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explored banding together to form a single group health all. Even fully insured association MEWAs are often sub­
plan, but their desire to do so has been thwarted by the ject to certification requirements under state law, as well as
realities of federal and state MEWA regulations. That’s other requirements such as a minimum period for a bona
because the federal and state regulations currently imposed fide association to be in existence before it can provide a
health plan.
Now let’s get into why an association may want to create
The new regulations may result in its own AHP and why participating employers may want to

coverage under an AHP that is less join that AHP.
For members of some associations, such as NSAA, the
expensive than coverage offered new regulations may result in coverage under an AHP that is
less expensive than coverage offered through the individual
through the individual and small and small group health insurance markets under the ACA.

group health insurance markets There are several factors that could result in lower cost—at
least for some individuals and small employers.
under the ACA.
1. Under the new rule, compliant AHPs will be treated as
one single large employer plan rather than an aggregation
on MEWAs are substantial and may sometimes make cre at­ of small employer and individual plans. Thus, they will not
ing a MEWA impractical. This difficulty is particularly be required to cover the ACA’s 10 essential health benefits
present where a MEWA would attempt to cover employers (like providing vision care, mental health benefits, etc.).
in multiple states (across state lines), in which case they This means an AHP could, for example, choose not to cover
may find widely differing and conflicting state laws and, pediatric dental and vision or rehabilitative services. Or, it
in the case of self­insured MEWAs, no clear avenue for the could exclude coverage for prescription drugs or inpatient
MEWA to lawfully operate within one or more states at hospital care. It may also exclude coverage for specific

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