H&W: Same-Sex Spouse Coverage

Same-Sex Spouse Coverage: Beginning with the 2015 plan year, a health insurance issuer offering non-grandfathered health coverage must offer  legally married same-sex spouse coverage, if they offer coverage to opposite-sex spouses. This requirement was released as a single FAQ by the Centers for Medicare and Medicaid Services (CMS).  For purposes of the guidance provided in this FAQ, coverage of a same-sex spouse must be based on a marriage that was validly entered into in a jurisdiction where the laws authorize the marriage of two individuals of the same sex.

This does not override a sponsors’ ability to determine its own eligibility requirements or its right to define a dependent “spouse” as it chooses for eligibility in its health plan. Under the guidance provided in the FAQ, if the plan sponsor chooses to offer coverage to same-sex spouses under a non-grandfathered plan, the health insurance issuer must provide that coverage. This is true even if the plan sponsor and insurer are located in a state that does not recognize same-sex marriages.