Lower your health plan costs without changing your plan.
Employees with access to another group health plan, usually a working spouse’s, can choose to enroll in it. You reimburse 100% of their eligible out-of-pocket costs. The health claims risk moves off your plan, and your plan stays exactly as it is.
Voluntary. Not a carve-out or a surcharge.
Generally, about 33% of employees qualify. $8,000 is the top of the historical average of $6,000 to $8,000 per participating employee. Results vary.
What it could be worth at your size
| Employees on plan | Enrolled at 10% | Estimated savings a year |
|---|---|---|
| 50 | $400,000 | |
| 100 | $800,000 | |
| 250 | $2.0 million | |
| 500 | $4.0 million | |
| 1,000 | $8.0 million |
Illustration: 10% participation at $8,000 per enrolled employee, the top of the historical average of $6,000 to $8,000. Results vary. Not a projection for your organization.
See the mathHow a voluntary Spousal HRA works
A technical summary written for benefits professionals, a seat in every meeting, and review of every document before you see a recommendation.
Read all 26 answers in the FAQWhat employees get
- 100% of eligible copays, deductibles, and coinsurance reimbursed under the spouse’s plan, subject to plan rules
- 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
- If the spouse’s plan ends, they can return to your plan under your plan rules
- It’s always their choice. Declining it changes nothing.
How it works
Keep your plan
You keep your current plan, carrier, and plan design.
Offer the option
Every employee on your plan is offered the same option. Those with access to another group plan, usually a working spouse’s, can choose to switch.
They enroll
Those who choose it enroll in that plan, which becomes their primary payer.
You reimburse
You reimburse 100% of their eligible out-of-pocket costs under it: copays, deductibles, and coinsurance.
- Voluntary, not a carve-out
- Not insurance
- Ceiling: $12,000 self-only / $24,000 family (2027)
- Non-participants see no change
Who can switch
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.
You can read how it works here. Your number takes a census.
I build that analysis from your census, bring in the program’s administrator and underwriting team, and stay on the account from the first call through open enrollment.
- Your number, not an average.Modeled from your own census.
- Your advisors in the room.Your broker and counsel review everything.
- One accountable person.From the first call to the first claim.
The program: administered 25+ years · 97% client retention · $400M+ health claims administered · employers from 300 to 150,000+ employees
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.
Is it a fit? Three questions.
- Do you have 300+ full-time employees?
- Is your plan self-funded?
- Do many of your employees have a working spouse?
Not insurance. An employer-funded Health Reimbursement Arrangement. Savings figures are historical averages; results vary.