Daily Archives: July 22, 2018

ASSOCIATION HEALTH PLAN (AHP) FINAL RULES ISSUED

On January 4, 2018, the U.S. Department of Labor (DOL) announced proposed rules to expand the
opportunity to offer employment-based health insurance to small businesses through Association
Health Plans.

On June 19, 2018, the Trump Administration released a final rule as well as a fact sheet on the new rule.
The rule was in response to an executive order issued by President Trump on October 12, 2017 directing
federal agencies to expand the availability of AHPs, short-term limited duration insurance policies and
Health Reimbursement Arrangements. The proposal calls for a revision to ERISA in order to redefine
“employer” to allow more groups to qualify as associations and treat health coverage sponsored by an
employer association as a single group health plan that would not be subject to the ACA’s ten essential
health benefits required in the consumer and small group markets.

The goal of the Administration’s rule is to provide small-business owners, employees of small businesses and
family members of working owners and their employees with more coverage options, more affordable pricing,
enhanced ability to self-insure, less regulatory burden and complexity and reduced administrative costs.

HOW
Under the final rule, self-employed individuals, sole proprietors and common-law employees would be
permitted to join an AHP.
The final rule does say that there must be at least one other service, e.g., education, offered to members
so that the association cannot solely exist to provide health insurance. Allowing the self-employed without
employees to join is beneficial as they were excluded in 2014 when they could no longer get group coverage,
but there is a risk of anti-selection. It was suggested that they should have one open enrollment season to
avoid any anti-selection. Although the final rule does not mandate one enrollment period, it does allow the
association to incorporate the suggested rule.

State laws are not preempted, which means the final rule will apply to them.

REGIONAL STATE REVIEW
New York State DFS (New York State Department of Financial Services) has reported that the Trump
Administration’s final rule expanding the role of association health plans won’t prevent its authority to
regulate health insurance.

New Jersey DOBI (New Jersey Department of Banking and Insurance) has reported that it will not allow
non-compliant plans.

Delaware currently allows a Delaware-based employer to participate in an association plan from another
state if that state allows it and the Delaware group is a member of that association.

NEW JERSEY ENFORCES THE INDIVIDUAL MANDATE STARTING JANUARY 1, 2019

ƒƒ New Jersey is the second state after Vermont to enact an individual mandate, which becomes effective
January 1, 2019.  The purpose of P.L. 2018, Chapter 31 is to stabilize the market and help keep health insurance premiums
as low as possible.  The tax applies to all New Jersey residential taxpayers. Hardship exemptions shall be determined by the State Treasurer.  The mandate requires individuals to maintain minimum essential coverage (MEC) or pay a penalty.
ƒƒ The amount of the tax penalty is the New Jersey average premium for bronze level plans, $695 or 2.5% of income, whichever is greater. “Income” is defined as household income minus any deductions.

The tax will be collected via the New Jersey income tax return.

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Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA.
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