Spouse and Dependents - State Pensioners
Effective January 1, 2023, the State’s Spousal Coordination of Benefits Policy will be modified to permit a Pensioner whose spouse is Medicare eligible and also offered either a Medicare Advantage plan or cash in lieu of coverage, to choose either the coverage available through the spouse’s former employer or the State of Delaware Highmark BCBS Delaware Freedom Blue PPO Medicare Advantage Plan (with prescription through SilverScript).
Covering a Spouse and Spousal Coordination of Benefits Policy
You may elect to cover a spouse under your State of Delaware health plan. This DOES NOT mean they are automatically eligible for primary coverage under your health plan. The Spousal Coordination of Benefits (SCOB) Policy and Chart is used to determine your spouse’s benefit eligibility status under the State of Delaware Group Health Insurance Plan (GHIP).
There are two important questions to consider before enrolling your spouse in a State of Delaware health plan with prescription coverage:
Is your spouse employed full-time or retired from an employer that offers a health plan?
Is your spouse responsible for 50% or less of the premium for the lowest active or retiree health plan available to them?
If you answered “Yes” to both questions, then your spouse is most likely required to enroll in his or her employer’s coverage. You may still enroll your spouse in your State of Delaware health plan as their secondary coverage.
IMPORTANT: If you cover a spouse under your Highmark Delaware or Aetna health plan, you are REQUIRED to complete a Spousal COB Form online to determine your spouse’s eligibility status.
The online form must be completed within 30 days of enrolling your spouse in a State of Delaware health plan, within 30 days of your spouse losing or gaining employee coverage and every year during Open Enrollment in May.
FAILURE TO COMPLETE A SPOUSAL COB FORM OR PROVIDE DOCUMENTATION WHEN REQUIRED WILL RESULT IN A REDUCTION OF YOUR SPOUSE’S COVERAGE.