If you cover a dependent who has access to coverage through their own employer, your premium cost will be increased by a Working Spouse/Domestic Partner Surcharge. Your annual adjustment is $520 if your salary is less than $50,000 or $1,300 if your salary is greater than or equal to $50,000.

• You will also pay tax on the value of coverage (imputed income) if you cover a spouse or domestic partner and/or child of a spouse or domestic partner if they don’t qualify as dependents for federal income tax purposes.
• If the birthday of your spouse or domestic partner falls before yours in the calendar year, and you choose to cover your dependent children under a Rockwell Automation-sponsored plan, the surcharge will apply.

The surcharge won’t apply if your spouse or domestic partner is eligible for coverage as a retiree of a former employer, is self-employed, or is a Rockwell Automation employee. It also won’t apply if a divorce decree requires you to provide medical coverage for your dependent children.