Making sense of the Mid-Atlantic group health marketplace

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By: Zack Pace, SVP, Benefits Consulting

Map of DC Graphic 2

Geographically and economically, the greater Baltimore / District of Columbia / Northern Virginia region operates as a single, integrated region. However, politically, these three sub-regions might as well be in different time zones. As a result, policies and procedures dramatically differ throughout the greater region.

Specific to group health plans, when a Mid-Atlantic client calls with a question, we must run through a quick mental check-list before answering. For example, is the employer:

  1. Based in DC, Maryland, or Virginia?
  2. Subject to ACA Shared Responsibility?
  3. Subject to ACA Fair Health Insurance Premium Rules?
  4. Fully insured? Self-funded?

Fortunately, since the advent of the PACE Act last October, much of the complexity regarding who is subject to the Fair Health Insurance Premium rules (AKA age-banded rates) has ebbed. Thus, for employers with more than 50 full-time employees + full-time equivalents, there are now more similarities and differences within the three sub-regions. However, in the small group market, stark differences remain. Here is the chart we use to keep it all straight. I thought you might find this summary helpful.

Below is a chart preview. For a PDF file with clickable links to the resources mentioned, please click here.

health exchange graphic_making sense of the mid atlantic group health marketplace

You can reach me on zpace@cbiz.com or via Twitter. My collection of LinkedIn essays is located here, and my Employee Benefit News articles are available here.

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Zack Pace

Zack Pace, SVP, Benefits Consulting at CBIZ Inc., and his team design, implement, and manage benefits packages that are highly effective at empowering clients to attract and retain the top talent needed in order to outperform competitors, while ensuring that the cost of the overall benefits program and its components are cost-effective.
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