Multi-state qualified health plans for employers

As an employer operating in multiple states, providing health coverage that works for all your employees can be challenging.

Luckily, employers of all sizes can implement a multi-state health benefit plan program that doesn't require buying plans from multiple insurance companies and health insurers. Learn more about your options in this ultimate guide.

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Need to offer health insurance that’s good in all 50 states?

Today's employees are more spread out than ever before. UpWork estimates that 22% of the American workforce will be remote by 2025. The rise of remote work makes it hard for companies with employees from all over the country to find health coverage that works for everyone.

Many states have their own regulations and requirements when it comes to health insurance, and navigating these differences isn't easy. Plus, plans available in one state may not be available in another. However, there are several options available to multi-state employers to ensure that their employees have access to quality health coverage.


National health insurance plans

One multi-state plan option for employers is a national health insurance policy. These plans provide comprehensive coverage to employees regardless of where they live or work. They typically have a large network of providers that employees can choose from, making it easier for them to access medical care wherever they're located.

National plans simplify the administration process for employers by providing consistent group health insurance for all employees, regardless of location, ensuring everyone receives quality coverage.

However, you may have a hard time finding an affordable national plan from traditional group health insurance issuers. Only some insurance companies offer multi-state plan coverage, which may result in a limited selection of plan types with higher premium prices.

State health insurance plans

Another option for multi-state employers is offering their staff separate state plans. This allows employees in various locations to receive essential insurance coverage that works in their area.

Insurance choices vary depending on which insurers offer coverage in each state. So, what's available to your employees in Texas may be different than what's available in California. This is why it’s important to check which healthcare providers are available within a particular plan network

The Small Business Health Options Program (SHOP) Marketplace is a federal program designed to help small business owners provide health insurance coverage to their employees, making it a good place for many employers to get started.

If you sign up for a SHOP plan in the state where your business is, you can provide coverage to your employees in other states in two ways:

  1. Choose a single health plan for all employees with a multi-state or national provider network.
  2. Offer different SHOP plans in each state where your employees work.

If you're sold on SHOP plans, keep in mind that they're not available everywhere. If a state has its own health insurance exchange, a shop plan may not be an option. Handling multiple policies simultaneously can also present challenges and consume a significant amount of valuable time for employers.

Health reimbursement arrangements (HRAs)

The most flexible multi-state plan option is a health reimbursement arrangement (HRA). An HRA is a cost-controlled and convenient way to offer a multi-state health plan and in-network medical care for all your employees.

An HRA is an IRS-approved, employer-funded health benefit employers can use to reimburse employees, tax-free, for their healthcare expenses, including individual health insurance premiums, out-of-pocket medical expenses, or a combination of the two. Because HRAs are reimbursement arrangements—not health insurance plans—coordinating their use across state lines requires no additional effort.

HRAs enable employers to reimburse employees for their medical costs by offering a set monthly allowance amount of their choosing, avoiding the hassle that comes with health insurance renewals and premium rate spikes every year. They also enable employees to select the healthcare products and services that are most accessible to them.

Why are HRAs good multi-state plans?

  • They empower employees to choose: With an HRA, employees can shop on the individual market and select their own individual plan with a network of providers that works in their area and covers the essential health benefits that matter most to them.
  • They satisfy federal government mandates: Some HRAs, like the individual coverage HRA (ICHRA), can satisfy federal regulations for applicable large employers (ALEs)—organizations with 50 or more full-time equivalent employees (FTEs)—including the Affordable Care Act's employer mandate.
  • They’re available to small businesses and nonprofits: One of the biggest hurdles small businesses face is the cost of offering a traditional group plan. With an HRA, you can offer a health benefit that fits your budget. Plus, there are no minimum participation requirements. If you have fewer than 50 FTEs, you can offer a qualified small employer HRA (QSEHRA) or an ICHRA instead of a group plan.
  • They offer flexibility: On top of setting your own allowance, the ICHRA gives employers the flexibility to personalize allowance amounts and eligibility by employee class. For example, you can offer your full-time employees a monthly allowance of $650 and offer your part-time employees $450. With a QSEHRA and ICHRA, you can also differ allowances by family status, such as single or married.
  • They give your company a competitive advantage: According to PeopleKeep's 2024 Employee Benefits Survey, 81% of employees said an employer’s benefits package is an important factor in whether or not they accept a job. While most employers offer rigid group health insurance plans, an HRA is a personalized health benefit that outshines other less personalized options.

Learn more about each HRA


For employers with 1-49 employees


A simple, controlled-cost alternative to group health insurance.




For employers of all sizes


A flexible health benefit that can be used alone or alongside group health insurance.




For employers offering group health insurance


A group health supplement to help employees with out-of-pocket expenses.



What multi-state health benefit is best for you?

Ultimately, the best health coverage option for multi-state employers depends on a variety of factors, including the size and location of their workforce, their budget constraints, and the specific needs of their employees. Working with a knowledgeable benefits consultant or broker can help you navigate the complexities of offering health coverage to your employees in multiple states and find a solution that meets their unique needs. By exploring the various options available, multi-state employers can ensure that their employees have access to quality health coverage, no matter where they live.

How can PeopleKeep help you offer multi-state health benefits?

If you're new to HRAs, making the switch to one may feel overwhelming. At PeopleKeep, we’re here to help. Our user-friendly software simplifies the process of offering personalized health benefits that meet the needs of your unique employees. Our team of experts handles documentation reviews for employee expenses, customer support, and generating federally required plan documents for compliance and privacy. We happily take on these tasks for you so you can focus on running your business.

We also work with Remodel Health to provide white-glove service to your employees as they enroll in a plan that best suits their needs. Remodel Health’s team of licensed consultants, benefits advisors, and customer success representatives assist your organization and your employees every step of the way.

Want to learn more? Speak with a PeopleKeep personalized benefits advisor who can answer your questions and guide you toward the best HRA for your organization.


Frequently asked questions

Do all employees have to be offered the same benefits?

There's no legal requirement that says all employees need to be offered the exact same benefits. This means you can legally offer a different health benefit allowance to employees who live in a state where the cost of living or healthcare is more expensive.

However, there are some anti-discrimination rules you'll need to keep in mind if you're going to be offering different benefits to employees in different groups.

Learn more about the regulations on offering different coverage for health benefits

Does an individual health insurance plan offer worse coverage than a group plan?

There's a common misconception that an individual health insurance plan doesn't offer the same quality of coverage as a group health plan. This is far from the truth, since all qualified health plans available on the health insurance exchanges cover the 10 essential health benefits.

While many employees are already familiar with group health insurance plans, their one-size-fits-all nature and strict requirements can actually make them a less attractive option.

Reimbursing employees for individual health insurance coverage is generally more cost-effective and flexible and empowers employees to make their own healthcare decisions—getting them the network providers they need at a price they can afford.

Learn more about how individual health insurance compares to group health plans

What if my employees need help finding a plan on the health insurance exchange?

If your employees are new to the health insurance marketplaces, offers free help to all healthcare consumers. Plus, Remodel Health offers enrollment support. Their team of experts walks your employees through all their options when it comes to choosing a health plan.

If you're interested in an HRA with PeopleKeep, you'll have access to our wealth of broker partners and experts to help your employees find the best plan for them, no matter their health or financial requirements or where they live.

Are there additional benefits I can offer to employees across state lines?

A health benefit isn't the only thing employees want. Vision, dental, and retirement benefits are also important to them. To see what's worth the investment, check out PeopleKeep's 2024 Employee Benefits Survey to find out what other benefits employees value most.

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Wondering how PeopleKeep can help you offer benefits?

Speak with a PeopleKeep personalized benefits advisor who can answer your questions and guide you toward the best benefits options for your organization.