United Benefit Advisors Insight and Analysis Blog

Who’s Eligible for Coverage? UBA Survey Looks at Dependents, Spouses, Hours Worked

By Bill Olson, VP, Marketing & Communications at United Benefit Advisors
  Nov 23, 2015 12:00:00 PM

2015 Health Plan SurveyThe UBA Health Plan Survey looks at over 18,000 health plans sponsored by nearly 11,000 employers nationwide to offer the largest data source on plan costs and design. While headlines talk about issues related to same sex and dependent coverage, the 2015 Health Plan Survey looks at the facts. When it comes to who is being covered, we also look at how many employers are complying with the requirement to cover employees working 30 hours or more. The findings may surprise you. The option to waive coverage altogether is fading but bonuses to do so are on the rise. Here are the statistics on these issues.

Eligibility for Coverage—Consistent with the last few years, when employers aren’t required to offer coverage, they don’t. Less than 10 percent of employers provide coverage to employees working fewer than 30 hours per week. Interestingly, a significant number of employers still do not provide coverage to those who must receive it under the Patient Protection and Affordable Care Act (ACA). Nearly 18 percent of plans require employees to work more than 30 hours per week to be eligible for medical coverage. This means that these plans have yet to be amended to cover all employees working 30 hours or more—an amendment that will need to take place for these plans to be in compliance with the ACA. In other words, these employers have yet to face the full costs of coming into compliance with the ACA. It is important to note that state laws do vary regarding the number of hours required for coverage. If you are struggling with determining if an employee is considered full-time, be sure to request the latest UBA ACA Advisor that can help.

Dependent Coverage—The survey shows that 46.5 percent of all covered employees also elect dependent coverage, a 2.7 percent decrease from last year. Since dependent coverage percentages have remained essentially the same for the past three years, UBA believes this modest decrease is a trend to watch, since many experts believe higher costs will lead to a rush to drop family coverage.

Spouse/Partner Coverage—A majority (61.3percent) of all employers provide no domestic partner benefits, a trend that has remained unchanged for the past three years. Of the remaining employers, 30 percent provide coverage for both same-sex and opposite-sex domestic partners, 4.6 percent provide same-sex coverage only, and 4 percent provide opposite-sex domestic partner benefits only. The Supreme Court’s decision in Obergefell v. Hodges may lead to an increase in plans that cover same-sex spouses. Our free legislative resource center offers a helpful summary of this case.

Bonuses to Waive Coverage—Fewer employers are offering bonuses to waive coverage, but for those that do, the bonus amount is on the rise. Only 2.9 percent of employers offered a bonus to employees to waive medical coverage in 2015, a 17.1 percent decrease from two years ago. The average annual single bonus in 2015 was $1,680, which is a 10 percent increase from 2013.

When it comes to making coverage decisions, be sure to follow best practices to avoid an audit by the Department of Labor.

Download the free 2015 Health Plan Survey Executive Summary for additional information on health plan design trends across the U.S., including wellness programs, prescription drug plans, and fertility benefits.

Topics: UBA Health Plan Survey, dependent coverage, health insurance eligibility, UBA Health Plan Survey Executive Summary, coverage waiver bonus