The Supreme Court in Windsor didn't make coverage of same-sex spouses mandatory; it said that the question of "who is a spouse?" is answered by the states, not the federal government. Since then, the IRS and DOL have made it clear in the retirement plan context that "spouse" includes all persons who are married in a state that recognizes the marriage. As a result, certain mandatory equivalent treatment of same-sex spouses exists in retirement plans (e.g. qualified annuities and QDROs). Many of us think that the question for health plans will be answered by state and federal nondiscrimination laws (i.e., they may bar discrimination against same-sex spouses). But, a participant's attempt to get the same result under ERISA recently failed. In Roe v. Empire Blue Cross Blue Shield, the federal district court in New York rejected claims that the exclusion of same-sex spouses was a "benefit interference" that violated Section 510 or a breach of ERISA's fiduciary duties. I don't read this decision as one that upholds an exclusion of same-sex spouses; I think the court is simply saying, "if an exclusion like this is wrong, this isn't why it's wrong."