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The Wagner Law Group

The Wagner Law Group is a nationally recognized practice in the areas of ERISA and employee benefits, estate planning, employment, labor and human resources and investment management.

 

Established in 1996, The Wagner Law Group is dedicated to the highest standards of integrity, excellence and thought leadership and is considered to be amongst the nation's premier ERISA and employee benefits law firms. The firm has seven offices across the country, providing unparalleled legal advice to its clients, including large, small and nonprofit corporations as well as individuals and government entities worldwide. The Wagner Law Group's 31 attorneys, senior benefits consultant and four paralegals combine many years of experience in their fields of practice with a variety of backgrounds. Seven of the attorneys are AV-rated by Martindale-Hubbell and six are Fellows of the American College of Employee Benefits Counsel, an invitation-only organization of nationally recognized employee benefits lawyers.  Seven of the firm's attorneys have been named to the prestigious Super Lawyers list for 2017, which highlights outstanding lawyers based on a rigorous selection process.

 

 

 

Contact Info

The Wagner Law Group

 

  Integrity | Excellence

  

Boston 

Tel: (617) 357-5200 

Fax: (617) 357-5250 

99 Summer Street 

13th Floor

Boston, MA 02110

 

Washington, D.C.

Tel: (202) 969-2800

 

Fax: (202) 969-2568

 800 Connecticut Avenue, N.W.

Suite 810

Washington, D.C. 20006

 

Chicago

Tel: (847) 990-9034

Fax: (847) 557-1312

190 South LaSalle Street

Suite 2100

Chicago, IL 60603

 

  

Palm Beach Gardens 

Tel: (561) 293-3590
Fax: (561) 293-3591
7108 Fairway Drive
Suite 125
Palm Beach Gardens, FL 33418

   

Tampa

Tel: (813) 603-2959

Fax: (813) 603-2961

101 East Kennedy Boulevard

Suite 2140
Tampa, FL  33602 

  

San Francisco

Tel: (415) 625-0002

Fax: (415) 358-8300

300 Montgomery Street

Suite 600

San Francisco, CA 94104

  

St. Louis

Tel: (314) 236-0065

Fax: (314) 236-5743
25 W. Moody Avenue
St. Louis, MO  63119 

 

 

www.wagnerlawgroup.com

 

 

 

 

    DOL to Expand Association Health Plans

January 11, 2018

 

 

 

The Department of Labor has issued proposed regulations that would allow "bona fide groups or associations of employers" to more easily join together to form Association Health Plans ("AHPs") that offer group health coverage to member employers and their employees under a single group health plan.  The proposed rule would allow employers to join together as a bona fide, single group to purchase insurance in the large group market.

 

 

Bona Fide Groups.  For these purposes, a bona fide group or association of employers must meet the following requirements:

 

  • The group or association exists , in whole or in part, for the purpose of sponsoring a group health plan;
  • The group or association has a formal organizational structure with a governing body and  by-laws or other similar "indications of formality";
  • The functions and activities of the group or association, including the establishment and maintenance of the group health plan, are controlled by its employer members, either directly or indirectly through the regular nomination and election of directors, officers, or other similar representatives that control the group or association and the establishment and maintenance of the plan;
  • The employer members have a "commonality of interest";
  • The group or association does not make health coverage through the association available other than to employees and former employees of employer members and family members or other beneficiaries of those employees and former employees; and
  • The group or association and health coverage offered by the group or association complies with certain nondiscrimination provisions of the ACA.

 

The proposal does not appear to limit the size of employers who may participate in an AHP.

 

 

 

Commonality of interest.  Commonality of interest of employer members of a group or association will be determined based on relevant facts and circumstances and may be established by:

 

  • Employers being in the same trade, industry, line of business or profession; or
  • Employers having a principal place of business in 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).

 

Discrimination.  The group or association:

 

  • Must not condition employer membership in the group or association  on any health factor of an employee or employees or any employee's family members or other beneficiaries. 
  • Must comply with the ACA nondiscrimination  rules for eligibility for benefits, and nondiscrimination in premiums.
  • Must not restrict membership in the association itself based on any health factor, as defined in the HIPAA/ACA nondiscrimination rules.  The ACA nondiscrimination rules define a health factor as: health status, medical condition (including both physical and mental illnesses), claims experience, receipt of healthcare, medical history, genetic information, evidence of insurability, and disability.

 

Owner/Employees:  The proposed regulations would also permit working owners of an incorporated or unincorporated trade or business, including partners in a partnership, to elect to act as employers for purposes of  participating in an employer group or association sponsoring a health plan, and also to be treated as employees with respect to a trade, business or partnership for purposes of being covered by the employer's group's or association's health plan.

 

 

 

Note:  Under the proposal, AHPs would not be required to comply with all provisions of the ACA.  For example, their group health plans would not have to cover all of the 10 "essential health benefits" (which include hospitalization, prescription drugs and emergency care).  They would also be exempt from an ACA rule requiring insurers to spend at least 80 percent of premium revenue on medical care.

 

 

 

 

 

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This Newsletter is provided for information purposes by The Wagner Law Group to clients and others who may be interested in the subject matter, and may not be relied upon as specific legal advice.  This material is not to be construed as legal advice or legal opinions on specific facts. Under the Rules of the Supreme Judicial Court of Massachusetts, this material may be considered advertising.