Working Spouse Coverage Clause Samples

Working Spouse Coverage. If an employee’s spouse is eligible to participate as a current employee or retiree in group health insurance and/or prescription drug insurance sponsored by his/her employer or any public retirement plan, the spouse must enroll in such employer (or public retirement plan) sponsored group insurance coverage(s). This requirement does not apply to any spouse who works less than 30 hours per week AND is required to pay more than 50% of the single premium to participate in his/her employer’s group health insurance coverage and/or prescription drug insurance coverage. Upon the spouse’s enrollment in any such employer (or public retirement plan) sponsored group insurance coverage that coverage will become the primary payer of benefits and the coverage sponsored by the Board will become the secondary payer of benefits. Any employee’s spouse who fails to enroll in any group insurance coverage sponsored by his/her employer (or public retirement plan) as required by this section shall be ineligible for benefits under such group insurance coverage sponsored by the Board. Every employee whose spouse participates in the Board’s group health insurance coverage and/or prescription drug insurance coverage shall complete and submit to the Board, 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 (or public retirement plan). If any employee fails to complete and submit the certification form by the required date, such employee’s spouse will be removed immediately from all health and prescription drug insurance coverage sponsored by the Board. Additional documentation may be required. If an employee submits false information or fails to timely advise the Board of a change in the employee’s spouse’s eligibility for employer (or public retirement plan) sponsored group health insurance and/or prescription drug insurance and such false information or such failure by an employee results in the Board providing benefits to which the employee’s spouse is not entitled, the employee will be personally liable to the Board for reimbursement of benefits and expenses, including attorneys’ fees and costs incurred by the Board. Any amount to be reimbursed by the employee may be deducted from the benefits to which the employee would otherwise be entitled. In addition, the employee’s spouse will be terminated immediately from group he...