By: Zack Pace, SVP, Benefits Consulting
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:
- Based in DC, Maryland, or Virginia?
- Subject to ACA Shared Responsibility?
- Subject to ACA Fair Health Insurance Premium Rules?
- 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.
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