Association Health Plans

Association Health Plans

Since the Affordable Care Act passed, insurance companies have been looking for ways to decrease prices. Many have offered lower costing plans for specific illnesses. Others have put time limits on how long their coverage will last or ask health questions and increase the rate or deny you coverage based on the answers. The best option available today, for small businesses, have been Association Health Plans.

* There may have been new association plans released since the creation of this article. Also, some of the association health plans listed below may no longer be available in Nevada. Please call our office if you would like information about an association plan that is not mentioned in this article.

Major Medical or Not

Plans today still fall into two general categories. They’re either major medical plans or they’re not. This has nothing to do with being “qualified” or “Obamacare”. The plans offered through the state and federal exchanges are all major medical plans. However, many plans sold outside the exchanges are major medical plans as well. A major medical plan has:

  • A maximum out of pocket amount. This is an annual limit to the amount you pay in a year for medical services. This is a good thing.
  • These plans pass certification by the state division of insurance. This means that if you have a problem, there is an ultimate authority that’s not the insurance company.
  • These plans have contracts with doctors. This also means that the doctor sends the bill to the insurance company first. This is not a plan where the employee is reimbursed by the insurance company. This is also known as an indemnity plan.
  • They do not ask health questions. With all carriers except Aetna and ABC plans, there is no rating-up based on the answers to health questions or denying coverage.
  • They don’t cover just one specific illness or injury. These are 24/7 plans that cover you no matter when or how the injury happened (unless it was an intentional injury, etc)

The new Association Health Plans being offered are major medical plans that meet all of these requirements.

Aetna – Aetna Funding Advantage

One of the first insurance companies to begin offering a version of these types of plans was Aetna. Aetna calls it the Aetna Funding Advantage plans. These save an average of about 24% for groups. The qualification process is very strict. The insurance company can deny coverage based on health history. Groups with 1 to 9 employees are not eligible. If the group has 10 to 14 employees, they need to pass health statements and rarely qualify. Groups with 15+ employees are rated using GRX (prescription drug use) to underwrite. Aetna issues rates based on 4 tier composite rates only (employee only, employee + spouse, employee + child, and employee + family). 25% of the groups are denied. Of the groups that pass the quoting, about 50% move forward (according to reps of Aetna).

The main advantages:

1. If you qualify, the rates are great.

2. If you didn’t use as much of the plan as you paid for, they reimburse a portion of your money at the end of the year. Nationally 55% of groups received this refund.

3. These plans include the Mayo Clinic.

Anthem – Las Vegas Metro Chamber of Commerce

Anthem partnered with the Las Vegas Metro Chamber of Commerce to offer Association Health Plans. These are mainly focused on members in the Las Vegas area.

Sierra Health & Life – Health Plan of Nevada

3 other Chamber of Commerce associations near Las Vegas combined for health insurance reasons to create the Clark County Health Plan Association. These are mainly focused on members of the Las Vegas area as well.

Prominence – Nevada Builders Alliance

Prominence has come out with two plans. The first was a partnership with the Nevada Builders Alliance. These Nevada Builders Alliance Health Plans are exclusively available to builders, subcontractors, as well as related trades. All Prominence Association Health Plans are on a calendar year. This year Prominence offered 5 plans with much better benefits than the standard plans. Regarding the rating, for groups with less than 20 employees, Prominence rates may be at or above expected. In addition, Prominence will rate up certain industries and smaller groups.

Prominence – Reno-Sparks Chamber of Commerce

For the non-builder businesses, Prominence offered plans through the Reno-Sparks Chamber of Commerce. These plans are almost identical to the Nevada Builders Alliance however, 6 plans are offered. They also have the same requirements as the Nevada Builders Alliance and the same rating-up for smaller groups.

Hometown Health Plans – Associated Builders and Contractors

Hometown has been offering these association health plans for several years. This was originally established with a pre-ACA trust agreement that allowed this type of plan. Although when the ACA passed, new agreements were very difficult to approve. However, this one survived. The group needs to pass a short-form health statement in order to qualify. Additionally, groups with less than 15 employees or groups with ANY prior history of medical conditions are unlikely to pass. These are strictly available to members of the Associated Builders and Contractors, so a contractors license is required as well.

Hometown Health – Builders Association of Northern Nevada

The Builders Association of Northern Nevada paired with Hometown Health to offer what is likely to be the most competitive rates for builders this year. These plans are different than the standard builder’s rates in a few critical ways. Like all builders plans, you need to be a member of BANN and need to be a contractor/subcontractor or in a related field. They released rates for “associate members” (non-builders) but there are better options available. The BANN health plans do NOT rate up based on group size or specific SIC codes. They also do not ask health questions and the savings for our average groups has been around 20%.