What Is the Definition of Spouse for Medical Plans?

Knowing what is the definition of spouse for medical plans is extremely important.  Many medical plans specify that a person's spouse will receive benefits with them, and/or will be allowed access to certain information on the plan. The word “spouse” can sometimes vary in its legal technicalities depending on the situation, contract, or case being defined.

In the case of a medical plan, a “spouse” is generally defined as a person to whom you are legally married. However, with recent changes in some state laws that allow for same-sex marriages, the word may sometimes need further definition.

• Typically, if your state recognizes your marriage as legal, your medical plan probably will too, and a same-sex spouse will be eligible to share your benefits.
• In some cases, however, a medical plan may define a spouse not only as a person to whom you are legally married, but as a person “of the opposite sex” to whom you are legally married.
• If this creates a problem, your medical plan may offer an alternative that would cover your situation. For example, many medical plans will allow a holder to share benefits with what is referred to as a “second domiciled adult” (SDA). This may refer to a person who is unrelated to you, unmarried to anyone else, at least 18, and who has shared your residence for at least six months prior to the coverage.

Of course, every medical plan may be slightly different and the key is to know the definition of spouse for your particular medical plan so you can be aware of what coverage you have available to you and your loved one. Questions about who is eligible to be considered a spouse on your medical plan should be discussed with a customer representative at the insurance company.