Is an employer required to set up new health insurance service areas f

[Guest SenecaCst2]

Is an employer required to set up new health insurance service areas for COBRA recipients moving outside NY State? The employer in question has headquarters in NYS and service technicains employed and covered in 5 other states. The former employee is moving outside of any currently established service areas. Thank you

[Guest KGibson]

When you say service area, do you mean access to network providers? Also does your plan have an out of area payment schedule for non network services?

[Guest SenecaCst2]

Yes, sorry I was unclear. The plan is an HMO, so there is no out of network coverage.

[Guest KGibson]

My understanding is that you are NOT required to make plan changes to accommodate someone who chooses to move outside of the area. The company offers a plan, the eligible participants then choose to elect or waive coverage. Is your plan self funded or fully insured HMO? There could be a state statute that I am not aware of. Also, will the plan not pay a lower benefit outside of the provider network?

[Kirk Maldonado]

I seem to recall that the final regulations expressly deal with this issue, but I just can't recall how they resolve it.

[Guest KGibson]

I did find something in reference to your comment Kirk. It states:

"If a COBRA participant is covered under an HMO or other health care plan that limits its services to a geographic area, and the covered individual moves out of the service area, the employer must offer other coverage if the employer would be able to provide coverage to the qualified beneficiary under one of its existing plans. (Prior to the 1999 final regulations, coverage would only be available in this situation if the employer had employees working at the qualified beneficiary's new location.)