Can an employer find a loophole not to offer WLS in Maryland?

I work for an employer  that just bought out another company, now we have 500+ employees over 4 states, one of them is now Maryland.

Up til now, we've had an WLS exclusion. They are combining and re-negotiating our health plans. Now, as I understand it, Maryland has a law requiring that WLS is offered in health plans, but I am not sure how far reaching that is.

I don't know if they can still get away with an exclusion for all, or if they would have to cover in only the state of Maryland...or...I don't know. Any ideas?

The two insurers they have in the running right now are Anthem and UHC, neither based in Maryland, that is for sure.

When I was denied I was told that if your insurance is not based out of Maryland they do not have to honor that law.  My BCBS was out of New York  and I live in Maryland but after my appeal letter I was approved.  Best of Luck to you!!

Stephanie

If the insurance is based in MD, and the employer is more than 50 employyes in the group, and is not a self insured company, they have to cover WLS in Maryland.  There is a MD mandate. 
(pasted info below)

State laws on insurance coverage for bariatric surgery: help or a hindrance?
Surgery for Obesity and Related Diseases, Volume 1, Issue 4, July-August 2005, Pages 424-429

Abstract: BackgroundThe purpose of this study was to determine which states have proposed or passed laws regarding insurance coverage for bariatric surgery and to obtain feedback from bariatric surgeons/programs regarding the effectiveness of these laws.MethodsThe Departments of Insurance in all 50 states and the District of Columbia in the United States and all members of the American Society for Bariatric Surgery were surveyed.ResultsResponses were obtained from all states and the District of Columbia, and 16 responses were received from the bariatric surgeons/programs. Michigan law requires all Health Maintenance Organizations to pay for all medically necessary treatments or procedures in general, such that if bariatric surgery can be shown to be medically necessary, it should be covered. Four states (Louisiana, Ohio, South Carolina, and Tennessee) have proposed state laws regarding bariatric surgery coverage, and four states (Georgia, Indiana, Maryland, and Virginia) have such laws in effect. However, none of the state laws that were passed “mandate” coverage, but rather “recommend” coverage or mandate that the insurer offer the coverage, for which the insurer can charge additional premiums. Although the numbers of responses from bariatric surgeons/programs were few, all of their responses were in agreement that the state laws have not increased insurance approvals for bariatric surgery and, in some cases, has made it more difficult to obtain approval.ConclusionSo far, the laws that have been passed have not adequately addressed the problems with decreasing coverage of bariatric surgery. Recommendations for future legislation are discussed.

In New hampshire, and Indiana, they also have a law.  read here

Utah is working on one, read here

If the insurance is based in MD, or the business? Do they just have to buy insurance from a company out of state to get around the rules, then?

Good question.  In my case, the insurance Aetna was based in MD, and I work in MD, but the Business was based out of state.  The best thing to do is speak to your HR dept to get the information and check the MD obesity laws.   Good luck!

The law covers employees who live in MD, and work for companies that employ over 50 employees in MD. The easiest loophole is that indemnity plans (my current insurer has one) are excluded. But, yes, there are ways around it. Are you planning on moving to MD? Otherwise the law wouldn't apply to you anyhow.

No, it doesn't apply to me. But, if it applies to the Maryland employees, than I want to make a case that they might as well apply it to the rest of the company. The point they are trying to make is ONE plan combined for more purchasing power, and if they include Maryland, doesn't that mean they have to include WLS? That is the question.

More than likely with multiple states, your employer will go for a self-funded policy. Self-Funded policies go by ERISA federal guidelines that say the employer can choose to exclude whatever they want as long as they exclude everyone across the board.

WIth an ERISA policy.....that whole MD rule is out the window for employees even if they do work in a office in MD.