Spousal Incentive HRA Eligibility Survey

To further understand your needs and help us prepare for Open Enrollment, please complete a brief survey on the Spousal Incentive Health Reimbursement Account. This survey is intended to determine your eligibility for this plan. Completing the survey does not automatically enroll you in the Spousal Incentive HRA plan. To continue, select Next.

Does your spouse's employer offer health insurance? *

Yes

No, my spouse is not employed

No, my spouse's employer doesn't offer health coverage

Is your spouse eligible to enroll in their employer's health insurance? *

Yes

No

Would you be interested in enrolling in a plan that covers 100% of your out-of-pocket medical and prescription expenses? *

Yes

No

If you would like to be reached out to in regard to the Spousal Incentive HRA plan, please enter your contact information below.

First Name