Carson City, NV June 27, 2019
There has been some confusion regarding the sale of
Association Health Plans (“AHPs”) after a court order vacated some aspects of
the U.S Department of Labor’s (“DOL”) 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, 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
- 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
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, an employer should obtain written assurance from the
Association that it is an approved Pathway I AHP.
If a consumer has any questions or believes they may have
purchased a Pathway II AHP after March 28, 2019 they may contact the Division
by calling (702) 486-4009 in Las Vegas or (775) 687-0700 in Carson City.
About the Nevada Division of Insurance
The State of Nevada Division of Insurance, a Division of the
Nevada Department of Business and Industry, protects the rights of Nevada
consumers and regulates Nevada’s $14 billion insurance industry. The Division
of Insurance has offices in Carson City and Las Vegas. In 2018, the Division
investigated more than 3,100 consumer complaints and recovered over $8.4
million on behalf of consumers. For more information about the Division of
Insurance, visit DOI.NV.GOV.
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