Spousal surcharge calculator: what could a surcharge save the plan?
Enter the number of covered spouses, how many have other coverage and the surcharge to estimate the savings from the surcharge and from spouses who leave the plan. Built for HR and finance teams weighing a plan design change.
Estimate the effect of a spousal surcharge.
The shares are your assumptions. The result updates as you type.
Your assumption. Only these spouses are charged the surcharge.
Your assumption.
What the plan costs the employer for a covered spouse.
Your estimate
An estimate built on your own assumptions. Real results depend on who leaves, claims and your market. Review the design with counsel and consider the effect on employee relations.
What is a spousal surcharge?
A spousal surcharge is an extra monthly charge for covering a spouse who has coverage available through his or her own employer. A related design, the spousal carve-out, does not allow those spouses on the plan at all. Both aim to move the cost of a spouse with other options off the employer’s plan, and both are common in group health plan design.
What should an employer watch?
Employees notice the change, so communication matters. Claims data can show how many spouses are covered and what they cost. A surcharge should be applied consistently, written into the plan document and communicated before open enrollment. Plan design changes also need the notices described in our notice deadline calculator.
Common questions
How do I find out who has other coverage?
Ask at enrollment. A short attestation form on which employees state whether a spouse has coverage through an employer is a common method.
Does a surcharge affect ACA affordability?
Affordability looks at the cost of employee-only coverage, so a spousal surcharge generally does not enter the test. Confirm with your advisor.
What about spouses with high claims?
A spouse with high claims on your plan is costly, and moving that spouse to another plan can be worth the most. It is also the case that demands the most care in communication.
Is a carve-out better than a surcharge?
A carve-out removes the cost entirely for spouses with other coverage, and a surcharge lets the employee choose. Test both with your own numbers.
Laws and rules referenced
26 U.S.C. § 36B(c)(2)(C) — Employer coverage is affordable when the employee’s cost is within the percentage of household income the IRS sets each year.
26 C.F.R. § 54.4980H-5 — Affordability and the three safe harbors (Form W-2 wages, rate of pay and federal poverty line) in paragraph (e)(2).
This tool gives estimates for education, not tax or legal advice. Rules change, so confirm your situation with a qualified advisor.
Talk to us about plan design
Book a 30-minute call and we will look at your spouse enrollment, your claims and the design options that fit. Visit us at 41000 Woodward Avenue, Suite 350 East, Bloomfield Hills, MI 48304, or call 248.370.8853.
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