Page 16 - SIH 2022 Re-Enrollment Guide
P. 16
WORKING SPOUSE CONTRIBUTION
Spouses who are eligible for their employer’s group medical coverage but choose to be covered by SIH’s plan
will pay a $75 per pay period working spouse contribution.
The additional contribution will not apply if:
X You do not have a spouse X Your spouse is employed, but is not eligible for
X You do not enroll your spouse in the SIH group medical coverage from his/her employer
medical plan X Your spouse is not employed and has access to
X Your spouse is not employed or is employed medical coverage in a government-sponsored
part-time, temporarily, or on a short term medical plan such as Medicare, Medicaid,
contractual basis or Tricare
X Your spouse is self-employed and is not eligible X Your spouse is not employed and has access
for group medical coverage to medical coverage through a retiree medical
plan from his/her former employer
X Your spouse is employed by an SIH entity
As part of the beneits enrollment process, you will be asked to answer a questionnaire about whether your
spouse has access to a group medical plan from his or her own employer. You will also be asked the name,
address, and phone number of your spouse’s employer. If you are not including your spouse on medical
coverage, you can answer “Not Applicable” for each of the questions on the questionnaire. Failure to answer
truthfully is considered fraud and can result in termination of employment.
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Spouses who are eligible for their employer’s group medical coverage but choose to be covered by SIH’s plan
will pay a $75 per pay period working spouse contribution.
The additional contribution will not apply if:
X You do not have a spouse X Your spouse is employed, but is not eligible for
X You do not enroll your spouse in the SIH group medical coverage from his/her employer
medical plan X Your spouse is not employed and has access to
X Your spouse is not employed or is employed medical coverage in a government-sponsored
part-time, temporarily, or on a short term medical plan such as Medicare, Medicaid,
contractual basis or Tricare
X Your spouse is self-employed and is not eligible X Your spouse is not employed and has access
for group medical coverage to medical coverage through a retiree medical
plan from his/her former employer
X Your spouse is employed by an SIH entity
As part of the beneits enrollment process, you will be asked to answer a questionnaire about whether your
spouse has access to a group medical plan from his or her own employer. You will also be asked the name,
address, and phone number of your spouse’s employer. If you are not including your spouse on medical
coverage, you can answer “Not Applicable” for each of the questions on the questionnaire. Failure to answer
truthfully is considered fraud and can result in termination of employment.
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