Seeking to save money on rising health insurance premiums, a growing number of Pennsylvania companies are squeezing out spouses who have access to insurance of their own.

The concept, known as a spousal exclusion, is viewed as a way for companies to rein in costs without directly costing their employees more money.

Under one version of a spousal exclusion policy, a wife wouldn't be able to get coverage on her husband's insurance plan if she were eligible for insurance through a job of her own. Another variation might allow a working husband to join his wife's employer's plan, but charge him a fee to do so.

A survey from Mercer Human Resource Consulting released last year reported that 14 percent of Pennsylvania employers said they used a spousal exclusion provision, compared with 8 percent nationally. Additionally, 8 percent of Pennsylvania employers said they planned to add a spousal exclusion provision, vs. 5 percent nationally.

Tom Tomczyk, a consultant with Mercer, said the Pennsylvania figures might be higher than the country as a whole because several large employers here, including the state and Downtown-based Highmark, use the provisions.

Highmark instituted the policy for its employees about 10 years ago, said spokeswoman Kristin Ash. "We believe that it is our responsibility to provide health care coverage to all of our employees, but other employers have responsibility for their employees," she said.

Highmark does allow employees to add their excluded spouses to the company plan for a surcharge -- an option used by about 10 percent of employees. Ms. Ash said that the amount of the surcharge is determined by a formula taking the employee's salary into account.

Though Highmark has had its policy for nearly a decade, other companies, including the Pittsburgh Post-Gazette for its managers, have adopted spousal exclusion provisions more recently as a cost-saving measure. Premiums for employer-sponsored plans have risen 87 percent since 2000, according to a study from the Kaiser Family Foundation, a Washington, D.C.-based health policy group.

"Obviously the cost of health care is becoming extremely unmanageable for some employers," said Sandra Mihok, an employment lawyer with Eckert Seamans Cherin & Mellott, Downtown. "This is one way to cut those costs and save some money while not impacting the employee in a way that would be really detrimental."

Ms. Mihok said when she first started practicing law in the mid-1990s, one or two of her clients would inquire per year about spousal exclusion. Now, she said, about a quarter of them do.

Years ago, some firms also offered the policy in a friendlier fashion, said Eric Smith, a Pittsburgh attorney with the Philadelphia law firm Schnader Harrison Segal & Lewis. They would give employees a credit if their spouse chose to accept alternate insurance.

Another, similar way of cutting back costs spent on spouse coverage is what Vince Wolf of Downtown consulting firm Cowden Associates calls the "West Coast style of contributions." Under that model, an employer covers 100 percent of its employee's insurance premium, but the employee has to pay full coverage for his or her family.

Spousal exclusion policies are particularly appealing for employers who offer relatively generous benefits that would ordinarily attract spouses whose jobs offer less generous plans.

In part, that concept is what prompted the Pennsylvania Employees Benefit Trust Fund (PEBTF) to add the provision when it tried to fix a funding shortfall several years ago.

"State benefits have always been very rich," said communications manager Christy Leo. "We used to have free insurance, and we were finding that people were always choosing our health plan. If the spouse has coverage, they should choose that other coverage."

For the PEBTF plan, spouses of employees who were hired on or after Aug. 1, 2003, are not eligible for coverage if their employer offers any type of insurance. Spouses of those hired before that date are eligible for PEBTF coverage unless their job offers totally free coverage or provides a financial incentive if they decline coverage.

While spousal exclusion plans sound like a relatively friendly way to cut back on health insurance costs, there are downsides.

One spouse's employer may only offer a high-deductible plan, for example, or one with premiums costing hundreds of dollars per month. For families on different insurance plans, it might be more difficult to reach yearly or lifetime maximum deductibles, said Gary Claxton of the Health Care Marketplace Project at the Kaiser Family Foundation.

A national survey by the foundation found that 12 percent of companies nationally alter their health insurance contribution depending on an offer that the spouse has, he said.

Ms. Mihok, of Eckert Seamans, said the plans might indeed cost families more money.

But it's better than some of the alternatives, she said, which include higher premiums and more restrictive coverage. "In this environment, there are so few ways to cut costs that employers are just looking for any possible angle. It may not be in the best interest of the employee, but at least everyone's covered."

For that reason, unions also are accepting of the spousal exclusions. The American Federation of State, County and Municipal Employees agreed to the PEBTF changes and the local Service Employees International Union includes the provision in its plan for insurance for Downtown janitors.

In part, said Mr. Tomcyzk, employers are embracing it because they don't want to be the company attracting all the spouses.

"It's something that everybody looks at," he said. "If you weren't looking at that, you could really miss out, because you can bet that somebody else is. Once they put that in, if you don't have it, you'll be the one paying."