Definition of Spouse for Medical Plans

Private and employer-provided medical plan companies determine their own definitions of spouse; as a result, no single, government-regulated or industrywide definition exists. The law firm Seyfarth Shaw reports that most plans use definitions that refer to state law, such as "in a marriage recognized under state law." While the issue of definitions is usually straightforward for opposite-sex couples, the wording and reference of a plan's definition can have important ramifications for same-sex couples.

Definitions

• Both Seyfarth Shaw and the Human Rights Campaign, a lesbian, gay, bisexual and transgendered civil rights organization, cite a number of common definitions over the course of discussions on ramifications for couples. Two common definitions are "spouse who is legally married" and "legally married spouse as recognized under state law." While most plans use similar definitions, plans have full right to establish whatever definition they please.

Opposite-Sex Couples

• For opposite-sex couples, the definition of spouse is clear and simple in most cases. The couple must be legally married under state law; they have a marriage license from a county clerk, for which the couple pays a fee and collects the appropriate witness signatures. If the couple legally divorces, they are no longer spouses. Unmarried opposite sex couples can sometimes meet the domestic partner definition of a plan, but many plans restrict the partner option or definition to same-sex couples.

Same-Sex Couples

• For same-sex couples, the situation can get complicated. First, to fit the spouse definition, the couple must be married in one of the five states -- Iowa, Connecticut, New Hampshire, Massachusetts and Vermont, as well as the District of Columbia -- that allow same-sex marriage. If the plan states explicitly "legally married spouse as recognized under state law" or something similar, and the couple lives in the state where they married, the couple fits the definition. If a same-sex couple is married but lives in a state that does not recognize that marriage, or if the plan has a vague "legally married" definition, the couple should contact the company for clarification.

Considerations

• Regardless of the partners' genders, unmarried people cannot be spouses on a plan, which means no roommates or friends. Furthermore, federal, state and local laws restrict marriage to couples; no triads. If a couple lives together in a committed, intimate relationship and shares finances, the couple may fit a plan's domestic partner definition and should ask about it.