Who a plan covers is also an anti-discrimination question.
Eligibility rules for spouses and dependents sit at the meeting point of benefits law and civil rights law. This guide covers the main federal and Michigan rules for employers that sponsor group health plans.
The rules that shape spousal and dependent eligibility.
Treat this page as general information, not legal advice, and verify against the current rules before acting on spousal or dependent coverage terms.
Same Terms for Both Sexes
Title VII and EEOC regulations require that benefits be offered to male and female employees and their families on equal terms.
Dependent Coverage to Age 26
A group health plan that offers dependent coverage must make it available to an adult child until age 26, regardless of marital status or residency.
Marital Status in Michigan
Michigan lists marital status as a protected trait, so differing treatment of married and unmarried employees needs a lawful, neutral reason.
Applying the rules in plan design.
Same-sex spouses are treated as spouses for federal employment and plan purposes, and the Supreme Court has held that Title VII protects employees against discrimination because of sexual orientation or gender identity. Plan documents that define spouse narrowly should be reviewed.
Spousal surcharges and spousal exclusion rules for those who can get coverage elsewhere are lawful in many designs, but they must be applied evenly and disclosed in plain language in the plan documents and enrollment materials.
Special enrollment rights apply on marriage, birth, adoption and loss of other coverage, so eligibility change dates in the plan must match the federal minimums.
Where this shows up in your plan.
Plan Document Definitions
Check that the definitions of spouse and dependent in the plan, the carrier contract and the benefits guide say the same thing.
Employer Mandate Offers
The ACA employer mandate makes an applicable large employer offer coverage to full-time employees’ children to avoid a penalty, while spouses fall outside that requirement.
COBRA for Spouses and Dependents
Spouses and dependents are qualified beneficiaries with their own election rights and must receive notice.
Setting it up.
Compare your plan definitions of spouse and dependent with current law.
Confirm adult child coverage runs through age 26.
Review any spousal surcharge or exclusion with benefits counsel.
Make sure open enrollment materials explain special enrollment events.
Keep carrier contract definitions aligned with the plan document.
Mistakes to avoid.
Using outdated spouse definitions in a handbook or guide.
Cutting off adult child coverage at graduation or marriage.
Applying a spousal surcharge to some groups only.
Giving employees an informal answer on eligibility that differs from the plan.
Other rules employers work with.
Harassment and Discrimination Rules
Return to the parent guide.
Summary Plan Description vs. Benefits Guide
Keep documents aligned.
ACA Compliance for Employers
Employer mandate basics.
Laws and Rules Referenced
Title VII, 42 U.S.C. 2000e-2 — Bars bias in compensation, terms, conditions and privileges of employment.
Bostock v. Clayton County, 590 U.S. 644 — Sexual orientation and gender identity under Title VII.
Dependent coverage to age 26, 42 U.S.C. 300gg-14 — Public Health Service Act dependent coverage.
HIPAA special enrollment, 29 U.S.C. 1181(f) — Special enrollment rights.
Quick answers.
The questions below come up most often on this topic; each answer points to the full guide.
Must we cover spouses?
No federal law requires a plan to cover spouses, but if you do, the terms must be lawful and consistently applied.
Can we charge a surcharge for spouses with other coverage?
Often yes, if documented in the plan and applied evenly, but get advice on your specific design.
How long must a child stay covered?
Until age 26 if the plan offers dependent coverage at all.
More guides in this series.
Federal Workplace Harassment Law and Title VII Employer Duties
A companion guide in the same series.
Michigan Elliott-Larsen Civil Rights Act Employer Obligations
A companion guide in the same series.
Retaliation After a Harassment Complaint and Employer Risk
A companion guide in the same series.
Age Discrimination and Employee Benefit Plan Design
A companion guide in the same series.
Family Leave and Pay Equity Effects on Employee Benefits
A companion guide in the same series.
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