Attention: Married Couples at North Shore-LIJ

Being that North Shore-LIJ is the largest employer in the region, it's no wonder there are a number of married couples in the health system. If  and your spouse both work within the health system and are also non-union and benefits-eligible you need to be aware of the new requirement for benefits enrollment in 2014.

New for 2014 Open Enrollment: The spouse who is categorized in the higher benefit group (Group 1A being the highest) will now be responsible for electing coverage for themselves, or for themselves and their dependents.

For example: Mary works as an administrative assistant in IT (putting her in Benefit Group 3) and her husband, Larry is a physician on staff at North Shore University Hospital (putting him in Benefit Group 1A). Mary has always been responsible for electing benefits for herself, her husband and their two children. With this change in the enrollment process, Larry will now be responsible for electing coverage due to his higher benefit group.
For consideration in this case: Mary can continue to claim herself and two children. Since she chooses the Value Plan and completes all four Wellness Pledges her cost for benefits will remain at $0. Larry can cover himself as single, under Benefit Group 1A.

Benefit Group 3 generally refers to staff-level employees
Benefit Group 2 generally refers to manager-level employees
Benefit Group 1 generally refers to directors and assistant vice presidents
Benefit Group 1A generally refers to executives (above the AVP level) and physicians
Benefit Group 1A is considered the highest level of the Groups 

North Shore-LIJ feels this change in enrollment is in alignment with the compensation or its employees.

Employers Evaluate Spousal Coverage

You may be wondering "why this new spousal charge of $1040 for 2014". After all you have been claiming your spouse as a dependent for years. The reason behind the surcharge is based on the health system's goal to align with the initiative of Healthcare Reform. Many other organizations are either implementing or have implemented a spousal surcharge. According to Towers Watson up to 60% of hospital employees will have a spousal surcharge by 2015.

In comparison, there are a few large companies that skipped the surcharge and simply excluded a spouse's coverage when they have access to a medical plan through their own employer, referred to as Spousal Exclusion. According to benefits consulting firm Mercer, 6 percent of companies now exclude spouses who can get healthcare through their own employers, up 3 percent since 2008. That number is likely to grow.

Keep in mind, North Shore-LIJ will continue to cover your spouse if he or she is not eligible for health insurance through their own employer. In 2014 no one's spouse will be forced to purchase their own coverage on the State Exchange.

Here are some examples.

Benefits Eligible Employee at North Shore-LIJ	Spouse’s Status	Surcharge Status
Mary is married to Rob.	Rob is currently unemployed.	No surcharge - If Rob finds employment in 2014 and chooses to stay on Mary’s plan no surcharge will be incurred due to the fact that his employment status will not be considered a Qualifying Life Event (QLE).
Alex is married to Susan.	Susan is on Medicare.	No surcharge – Alex can enroll Susan in the medical plan with no surcharge because she is on Medicare.
Joe is married to Robert.	Robert is eligible for a medical plan through his own employer, but chooses to stay on Joe’s plan because his employer’s plan is much more expensive than the North Shore-LIJ plan.	Surcharge - If Joe continues to claim Robert as a dependent on his North Shore-LIJ medical plan he will see a surcharge of $1,040 in 2014.
Carol is married to Steven.	Steven, who is self-employed, wants to continue on Carol’s plan at North Shore-LIJ and not seek insurance on the State Exchange.	No surcharge – Carol can continue to cover Steven. He will not have to seek health insurance on the State Exchange because an employer is not offering him a medical plan.
Bob is married to Alice.	Alice, who just needs dental coverage, is eligible for a medical plan through her own employer and plans to enroll.	No surcharge - If Bob is electing just the dental plan for Alice he will not see a surcharge in 2014, but he will have to adjust his elections on Employee Self Service.

Read recent article from Newsday, The New Insurance Landscape for Spouses.