A short YouTube video (part 1 of a five-part series) by Andy Neary arguing that spousal surcharges are a misguided response to rising medical and pharmacy claims. Neary explains that charging spouses who have access to other employer coverage drives healthy spouses off the plan and leaves a higher-risk pool, so employers should consider alternative strategies to manage claims.
Chapters
Welcome back to Striking out the Status Quo where your health plan is one mindset shift away from greatness. Alright, here we are kicking off another five part series. This series focused on mindset shifts. We're going to focus on some beliefs, some theories you may have about your health plan that just aren't true. So let's dive into part one. We're focusing on those spouses. Today you're looking at your medical and pharmacy claims and you see the spousal claims continue to rise. So what do you do? Well, it's right about this point, your broker chimes in and starts talking to you about the spousal surcharge. Here's how it works. If you have spouses on your health plan that have access to coverage at their employer, you're going to charge them more, maybe 100 or $200 a month to stay on your plan. The theory, if you charge them more that surcharge to stay on your plan, they'll decide to go to their employer's health plan, thereby, well, taking them away from your plan and eliminating those claims. But here's where that theory is absolutely wrong. A spousal surcharge is really a self inflicted gunshot wound. Because if you charge the spouses more to stay on your plan, if they have access to coverage somewhere else, guess who leaves your plan? The healthy spouses that don't use your plan at all. They're going to say, well, why pay an extra hundred or two hundred dollars when I don't use the health insurance, I'll just go over to my employer's plan and. And you're left with a pool of unhealthy spouses on your plan choosing to stay there because of your coverage and your claims continue to rise. So next time you're being told that the spousal surcharge is the way to go, the way to reduce claims, just know that's a false belief and that you should be looking at other strategies to impact your medical and pharmacy claims. Until next time, bear down, focus on the target and strike out the status quo.
