How a voluntary Spousal HRA works
Two group plans, one household, and a reimbursement that closes the gap. Every step, for you and for your employees.
- Pays firstThe spouse’s group plan
The employee enrolls in it. It becomes their primary payer.
- Pays secondYour Spousal HRA
You reimburse 100% of their eligible out-of-pocket costs: copays, deductibles, and coinsurance.
- Stays as it isYour health plan
Same plan, carrier, and design. The family’s health claims risk moves off it.
Offered to everyone. Chosen by those it fits.
Every employee on your plan is offered the same option, on the same terms. Many are married to someone with an employer health plan of their own, and today your plan pays those families’ claims. Those with access to another group plan can choose to enroll in it, and you reimburse 100% of their eligible out-of-pocket costs under it.
- Offered to everyone, chosen voluntarilyEvery employee gets the same option. Declining it changes nothing.
- 100% of eligible out-of-pocket costsCopays, deductibles, and coinsurance under the spouse’s plan, reimbursed.
- Your plan stays as it isSame plan, carrier, and plan design. The health claims risk for participants moves off it.
Before and after, for each kind of household.
The employee is on your plan. Their spouse has a health plan through work.
- Your plan pays their claims.
- They pay their own copays, deductibles, and coinsurance.
- The spouse’s plan pays their claims first.
- Your HRA reimburses their eligible out-of-pocket costs, up to $12,000 a year (2027 self-only limit).
Illustrative, not to scale. Employees who don’t qualify, or don’t want it, see no change.
What you do
Analysis
I model participation and savings from your census, so you see the opportunity before anything else happens.
Plan design
The administrator prepares the HRA plan document and summary plan description. Your counsel and broker review them.
Communication
Employees receive a clear explanation of the option and decide for themselves at enrollment.
Enrollment
Participants enroll in the spouse’s plan, waive your medical plan for the participating family members, attest to their alternate group plan, and join the HRA.
Administration
The administrator issues HRA cards, processes reimbursements, and handles member service and reporting.
Ongoing
If a participant loses the spouse’s plan, they notify you within the qualifying event window and can return to your plan under your plan rules.
What changes for a participating employee
At the doctor or pharmacy
They show the spouse’s plan card first and the HRA card second.
After the visit
The spouse’s plan pays its share. The HRA reimburses the eligible copays, deductibles, and coinsurance.
On payday
Their contribution to your medical plan stops, because they’ve waived it.
Dental and vision
Can stay on your plans where your plan documents allow.
Before enrolling
They check that their doctors and prescriptions are in the spouse’s plan network.
Employees with access to another group plan
Qualifying group plans
- A spouse’s or domestic partner’s employer plan
- A parent’s group plan, for employees under 26
- A second employer’s group plan
- A qualifying retiree group plan from a former employer
Not qualifying
- Medicare as primary
- Medicaid
- TRICARE retiree-only
- VA health care
- Individual marketplace or non-marketplace plans
- Limited-benefit or short-term plans
Employees who don’t qualify, or don’t choose it, keep exactly what they have: same plan, same carrier, same contributions.
What it is, and what it isn’t
Two questions benefits teams ask
Health Savings Accounts
If an employee who owns an HSA joins, their HSA contributions may need to stop, depending on who enrolls and how the HRA is designed. HSA funds also can’t pay for expenses the HRA reimburses. This is settled in plan design, with your advisors.
Compliance, plainly
The program is offered to every eligible employee on the same terms, structured for compliance, and documented in a formal plan document. It’s run by an administrator that has implemented this arrangement for more than 25 years, and its compliance commitments come to you in writing with your analysis. We recommend review by your legal, tax, and benefits advisors before implementation.
Find out what it’s worth to you.
A no-cost savings analysis built from your census. You’ll see projected participation, estimated savings, and how the program would run, in writing, before any decision.
In one line
Employees with access to a working spouse’s group plan can choose to enroll in it, and you reimburse 100% of their eligible out-of-pocket costs. It’s voluntary. It is not a spousal carve-out or surcharge.
Not insurance. An employer-funded Health Reimbursement Arrangement. Savings figures are historical averages; results vary.