Question about WLS insurance laws in Maryland...

Hello. I'm in Texas, but my company just bought out another company headquarted in Columbia, MD, and doubled their employees to 500+. I've been working for HR regarding an insurance changes over the next year, because as of now WLS is an exclusion on the Texas side.

As I understand it, WLS coverage has to be included by law in Maryland. So, at least some of our employees will have to have a plan that covers it, right? Any details I should know, like loopholes, etc?

I'm hoping to hop on the MD employee's coattails into coverage so any insight you can give me will be most appreciated.

In Maryland, it has to be covered by the insurance company (if there are over a certain number of employees, 60 or more I think).  However, the employer can exclude it from their policy.  So you'll need to check for exclusions in their policy.

So, help me understand.

Here, all WLS is excluded UNLESS your employer buys a rider...

In Maryland, it's INCLUDED unless the employer adds a rider to exclude it?

Can an employer buy an out of state contract to avoid including it, I wonder?

Yes, in MD it is included unless the employer adds a rider to specifically exclude it from the policy.  I'm not sure if they can buy an out of state contract, but it is doubtful.  MD law mandates that insurance companies must cover.

It depends on what state your policy is written in.  For example, your company might have an office in Columbia, MD, but because your home office is in Texas, the policy might be written in Texas.  In that case, the MD law would not apply.   The MD law also excludes self funded policies.  So if the company itself covers the claims, it is considered self funded and would also be excluded from the MD policy.   Clear as mud????

Marcia

"Clear as mudd???"

I would expect nothing less from the insurance companies trying to avoid paying for care at every turn. ;)

Well, it will be interesting how this all plays out. We have our headquarters in Texas, and an office in Ohio. Our insurance is out of Ohio. The company we bought out is headquartered in Maryland, with another office in Arizona.

From what I understand.  The only exclusions under Maryland law would be self insured and small group coverage (less than 50 employees).  I learned this the hard way a few years ago since I work for a smaller company.  I had to be added to my husband's plan to get coverage.  Hope this helps.

If a company draws their insurance policy in MD, and employs 50 or more, and is not a government agency, they have to cover it. The exclusion is companies with URISA plans, which are basically self funded plans. That is why my old plan didn't have to cover me. Thankfully, I switched plans, and my current plan does cover it, and thankfully I am 7 months post-op and I only had to pay about $1000 out of pocket.