How Spousal Coordination Could Affect You

DOES YOUR SPOUSE WORK FULL TIME?

If so, remember that all University of Delaware health plans have a spousal coordination of benefits guideline. This means that spouses who regularly work full time and are eligible for health coverage through their own employers must enroll in their employer's plan, which will be primary coverage.

ARE THERE CIRCUMSTANCES WHERE SPOUSES ARE NOT REQUIRED TO ENROLL IN THEIR EMPLOYER'S HEALTH COVERAGE?

Yes, your spouse need not enroll in his/her employer's plan if one of the following applies:

• Your spouse does not work full-time.

• Your spouse's employer requires a contribution of more than 50 percent of the premium for the lowest benefit plan available.

• Your spouse is not eligible for health coverage under the employer's plan because he/she has not satisfied the employer's requirements for participation ( for example, number of hours worked, probationary waiting period, etc.).

• Your spouse's medical history does not meet the underwriting requirements of the employer's health coverage.

• Your spouse's employer does not offer health coverage.

The University's health coverage will pay only 20 percent of allowable charges for services covered under the plan if your spouse is eligible and does not enroll in his or her employer's plan.

WHAT HAPPENS IF SPOUSES ARE ENROLLED IN THEIR OWN PLAN AND ALSO ENROLL WITH THE UNIVERSITY?

The University plan will pay benefits for covered services AFTER the spouse's plan pays first.

WHAT IF SPOUSES ARE NOT ELIGIBLE FOR AND THEREFORE NOT ENROLLED IN THEIR EMPLOYER'S HEALTH COVERAGE OR ANY OTHER HEALTH COVERAGE?

The University plan will pay benefits as described under the particular health plan you have chosen (Basic, Comprehensive, BlueCARE or Principal Health Care).