Spousal Incentive HRA
AI-Driven Spousal HRA
Lower costs and strengthen benefits with our AI-driven Spousal Incentive HRA, which reimburses 100% of eligible out-of-pocket costs for participants.
Voluntary for employees. Not a carve-out or a surcharge.
Per participating employee, at the top of the historical $6,000 to $8,000 range. Based on historical client data. Results vary.
- 1They choose the spouse's plan. It becomes their primary plan.
- 2Your HRA joins it. It reimburses 100% of their eligible out-of-pocket costs.
- 3Your cost drops. From a full plan cost to a reimbursement plus an administrative cost.
- 4The difference is savings. Your plan stays exactly as it is.
What it is
A strategic risk-transfer solution, offered alongside your plan.
Our AI-driven Spousal Incentive Health Reimbursement Arrangement (HRA) is a strategic risk-transfer solution. It’s designed to optimize healthcare benefits and drive significant cost savings.
When spouses use their own employer’s health plan, overall healthcare expenses go down, which gives the employer real financial relief.
The program encourages participants to take care of their medical problems. It reimburses 100% of their eligible out-of-pocket costs under the other plan, instead of discouraging care the way most plans with high deductibles, copays, and coinsurance do.
How it works
Four steps. Your plan stays exactly as it is.
Every employee on your plan is offered the same option. Those with access to a qualifying group plan can choose it.
Keep your plan.
It's offered as another plan option alongside all your benefits. There's no need to eliminate any medical plan.
Offer the option.
Employees with access to another group plan, usually a working spouse's, can choose to enroll in it.
They enroll.
That plan becomes their primary plan.
The Spousal HRA reimburses
100% of their eligible copays, deductibles, and coinsurance under it. The administrator handles every claim, so there's no added work for HR.
- Voluntary
- Not a carve-out
- Not insurance
- Non-participants see no change
Who can switch
See it by household.
Before and after, for each kind of household that can participate.
Before
Your plan
- Employee
After
Spouse’s plan
- Employee
+ Your HRA: 100% of eligible out-of-pocket costs reimbursed
An employee covered alone joins a working spouse’s group plan. Their contribution to your medical plan stops. Your plan is unchanged for everyone else.
Key benefits
Key benefits of our Spousal Incentive HRA
Reimbursement employees feel.
It pays 100% of eligible copays, coinsurance, and deductibles under the spouse's plan for participants who qualify.
Financial efficiency.
Substantial savings and more predictable budgets, so you can plan and allocate with confidence.
Historically 25% to 65% or more of each participating employee’s plan cost. Results vary.
A stronger benefits package.
It supports employee satisfaction and retention, and it sits alongside every benefit you already offer.
Most plans with high deductibles, copays, and coinsurance quietly discourage care. This one encourages participants to take care of their health.
For employees
What changes for a participating employee
It's voluntary, declining changes nothing, and eligible out-of-pocket costs are reimbursed.
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, and the HRA reimburses eligible copays, deductibles, and coinsurance. If a provider won't process the HRA card, the employee submits the Explanation of Benefits or pharmacy record.
On payday
Their contribution to your medical plan stops, because they've waived it.
Dental and vision
Can stay on your plans where plan documents allow.
Before enrolling
They confirm their doctors and prescriptions are in the spouse's plan network. The HRA follows the spouse's plan's coverage decisions, so it can't make an excluded service eligible.
If the spouse loses that plan
They notify you within the qualifying event window and can return to your plan under its rules.
Eligibility
Who qualifies
Approximately 30% of employees typically have access to a qualifying 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.
Plainly
What it is, and what it isn’t
It’s structured for compliance, documented in a formal plan document, and reviewed with your counsel.
Reimbursement is capped by plan design at the ACA out-of-pocket maximum: $12,000 self-only and $24,000 family for 2027 plan years. Refreshed every January.
Our implementation partner
We connect you with the best resources.
We partner with a highly reputable administrator with more than 25 years of experience. That means seamless integration and strong service delivery.
Our role is to connect you with the best resources, so you get a robust solution without the complexity of implementing it yourself. The administrator’s name, credentials, and plan documents come with your savings proposal.
Typically 90 to 120 days from decision to launch.
What you go through
Watch
The questions a careful broker asks
Isn't this a spousal carve-out?
No. A carve-out pushes spouses off the plan, and a surcharge charges them more. Both leave families paying out-of-pocket costs. This program is voluntary, adds an option, and reimburses eligible out-of-pocket costs.
Who administers it?
A specialist third-party administrator implements and runs the HRA. Bentley & Green is the advisory firm. The administrator's name, credentials, and plan documents come with the savings proposal.
What happens to the current plan?
Nothing. Same plan, carrier, and plan design. Employees who don't qualify, or don't choose it, keep exactly what they have.
What does an employee have to do?
Enroll in the other group plan, waive your medical plan for participating family members, attest to the other coverage, and join the HRA. They confirm their doctors and prescriptions are in that plan's network first.
Free consultation
Take control of your healthcare costs.
See how our Spousal Incentive HRA can change your healthcare strategy: lower costs and a stronger benefits package.
Not insurance. An employer-funded Health Reimbursement Arrangement. Savings figures are historical; results vary.