The Pool and Hot TubAlliance is now offering a new health Insurance program that is exclusive to its Texas members.
The program is being offered through Aqualine Insurance Services, a fullservice brokerage that is working with PHTA as their exclusive insurance partner.
They have created an Association Health Plan, AHP, which is a group benefit program that allows smaller employers to access the lower rates and better benefits of their larger competitors. AHP’s also allow eligible companies to take advantage of different underwriting guidelines than are allowed by the Affordable Care Act.
Aqualine has partnered with PHTA and UnitedHealthcare, the largest insurance carrier in the country, to develop an AHP exclusively for PHTA member firms in Texas.
By pooling PHTA’s smaller members together, they can provide the better benefits that companies of hundreds to thousands of employees have.
To understand how an Association Health Plan works, its useful to look at how traditional medical insurance works under the Affordable Care Act.
There are a few underwriting restrictions that differentiate the two.
With traditional medical insurance under theAffordable CareAct, males and females are rated the same. However, in general, females are more costly to insurance carriers. Females have babies and tend to visit doctors more often than men. Because men are less expensive to insurance carriers than women, a company that is comprised mostly of men doesn’t see an advantages from this fact under a traditional ACA plan.
Also, under ACA, there is a 3:1 limit on age rating. That means that a 64-yearold cannot be charged more than three times the premium of a 21-year-old for the same plan.
Furthermore, pre-existing health conditions do not affect the rates under an ACA plan. So, if your company has a group of healthy employees, you will be given the same rates as a company whose employees have major health concerns.
Aqualine Insurance Services has found in their research that PHTA member firms typically have a young, healthy population of employees with a high percentage of men, which traditional ACA group insurance plans do not favor.
Through the PHTA Association Health Plan, discounts are given for an employer with more male employees than female employees. Discounts are also given for an employer with an average employee age in the 20’s or 30’s. Discounts are given for employees with little or no pre-existing health conditions.
According to John Dudek, Head of the Benefits Department of Aqualine Insurance, it is common for insurance carriers not operating under the ACA to look at this type of demographic data – it’s just part of the rating process.
Because of these discounts, the PHTA can offer group medical rates that are 20% to 30% less expensive than traditional small group carriers.
While any member of PHTA in Texas with 50 or fewer employees is eligible for this program, companies with specific demographics will see the largest savings.
The greatest saving will be seen for member firms with 10-50 employees with a high male population of employees with an average age of under 40-years old, with few pre-existing conditions.
Savings will also be seen for member firms with existing coverage, and for these firms, they can switch to the PHTA Association Health plan outside of their existing benefits renewal date without penalty.
UnitedHealthcare is the largest insurance carrier in the country. They are offering a suite of plans and benefits that is not available to any other small employer in Texas. Coverage options include:
• Medical HMO’s
• Medical PPO’s
• High deductible, eligible medical plans
• Dental PPO’s • Vision PPO’s
• Employee and spouse life and AD& D Insurance
• Short term disability
• Long term disability While the PHTA Association Health Care Plan is currently only available to PHTA Texas members, the organization is hopeful to bring the plan to other states as well. However, according to Dudek, some states such as California and Virginia have enacted legislation disallowing association health plans, mainly to protect the ACA.
“We’re hoping we can show that we’re successful in Texas and then go to other states and say, ‘This is helpful to the association, this is helpful to our members, why don’t we try it in other states as well?’” Dudek said.
To learn more about the PHTA Texas members Health Care Plan, visit the Texas Pool & Spa Coalition at https:// www.txpsc.org/advocacy/news/