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Employee Marital Status Options and How it Relates to Health and Dental Benefits

By: Willow Munro | Tuesday June 20, 2023

Updated : Wednesday September 6, 2023

Text: Employee Marital Status Options and How it Relates to Health and Dental Benefits. Image: scattered gold rings and a form with different marital status options.

How do the different marital status options of your employees affect their extended health and dental benefits?

Just as all businesses are unique, employees and their families come in all shapes and sizes. And sometimes they change and evolve with time. Which means as an employer, you may find yourself needing to adjust the coverage every once in a while.

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What are the different Marital Status Options?

There are five common marital status options that an employee can be classified under for the purposes of group benefits. Marital status refers to the relationship status of an individual employee.

For the purposes of group insurance, these statuses are:

Single– the employee is currently not in a relationship or has never been in one.

Common-law* – the employee is living in a conjugal relationship with their partner continuously for at least 12 consecutive months and they are not married.
Married – the employee has a spouse and has legally signed documents.
Separated – the employee has not been living with their spouse or common-law partner for at least 90 days.
Divorced – the employee has legally divorced from their married spouse.
Widowed – the employee (or employee’s surviving spouse) had a spouse or common-law partner who is now deceased.

*For tax purposes, a common-law partner is considered such after living in a conjugal relationship for 12 months straight. This would be what is most often used to define a common-law spouse in group benefits. However, in Common Law, the definition of a common-law partner varies by province. And the rules surrounding their rights as a spouse differ as well.

What Does Each Marital Status Option Mean for Employee Health and Dental Benefits?

Employee marital status can directly affect the type of health and dental coverage an employee will be set up under. An employee with no dependents would be set up with Single coverage. And an employee with one or more dependents would be set up with Family coverage. There are some plans that offer Couple coverage for an employee and just one dependent. However, for the purposes of this blog post, we will focus on Single and Family coverage only.

Single or Never Married

This is the easiest marital status option when setting up benefits. The employee should be enrolled in all mandatory benefits, including health and dental. They will have single coverage with single deductibles (if applicable). If the employee has individual coverage of their own, it is often in their interest to switch to the employee coverage. This is because the rates are generally more affordable. Plus, employers often have cost-sharing, so the employee only pays half the cost of the less expensive coverage.

Common-Law

When an employee has indicated their marital status as Common-law, they should be set up with Family health and dental coverage. This means that the insurer will require the partner’s information – name, date of birth, and effective date of their common-law status – in order to register them for benefits as well.

If an employee is in a conjugal relationship, but they have been living together for less than 12 months, the employee should be set up with single coverage until they reach the 12-month milestone. At which time they will be required to inform their Plan Administrator or insurer so that their partner can be added to the benefits plan.

Upon the birth or adoption of a child of the couple, coverage may be extended to the common-law partner before the 12-month timeframe. This will usually require prior approval, and employers can check with their insurer to confirm if this is something they offer.

Married

Married employees’ spouses should be added to the group benefits health and dental plan. This would also be set up under Family coverage, as with common-law partners. It’s important to provide the spousal information, even if the spouse does not need coverage. This way, if they do need to come onto the plan at a future date, there is no confusion as to why the insurer was not informed the employee was married.

So, what if the employee’s spouse or partner has their own health and dental benefits? The employee can choose to waive their health and dental benefits, or have dual coverage and coordinate the benefits between the two plans. The third option is a combination of the above, where the employee keeps one or the other of the health and dental benefits, and has dual coverage for the other.

Coordination of Benefits: Can I Have More Than One Benefit Plan?

Separated

Separated employees should not include their ex-partner on their health and dental applications. This sounds obvious, but sometimes when people have children together, or other obligations, they may believe that their ex-partner is eligible for coverage.

If an employee gets separated while they are covered, they should inform the insurer within 31 days of the separation so the ex-partner can be removed from the health and dental plan. An employee with dependent children should keep them on the plan, and they would continue to have Family coverage. An employee with no dependent children would have their coverage changed to Single.

Divorced

As with separated employees, divorcees need to inform their plan administrator or insurer within 31 days of the divorce in order to have the ex-spouse removed from the health and dental plan.

In circumstances where there is a court order to continue coverage, the insurer may agree to do so. However, only one spouse can be covered at a time, so if the employee is covering their ex-spouse and then is re-married, they wouldn’t be able to cover both.

If the spouse is to be removed from the plan, the coverage would be updated to Single.

Widowed

Widowed employees will need to have their deceased spouse or partner removed from the benefits plan. They would also need their coverage updated to Single if they do not have any dependent children.

If an employee passes away while covered, most health and dental plans offer Survival benefits. This means the surviving spouse, along with any dependent children, will continue to receive benefits coverage free of charge. The length of time depends on the contract, but the industry average is 24 months.

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If you haven’t done an employee audit in a while, there’s no time like the present. Confirming the marital status of your employees could save you money by removing ineligible dependents. It could also ensure that new dependents (such as a newborn baby, new common-law partner, or new stepchild) are added in a timely manner, so they do not become late applicants.