For as long as I can remember, abortion has been a controversial topic in America – people tend to have an opinion, and tend to feel strongly about it. My intent in this writing is to provide some useful information, while deftly avoiding the controversy.
Several employer clients with group health plans have asked what they need to do – or what their options are – with their health insurance, in the event that Roe vs Wade is overturned.
If you have a self-insured health plan, the governing laws and regulations like ERISA are on a federal level, and your policy will likely not need to include the various state insurance mandates. However, plan administrators will still need to make a decision – whether to stop covering abortion, or whether to cover the procedure only where legal.
If you have a fully-insured health plan this would become an issue dealt with state by state – and what happens next is going to depend in part on a policy contract term you may have never heard of before… situs.
Where a health insurance policy is sitused is essentially where the contract is written – for many employers this is a simple answer – if I have 100 employees at a mill in Oregon, and all the employees live in the area, the company’s fully insured health plan will be sitused in Oregon.
However, things get a bit more complex when you have a geographically distributed workforce. Maybe instead of having all your employees in one state, maybe you have 35 employees in Oregon, 35 in California, and 35 in Texas. Where is the policy situs?
The answer will determine whose state laws are followed. If the situs state is California, all private health plans are required by law to cover abortion in the state. In Texas for instance this will not be the case.
For fully insured plans, the State where the policy is sitused is going to determine the types of benefits and coverages included in the plan. We anticipate that plan issuers / carriers will need to update the plan contract language for the specific laws where the contract is written.
Your employees may assume that their health insurance contract and the accompanying laws are determined by the state in which they reside, but with employer-based fully-insured health insurance, this is not the case.
If you have questions or concerns about this issue, please don’t hesitate to reach out to your Bolton team.
