Can you exclude spouse's from enrolling in the group health plan?

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Is an employer permitted to exclude spouses from enrolling/participating in their sponsored group health plan?  In other words, only employees and children up to age 26 would be eligible to enroll. 


Does ACA/PPACA prohibit this? 


 Does it depend at all any whether the employers group health plan is self-funded or fully insured?  Does it depend on the number of full-time equivalent employees that the employer has?  Until 2016 a small group between 2-50 employees while a large group is 51+.  Thank you,


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  • There is no requirement
    that employers provide employees with health insurance coverage, and generally,
    they can set up different arrangements with employees and design their
    benefits/compensation as they see fit. The Affordable Care Act (ACA) also does not
    require employers to provide healthcare insurance for their employees or their
    dependents. Instead, its “play or pay” provision requires employers to share
    healthcare responsibility by either providing coverage or paying penalties.
    More specifically, under the ACA's play or pay provision, employers with 50 or
    more employees face penalties if they don’t offer health insurance coverage to
    their full-time employees and their dependents or if the coverage they offer is
    insufficient. A dependent for this purpose is an employee’s child who is
    under 26 years of age. The term "dependent" does not include any
    individual other than children, including an employee’s spouse. Thus, an offer
    of coverage to an employee’s spouse is not required.


    For more information on the
    play or provision (and on what coverage is considered sufficient), visit

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