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DOL Proposes New Rules Expanding Association Health Plan Options

January 11, 2018

On January 4, 2018, following Presidential Executive Order (EO) 13813, the U.S. Department of Labor (DOL) announced its plan to expand access to healthcare through small business health plans. EO 13813, “Promoting Healthcare Choice and Competition Across the United States,” directed the U.S. Departments of Labor, Health and Human Services (HHS), and the Treasury to develop rules to expand association health plans (AHPs), short-term limited duration insurance, and health reimbursement arrangements (HRAs).

The DOL’s proposed rule pertains to AHPs only by modifying the definition of “employer” under Section 3(5) of the Employee Retirement Income Security Act of 1974 (ERISA) regarding entities (AHPs) that could sponsor group health coverage.  This change would allow employers to band together to offer health coverage if they either are: “(1) in the same trade, industry, line of business, or profession; or (2) have a principal place of business within a region that does not exceed the boundaries of the same State or the same metropolitan area (even if the metropolitan area includes more than one State).” The proposed rule would also allow working business owners, such as sole proprietors and other self-employed individuals, to act as employers for purposes of participating in an AHP and treated as employees of their businesses for purposes of being covered by the group or association’s health plan.

The proposal could increase the flexibility for small employers to join groups or associations to offer insured health coverage in the large group market at potentially more favorable pricing with less restrictive requirements, but questions remain, such as the impact state laws might still have, especially for plans that are not fully insured and generally remain subject to state insurance laws. 

Comments are due by March 6, 2018. AGC will provide input to the DOL on the proposal and notify members of all developments.

For more information, contact Jim Young at youngj@agc.org or 202-547-0133 or Claiborne Guy at claiborne.guy@agc.org or 703-837-5382.

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