Nevada Provides Clarification Regarding Sale of Association Health Plans

June 27, 2019

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Source: KTVN

The State of Nevada Division of Insurance says it wants to clear up some confusion regarding the sale of Association Health Plans after a court order vacated some aspects of the U.S Department of Labor’s final rule on AHPs.

With the new rule, the DOL extended the eligibility for AHPs, with eligibility under the new rule known as Pathway II. AHPs eligible under the prior rule are known as Pathway I.

Pathway II AHPs are the ones that are affected. While the court’s decision is on appeal, DOI says only Pathway I AHPs can enroll new companies; Pathway II AHPs are not permitted to enroll new members.

“Consumers need to be cautious if they are interested in purchasing an AHP now,” said Insurance Commissioner Barbara Richardson. “There is certain very restrictive criteria that AHPs have to meet in order to be considered a Pathway I and continue to be sold. Unless the DOL has provided a formal opinion to an insurance company certifying the AHP is a Pathway I, such plan may not be valid.”

Before purchasing an AHP, an employer should ask the following questions:

  • Is this plan being sold to consumers with a similar job, industry or line of business as me?
  • Is this plan being sold to sole-proprietors?
  • Is this plan being sold to other people in different zip codes who do not share a similar jobs, industry or line of business as me?

A “No” response to the first question or a “yes” response to the last two questions may indicate that the AHP was approved under Pathway II and the sale of these new AHPs may not be allowed by the DOL. Prior to purchasing an AHP, DOI says an employer should get written assurance from the Association that it is an approved Pathway I AHP.

If you have any questions or believe you may have purchased a Pathway II AHP after March 28, 2019, call the Division by calling (702) 486-4009 in Las Vegas or (775) 687-0700 in Carson City.

(DOI contributed to this report.)

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