After you enroll a new dependent in a Caterpillar healthcare plan, you must provide documentation to verify his/her eligibility, such as a birth certificate or marriage certificate. If you add a spouse/same-sex domestic partner to coverage, you'll also need to complete the spousal surcharge affidavit.
Soon after enrolling a new dependent, you'll receive a letter or email from Alight with instructions for submitting the required documentation. If you don't complete the verification process by the deadline, coverage will be dropped for the dependent, and you won't be able to re-enroll him/her until the next annual enrollment (unless you experience a qualified status change).
What's the spousal surcharge?
If a spouse of an active employee has access to group insurance coverage, but declines that coverage and enrolls under a Caterpillar group health plan as the sole and primary coverage, the spousal surcharge applies. If the spouse is actively employed or retired and doesn't have access to other group health coverage, spousal surcharge does not apply. Spousal surcharge also does not apply for Medicare or COBRA coverage.
You'll be asked to confirm whether or not your spouse has other coverage available during annual enrollment. It's your responsibility to provide accurate and up-to-date information. Providing false information to the Plan could result in loss of elected benefit(s) or disciplinary action, up to and including discharge. The surcharge can only be discontinued during annual enrollment or within the 31-day window of a qualified status change.
Why did Caterpillar institute a spousal surcharge?
The spousal surcharge encourages those participants eligible for other group insurance to take advantage of that coverage. It also allows Caterpillar to share healthcare costs with other employers. Spousal surcharge is a method adopted by many employers.
Is there a certain level of insurance offered through a spouse's employer needed to qualify as a viable alternative to what Caterpillar offers, or does any coverage count toward paying a surcharge?
Spousal surcharge applies whenever the spouse has access to medical coverage though his/her employer and opts out of that coverage. All plans are treated the same. The spousal surcharge applies to catastrophic and 100% employee-reimbursed plans, and in cases where the other employer subsidizes or incents the employee to opt out of that coverage for Caterpillar-only coverage.
When the spousal surcharge is applied, how does the primary and secondary insurance work?
Spousal surcharge is a fee applied to the premium. It has no impact on coordination of benefits between two or more plans. If the spouse has enrolled in his/her employer’s health plan, spousal surcharge does not apply.
Does Caterpillar have a right under data privacy to ask if the spouse is eligible for insurance coverage from another company?
Yes, the company has a right to inquire about a spouse's other insurance. Data privacy involves health information specific to an individual's medical condition or treatment.
If an employee chooses to go on his/her spouse's group coverage, will the employee receive an incentive?
No. Caterpillar offers no incentive or premium reduction to encourage employees to enroll in their spouse’s plan. That's a personal decision. Caterpillar implemented the surcharge because we believe all employers should share the responsibility for their employees' healthcare coverage.
If a spouse is hired during the plan year and becomes eligible for benefits elsewhere, would the spousal surcharge be applied at that time?
Yes, the employee would need to update his/her dependent information to add the surcharge by calling the Caterpillar Benefits Center at 1-877-228-4010.
If my spouse loses his/her job and benefits, would he/she have to wait until an open enrollment period to be eligible for Caterpillar insurance?
No, the loss of a spouse's employment and related benefits is a qualifying life event change event that would allow an employee to enroll the spouse and any affected dependents into healthcare coverage through Caterpillar within 31 days of the qualifying event. Call the Caterpillar Benefits Center at 1-877-228-4010.
If my spouse was offered medical coverage through his/her employer, but the open enrollment window is different than Caterpillar's, and he/she opted out at the time of open enrollment or the initial offer and isn't offered coverage access until the next annual enrollment, does the spousal surcharge apply?
Yes, the spousal surcharge applies if an individual is offered healthcare coverage in any capacity and opts out of the coverage for Caterpillar's plan.