Jul 23, 2018

How the new AHP rule changes will transform small businesses

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With more than half of U.S. workers leaving their current job in search of better pay and benefits, a compelling benefits package is a critical competitive advantage for small businesses. It allows them to stand apart from companies of similar sizes and better stack up against larger ones when competing for candidates or attempting to retain talented staffers. Unfortunately, the historical realities of running a small business and sometimes-burdensome health insurance requirements make those benefits packages all but unattainable for most companies.

That all changed this week. The new DOL change loosens restrictions so that beginning Sept. 1, 2018, small businesses are eligible to band together with others based on industry or geographic affinity to form collectives that can purchase large group health plans. This effectively opens the door for millions of small businesses to offer cost-effective health insurance benefits to millions of American workers.

Known as association health plans, these plans deliver big company benefits with the savings available through group purchasing — typically 10-30%. The move effectively widens the pool of available benefits to employers and employees while reducing administrative overhead for small businesses. The ability to tap AHPs can return the competitive HR advantage to smaller businesses and organizations.

And these businesses are ready to embrace this opportunity. We recently surveyed more than 700 small business and franchisee employers and uncovered strong demand for these benefits, with 84% of respondents expressing a desire to offer their own plans.

An AHP can offer tremendous financial and operational benefits for a group of businesses. For example, in only the first 40 days of launching an AHP, one trust membership saved its owner-operators more than $1.5 Million. Additionally, the program realized cost savings of over 20% on medical insurance, averaging over $1,000 per full-time employee.

So, what should small businesses know about these rule changes, including their eligibility and how to effectively prepare for September 1?

The key provisions in DOL ruling include the following:

  • The rule expands the definition of “employer” allowing small-business owners, their employees, sole proprietors and other self-employed people to join to buy health insurance plans. The increased bargaining power can lead to lower prices and more cost-effective coverage — this can result in lower premiums for employees.
  • The DOL affirmed that "commonality of interest" is still the measurement used to determine eligibility, however that has been expanded to include geography within a state in addition to common business interest (same trade or business)
  • An association now can be formed for the sole purpose of offering an association health plan to its members
  • As Robert Cresanti, president and CEO of International Franchise Association, noted, “franchise small business owners will be exempt from any possible joint-employer liability that may have come about if they partnered with other franchisees operating under the same brand”.

How to prepare

An AHP or Trust can be sponsored by a group member association and overseen by members of this organization. The job of the AHP is to aggregate and manage member needs to secure coverage on behalf of its members. The AHP often contracts with a broker specializing in small business and program management to create a benefits portfolio for the members, negotiate with insurers on its behalf, and provide program management. The goal is a turnkey solution for the collective sourcing of small business benefits.

An AHP can be set up using three different structures for medical and other benefits:

Fully Insured Medical: This plan requires no initial capital reserves and does not share risk among the members. Instead, the insurer takes on all risk with little or no financial outlay from the AHP at startup. This is the easiest plan to administer and communicate.

Self-Funded Medical: This approach requires the AHP to fund some initial capital or financial reserves, meaning it assumes a collective financial risk for providing health care benefits to its members. While insurers prefer this approach, the advantage to the AHP is group-wide savings if the collective group has positive claims experience over time.

Hybrid Medical: This approach blends risk for all parties and allows dividends or gain sharing for members based on good loss performance. It is sometimes called a Minimum Premium Program.

The AWANE Team specializes in AHPs, with compliance, administration, finance, and strategy a part of our ongoing service to our members. From underwriting to open enrollment, AWANE looks out for member businesses so that business owners and employees can focus on the success and growth of their business.

Contact us today to learn more about why we are entering our 90th year of strength and stability.

AWANE is happy to share this article from our friends at the Employee Benefit Advisor.



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