requirements. Under the St. Olaf plan, the determining factor is whether the spouse is eligible for another employer-sponsored group plan, which itself is required to meet the affordability standard of ACA. Concerns about whether that plan meets those criteria would need to be brought to that employer. St. Olaf must assume that the other employer is meeting the legal requirements for its health plans.
If your spouse has concerns about the affordability of the coverage available to them, they may also wish to explore whether other coverage options or financial assistance are available through the Health Insurance Marketplace.
What if my spouse and I both work at St. Olaf?
If both spouses are eligible employees of St. Olaf, you are not required to enroll separately in the college’s medical plan.
One spouse may enroll as the employee and cover the other as a dependent spouse under the same St. Olaf medical plan. For example, you may continue to elect Employee + Spouse or Family coverage rather than enrolling separately.
The new provision is intended to address situations in which a spouse has access to another employer-sponsored group plan outside of St. Olaf. It does not require two St. Olaf employees who are married to maintain separate coverage.
What if my spouse’s other plan has a much higher deductible or different benefits?
We understand that plans can differ significantly in deductibles, copays, coinsurance, prescription coverage, and other benefits.
The new provision does not compare the relative value or design of the two plans. Instead, eligibility is based on whether your spouse has access to another employer-sponsored group plan.
What if the other plan has a limited provider network in Minnesota?
We recognize that provider networks can be an important consideration, particularly when a spouse works remotely for an employer located outside Minnesota.
Differences in provider networks generally do not change the eligibility requirement if your spouse is eligible for the other employer-sponsored group plan.
However, there is an important distinction between a plan having a limited network and the plan not actually being available to your spouse. If your spouse’s employer indicates that employees living in Minnesota are not eligible for its medical plan, please contact St. Olaf Human Resources so we can review the circumstances with you.
My spouse works remotely for an employer located in another state. Does that make a difference?
Working remotely or having an employer located in another state does not, by itself, determine eligibility. The important question is whether your spouse is eligible for the employer’s group medical plan while living and working in Minnesota.
If the employer does not make its plan available to employees residing in Minnesota, please contact St. Olaf Human Resources so we can review the situation.
What if my spouse is eligible for Medicare?
Medicare is not a group health plan. Therefore, eligibility for Medicare alone does not make a spouse ineligible for St. Olaf medical coverage under this provision.
If your spouse is already enrolled in Medicare, you may want to compare the cost and value of maintaining St. Olaf coverage in addition to Medicare when making your enrollment decision.
What if my spouse is retired and has access to a former employer’s retiree health plan?
Please contact St. Olaf Human Resources so we can review the specific circumstances.
Retiree health arrangements can vary, and because the eligibility provision refers to eligibility for “another employer-sponsored group plan,” we may need to review the particular coverage available to your spouse before determining how the provision applies.
What if my spouse is self-employed?
If your spouse is self-employed and does not have access to a group health plan, the new restriction generally would not apply.
The ability to purchase an individual policy through the Health Insurance Marketplace is not the same as being eligible for another employer-sponsored group plan.
What if my spouse works part time?
Part-time status by itself does not determine whether the new provision applies.
Some employers offer medical coverage to part-time employees and others do not. If your spouse is eligible for a group medical plan through their employer, the new St. Olaf eligibility provision applies. If they are not eligible for the employer’s plan because of their part-time status, they may remain eligible for St. Olaf coverage.
What if my spouse is in a waiting period for their employer’s coverage?
Please contact St. Olaf Human Resources if your spouse has started a new job but is still in a waiting period before their coverage becomes effective.
Our goal is to distinguish between someone who is currently eligible for another employer-sponsored group plan and someone who will become eligible at a future date. HR can review the effective dates with you to help avoid an unintended gap in coverage.
What if my spouse’s employer has a different plan year than St. Olaf?
A different plan year does not necessarily mean your spouse must wait until the employer’s next Open Enrollment.
Loss of eligibility under another group health plan generally creates a special enrollment opportunity. We encourage employees affected by this change to contact the spouse’s employer as soon as possible to understand the enrollment process, documentation requirements, and deadlines.
If your spouse’s employer indicates that they cannot enroll because of the timing of its plan year, please contact Human Resources before completing your St. Olaf enrollment so we can review the situation with you.
Are spouses being removed from coverage in the middle of the year?
No. The new eligibility provision takes effect January 1, 2027, which is the beginning of St. Olaf’s new plan year.
A spouse who is currently eligible for St. Olaf coverage may remain covered through December 31, 2026, assuming all other eligibility requirements continue to be met.
What happens if my spouse becomes eligible for another employer-sponsored group plan during 2027?
Please notify HR if your spouse’s eligibility for other group coverage changes during the year.
For example, if your spouse begins a new job or completes an employer waiting period, HR can review the effective date of the new coverage with you and explain any changes that may be needed to your St. Olaf coverage.
What happens if my spouse loses their other group coverage during the year?
If your spouse loses eligibility for another employer-sponsored group plan, you may be able to add them to the St. Olaf medical plan through a qualifying life event.
Please contact HR promptly if this occurs, as qualifying life event enrollment deadlines apply.
Can I still cover my spouse under St. Olaf’s dental plan?
Yes. This change applies only to eligibility for the St. Olaf medical plan. An otherwise eligible spouse may continue to be covered under St. Olaf’s dental plan.
Can my spouse still use Nice Healthcare?
Yes. If you remain enrolled in a St. Olaf medical plan, your spouse may continue to access Nice Healthcare even if they are no longer enrolled as a dependent under St. Olaf medical coverage.
Can an exception be made if my spouse’s other coverage is particularly expensive or doesn’t meet our family’s needs?
We understand that employees and families have different circumstances and that another employer’s plan may have different costs, benefits, deductibles, or provider networks.
The new eligibility provision does not include exceptions based on those differences. Because this is an eligibility requirement of the medical plan, St. Olaf needs to apply the provision consistently to employees in similar circumstances.
If there is a question about whether your spouse actually has access to another employer-sponsored group plan, rather than a concern about the relative cost or quality of that plan, please contact Human Resources. We are happy to review the eligibility circumstances with you.
Why can’t St. Olaf make an exception for an unusual individual situation?
We recognize that individual circumstances can be complex and that the impact of this change will not be the same for every family.
Because this requirement is part of the medical plan’s eligibility provisions, St. Olaf needs to administer it consistently. Making exceptions that are not provided for in the plan could result in employees in similar circumstances being treated differently.
If you believe there is a question about whether your spouse is actually eligible for another employer-sponsored group plan, please contact Human Resources so we can review the situation with you.
How will St. Olaf know whether my spouse is eligible for another employer-sponsored group plan?
During Open Enrollment, employees who wish to cover a spouse will be asked to confirm that their spouse meets St. Olaf’s eligibility requirements.
Employees should answer the attestation based on the information available to them and notify HR if their spouse’s eligibility changes during the year.
What if I don’t know whether my spouse is eligible for another employer-sponsored group plan?
Your spouse should first contact their employer or plan administrator to confirm whether they are eligible for group medical coverage.
If the answer remains unclear, please contact Human Resources. We can help review the information and determine how St. Olaf’s eligibility provision applies.
Why is St. Olaf making this change?
Health care costs continue to be a significant expense for both St. Olaf and employees. As the cost of providing medical coverage continues to increase, the college is looking for ways to manage those costs while maintaining a comprehensive medical plan.
One approach is to focus St. Olaf’s medical plan resources on employees and family members who do not have access to another employer-sponsored group plan. This change is intended to help support the long-term sustainability of the college’s medical plan.
Were other options considered instead of changing spousal eligibility?
Yes. There are other ways the college can address rising health care costs, and each comes with its own impact on employees and their families.
Other approaches include increasing employee premiums more significantly, raising deductibles and out-of-pocket costs, making changes to prescription drug coverage, adjusting provider networks, or reducing certain benefits covered by the plan.
Many of these approaches would affect a broader group of employees and their families, including those who do not have access to other coverage.
The spousal eligibility change is intended to help manage health care costs while preserving the overall plan design and benefits available to employees and their eligible dependents. We recognize that this change will have a greater impact on some families than others, but it is one way to address rising costs without making broader changes to the coverage available under the plan.
Isn’t this just shifting costs to employees and their families?
We recognize that this change will affect families differently. For some employees, covering a spouse through another employer may result in higher premiums or different out-of-pocket costs.
At the same time, the college must balance the needs of individual participants with the overall cost of providing medical coverage to our employee population. The new spousal eligibility provision is one of the steps being taken to help manage those costs and support the long-term sustainability of the plan.
Why doesn’t this rule apply to St. Olaf employees who could obtain coverage somewhere else?
St. Olaf employees who meet the eligibility requirements of the college’s medical plan continue to be eligible for that coverage.
The new provision specifically addresses eligibility for dependent spouse coverage. It does not change the eligibility requirements for employees themselves.
What can I do to help manage my own health care costs?
One of the best ways to help manage your healthcare expenses is to take advantage of the benefits already available to you, including Nice Healthcare.
Nice Healthcare provides convenient access to healthcare services and can be a cost-effective alternative to traditional office visits for many routine healthcare needs.
By using Nice Healthcare when appropriate, you may be able to reduce your out-of-pocket expenses while also helping the college manage overall healthcare costs.
We encourage employees and their families to become familiar with the services available through Nice Healthcare and consider using them as a first option for appropriate healthcare needs.