On June 19, 2018, the Department of Labor (DOL) released a final rule that gives small businesses more freedom to join together as a single group to purchase health insurance in the large group market or to self-insure. These benefit arrangements are called association health plans (AHPs). The final rule allows working owners without other employees, such as sole proprietors and other self-employed individuals, to join AHPs.
The final rule allows employers to join together to form an AHP that is a single ERISA plan if either of the following requirements is satisfied:
- The employers are in the same trade, industry, line of business or profession; or
- The employers have a principal place of business within a region that does not exceed boundaries of the same state or the same metropolitan area (even if the metropolitan area includes more than one state).
Most AHPs will not be subject to the Affordable Care Act’s requirement to include Essential Health Benefits (EHB), which requires small group plans to cover a core set of 10 major items and services, such as mental health care, maternity and newborn care, prescription drugs and emergency services. Most AHPs will also be exempt from the ACA’s rating restrictions for the small group market, which means that AHPs may base premiums on factors such as age, industry and gender. The final rule requires AHPs to comply with certain consumer protections and anti-discrimination protections that apply to the large group market (learn more).
R&R will continue to keep you informed as we monitor developing guidance regarding AHPs and other benefits matters at the federal and state levels. For a more complete understanding of the new AHP rule, click here to read more.