Administration finalizes rule expanding access to association health plans

Enzi New Rule Will Provide More Options for Small Businesses to Get Health Care for Employees

He says this could be good news for small business employees.

America's Health Insurance Plans (AHIP), which represents insurers, released a statement saying the final rule does offer some important consumer protections, including for those with preexisting conditions.

The company showed signs of improvement in the first quarter of this year, earning a $2.8 million underwriting profit in NY. In signing the order, Trump said AHPs would "help small businesses overcome this competitive disadvantage by allowing them to group together to self-insure or purchase large group health insurance".

But they won't have to offer all the same benefits as plans bought by individuals on the Obamacare exchange. Decisely's deep expertise in the Association Health Plan (AHP) market uniquely positions them to help businesses quickly and easily take advantage of these rule changes. While there are many elements to the new rules, one key issue is that health plans will not be required to cover the Patient Protection & Affordable Care Act-mandated (PPACA) essential health benefits, which includes ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and addiction treatment services, prescription drugs, rehabilitative and habilitative services, laboratory services, preventive and wellness services and chronic disease management, and pediatric services. The new rule will begin applying to plans over the next year. "When they finally do get sick, they find out at exactly the wrong time and coverage is more expensive or unavailable". The agency also cited commenters on the proposed rule who observed that most small businesses can join a chamber of commerce or professional association, and that "a proliferation of groups or associations established for the exclusive goal of sponsoring an AHP" could diminish the value of such organizations.

On Tuesday, Dawn Sweeney, president of the National Restaurant Association, which has long pressed for broader access to association health plans, said "small restaurant owners from Nevada to North Carolina will now be able to purchase high quality insurance for a more affordable price". Such plans can continue to operate as before, or elect to follow the new requirements if they want to expand within a geographic area, regardless of industry, or to cover the self-employed.

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Morrisey says it could also provide lower-cost coverage, outside of the current marketplace. For insurance to be affordable, you need most of the policyholders to be paying premiums and not using very many services.

In addition to exemptions from the comprehensive coverage requirements, since they will be considered large group plans, AHPs will be allowed to charge different rates based on gender, age, occupation, and geography. Acosta emphasized that the rules keep the same "consumer protection and health-care anti-discrimination that now apply to large companies". It has estimated that average premiums for those buying small-group and individual plans will go up by 2 to 3 percent because of healthy people leaving those markets for association and short-term plans.

For example, people who work in the agriculture industry could team together to get their health insurance through the proposed AgCareFirst plan, which has been touted by NC Farm Bureau Mutual Insurance in trade publications.

The AHP rule does not preempt state laws, so states may continue to regulate AHPs as multiple employer welfare arrangements, whether fully insured or self-funded.

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