Understanding Multi-State Coverage Challenges
Businesses today are more global than ever before. That increases the odds of you having a client with employees not just locally, but in multiple locations. That could include out-of-state employees.
Of course, having employees beyond the borders of the Golden State means potential new regulations for your client – and a potential impact on you, too. It means multiple health plan carrier networks and compliance with requirements in California and elsewhere.
Health Care Considerations by State
While the Affordable Care Act (ACA) sets national standards for Essential Health Benefits (EHBs), specific services covered in each broad benefit category can vary based on state requirements.
Benefit differences
While all states have to cover rehabilitative services, one state’s benchmark might cover more visits for physical therapy than another state allows. Prescription drug coverage can also vary.
State individual mandates
Some states, like California, mandate that individuals have health insurance coverage or face a penalty when filing their state income taxes. The state does not require employers to offer coverage; it just requires residents to get coverage – whether they get on their own, through an employer, or through other means. Massachusetts, New Jersey, Rhode Island, Vermont, and Washington, DC, also have a mandate for residents.
Provider networks
Generally, health plan provider networks do not cross state lines since health plans usually operate in a specific state or region. Emergency care and national PPO or multi-state health plans are the exception. That means if you have a client with employees in multiple states, those in California could have access to a different range of plans and networks than those based elsewhere. While the two state networks likely will offer similar benefits, the available doctors and specialists will differ because of where they are licensed to provide medical services.
With Blue Cross and Blue Shield plans, it is almost guaranteed that employees in multiple states will be insured by different legal entities. For example, California employees may be covered by a Blue Cross plan issued by Anthem or a Blue Shield of California plan. Employees of the same employer may have claims processed by a different insurer. For example, employees in Washington may have claims processed through Premera Blue Cross. Or in other Washington counties, they could be processed through Regence Blue Shield (which does business in select Washington counties as well as Idaho, Oregon, and Utah).
Several prominent Blue Cross and Blue Shield (BC/BS) insurers do business in multiple states. You could have clients in different states all covered by Anthem (whose parent is Elevance Health). Health Care Service Corporation is another multi-state BC/BS insurer. It does business in Illinois, Louisiana, Montana, New Mexico, Oklahoma, and Texas. That means you could offer Anthem coverage for California employees and HCSC coverage to others. It all depends on the geographic spread of your client’s employee population. Obviously, it’s important to know where each employee resides to ensure coverage under the right health plan and carrier. Outside of the BC/BS network or Kaiser Permanente (operating in six regions nationally), your clients’ employees could be offered different plans through Aetna, Cigna, UnitedHealthcare, or another national insurer.
Reporting
Because of differences in ACA coverage, there may be different reporting requirements for employers offering multi-state health coverage. While federal ACA reporting involves the Internal Revenue Service (IRS), specific state-level ACA reporting will vary in format, deadlines, and the information required, depending on state laws.
Expert Guidance is Key
Having expert guidance can make an enormous difference in helping you serve the diverse needs of your clients – and staying in compliance. Word & Brown offers you the people, expertise, and resources you need. We can help you stay on top of evolving trends and changing regulations.
We’re the only General Agency with a dedicated in-house compliance team. We’ll support you and your clients with complex regulations, employer reporting, and ACA requirements. Count on us for the knowledgeable guidance and valuable tools that make staying compliant easier.
One of our newest resources, the WBCompliance Wiki, gives you and your clients a single place to easily – and quickly – look up compliance-related topics to get the answers you need. You no longer have to wade through PDFs or scroll through lots of web pages when in need of information. Our search feature gives you the ability to find exactly what you’re looking for in seconds. We empower you to explore the world of compliance with confidence and stay ahead of the compliance curve.
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