Pennsylvania Healthcare Insurance laws & compensation compliance analysis

Pennsylvania Healthcare Insurance: What you need to know

There is no state law requiring employers to offer group healthcare insurance to their employees, but most employers do provide this benefit. However, if any health insurance is offered, Pennsylvania's insurance laws require policies to cover certain benefits (mandated benefits). There is additional information about insurance continuation and conversion requirements.
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Under federal law, states are not allowed to regulate self-insured benefits plans. Pennsylvania's mandated benefits and conversion provisions do not apply to health plans in which the employer pays all benefits without the proceeds of any insurance policy. An employer's health plan is self-insured if the risk of paying claims is on the employer and not on an insurance company. Self-insured plans may contract with third-party administrators (TPAs), including insurance companies, to process benefits claims. The TPA pays the claims and then is reimbursed by the employer. Many self-insured plans also buy “stop-loss” insurance to cover very large claims. The purchase of stop-loss insurance does not result in the loss of self-insured status and the exemption from state insurance law regulation.
The Affordable Care Act (ACA) required the establishment of healthcare exchanges to provide individuals and small employers with access to affordable insurance coverage beginning January 1, 2014. States had the flexibility to design and operate exchanges that best met their unique needs while meeting the ACA’s statutory and regulatory standards.
Pennsylvania decided to default to a federally facilitated exchange. To access Pennsylvania’s federally facilitated exchange, go to ...

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