Spousal Coordination of Benefits – Eligibility Certification

If an employee’s spouse is eligible to participate in their employer’s group health insurance and/or prescription drug insurance, the spouse of the employee MUST enroll with at least single coverage in said employer’s sponsored group insurance coverage(s).

If a spouse is self-employed and offers a group health and/or prescription drug plan to his/her employees, such self-employed spouse MUST also enroll with at least single coverage in such employer-sponsored group insurance.

This requirement does not apply to any spouse who must pay more than 50% of the spouse’s employers’ monthly single premium.

Upon the spouse’s enrollment in any such spouse available group health and/or prescription drug insurance coverage, that coverage will become the primary payer of benefits, and the coverage sponsored by MCSEIC will become the secondary payer of benefits according to the primary plan’s Coordination of Benefits and participation rules.

It is the employee’s responsibility to advise the MCSEIC immediately (and not later than 30 days after any change in eligibility), if the employee’s spouse becomes eligible to participate in group health insurance and/or prescription drug insurance sponsored by his/her employer. Upon becoming eligible, the employee’s spouse must enroll in any group health insurance and/or prescription drug insurance sponsored by his/her employer, unless he/she is exempt from this requirement in accordance with the exemptions stated above.

Every employee whose spouse participates in MCSEIC group health insurance coverage and/or prescription drug insurance coverage shall complete and submit to their district’s Treasurer, upon request, a written certification verifying whether his/her spouse is eligible to participate in group health insurance coverage and/or prescription drug insurance coverage sponsored by the spouse’s employer. If any employee fails to complete and submit the certification form, such employee’s spouse may be terminated from the MCSEIC health and prescription drug plan.

PLEASE NOTE: Retired Spouses WITH access to Employer-Sponsored Coverage – spouses MUST enroll in their former employer-sponsored health and/or prescription drug plans unless Medicare eligible.

**If you AND your spouse both work for an MCSEIC School District, this provision does not apply to you.**

ANNUAL SPOUSAL COB ELIGIBILITY RE-CERTIFICATION

The MCSEIC Health Plan Spousal Coordination of Benefits (COB) language stipulates an annual re-certification is required for spouses covered as Primary under the MCSEIC health plan. PlanSource will conduct this re-certification every December. They will certify if your spouse will remain covered as Primary, change to Secondary, or terminate coverage under the MCSEIC health plan if the required information is not returned by the deadline.

Contact Information

If you have questions, contact Plansource at 888.266.1732 from 8 a.m. to 11 p.m. EST Monday-Friday.

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