Who is considered a member couple
Any two members married to each other and enrolled in the PPO medical option may qualify as a member couple. The couple can work for the same employer or different employers, and can be enrolled in Pastor’s Participation, menu options, or a combination of both.
- If you and your spouse are both enrolled in menu options, at least one of you must enroll for Member + Spouse coverage or Member + Family coverage (if you have eligible children). For example, if you and your spouse have no children and you enroll for Member-only coverage while your spouse enrolls for Member + Spouse coverage, you would qualify as a member couple.
- If one of you is enrolled in Pastor’s Participation and one of you is enrolled in menu options, the spouse enrolled in menu options must elect Member-only coverage, at a minimum.
- If you are both enrolled as members in Pastor’s Participation, you automatically are considered a member couple.
If one or both of you is enrolled in menu options and you both elect Member-only coverage, or if one of you waives medical coverage, you are not considered a member couple and will not qualify for member couple enhanced benefits.
How it works
Member couples have lower out-of-pocket costs for care:
- You pay $0 for network and non-network office visits for all covered family members.
- Your eligible children do not have to meet a deductible. The plan pays 100 percent of all eligible expenses for children.
- You and your spouse each pay a deductible, which is based on the minimum medical participation basis (the lowest salary band) regardless of either your or your spouse’s effective salary. After you meet your deductible, the plan pays 100 percent of all eligible expenses you incur for the rest of the year. Likewise, when your spouse reaches his or her deductible, the plan pays 100 percent of his or her eligible expenses for the rest of the year.
This provision does not apply to those enrolled in the EPO or HDHP medical coverage options. Member couple status also does not apply to dental coverage or vision eyewear coverage.
Prescription drug program
If you and your spouse qualify as a member couple, you pay $0 for generic or brand-name formulary prescriptions for yourselves and your eligible children. You pay the applicable copay (retail or mail-order) for non-formulary drugs.
Continuing member couple status in certain situations
Member couple status continues if
- either you or your spouse is eligible for and enrolls in the PPO option through transitional participation;
- one of you becomes disabled: your member couple status may be maintained for up to three years or until the disabled spouse turns 65, whichever occurs first; or
- one member dies: the surviving spouse retains member couple status for one year.
If you and your spouse are part-time ministers sharing one position at the same church, you are considered a 14-09 couple. As a 14-09 couple, only one of you is enrolled as the member for medical benefits; the other is enrolled as the spouse. Each of you is enrolled for pension and death and disability coverage. 14-09 couples are not eligible for member couple status.