Spousal Affidavit Form For Health Insurance

Employees’ spouses who have access to affordable, minimum essential coverage that provides minimum value through another employer are not eligible for health coverage in the Roanoke College/Virginia Private Colleges Benefits Consortium (“VPCBC”) health plans.

Employees who wish to carry their spouse must certify that their spouse does not have access to other coverage. This certification is done by completing the VPCBC Spousal Affidavit.

 If an employee intends to carry their spouse on the health insurance for the upcoming plan year, please complete the Spousal Affidavit linked below:

For more information about the spousal eligibility, please see the spousal benefits eligibility page on our website.