On June 26, 2015, the Supreme Court of the United States (SCOTUS) provided a ruling on same-sex marriage which is impactful to the health insurance industry. In a 5-4 ruling, the court determined that all states in the country must issue marriage certificates to same-sex couples, and states must also recognize same-sex marriages that are performed in other states.  

 

The ruling means that all individual market coverage throughout the country must now allow for an applicant to include their same-sex spouse as a dependent on the plan. Similarly, any fully insured plan offered in the group market anywhere in the country, or any group plan offered by an employer in the public sector, such as a state or local government plan, must now allow same-sex spouses to participate as a dependent on the health plan.

 

However, employers in the private sector with self-insured plans don’t need to extend coverage to same-sex spouses under the SCOTUS ruling. The reason being that the ruling impacts state and local laws, and employers with self-insured plans are subject to ERISA which exempts those laws and doesn’t require coverage to be extended to same-sex spouses.  

 

Most employers with self-insured coverage will probably still be inclined to extend coverage to same-sex spouses if they don’t already. Although they’re not required to do this under ERISA, the Equal Employment Commission recently announced that LGBT individuals can file valid claims under Title VII of the Civil Rights Act. This means employers could face sex discrimination lawsuits if coverage is offered to an opposite sex spouse but not a same-sex spouse. We may see a handful of employers who don’t extend coverage to same-sex spouses due to religious objections or other reasons, and we may see a lawsuit that finds its way back to SCOTUS for another ruling.   

 

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