Associations offer group health insurance to their members who may be employers or unions. Approximately 118,000 Oregonians receive health insurance through an association.
Health benefit plans sold through associations are generally regulated based on the purchaser. For example, coverage purchased through an association by an individual constitutes individual coverage, coverage purchased through an association by an employer with 40 employees constitutes small employer coverage, and coverage purchased through an association by an employer with 51 employees constitutes large group coverage.
However, under limited circumstances, the association itself, rather than the purchaser, is considered the group. Generally, an association is considered to be one group when the employers that make up the association have a certain level of control over the association and a degree of commonality of interest with the sponsors. This is a fact-specific determination made under federal law and is a difficult standard for most associations to meet. However, when an association meets this standard and it has group membership (not individual membership) totaling 51 or more, it is considered one large group and is not subject to Oregon's small group rating laws or federal pooling or rating requirements.
The ACA made several changes to the way associations are regulated in Oregon. For example, individual and small group association plans must be pooled with plans in the individual and small group markets and meet the same rating requirements. Also, with few exceptions, plans sold to association members must also be available in the overall market to individuals and groups who are not members of the association.