Lastly, there is a small handful of states that continue to allow mom and pop businesses meeting certain criteria to qualify as a group. Carriers and brokers licensed in the state can provide specific information about the respective state’s rules.
Question: The Affordable Care Act (ACA) requires our medical plan to cover out-of-network emergency services at the in-network benefit level. Does that apply just to the emergency room charges, or also to follow-up care?
Answer: According to the ACA regulations, the definition of emergency services includes:
- The initial evaluation or treatment in the emergency room or similar setting;
- Related ancillary services; and
- Further treatment if needed to stabilize the condition.
The plan cannot impose a time limit during which the emergency services are provided.
For instance, if the patient was treated in the emergency room and from there admitted to the hospital for surgery, it appears the emergency room services, hospitalization, and surgery are all within the ACA’s definition of emergency services.
Extra Comp for FLSA Exempt Employees