When unrelated employers join together in an association or other group to purchase or arrange for health insurance, the association is defined as a “multiple employer welfare arrangement” or “MEWA” under the law. MEWAs are unusual under the Employee Retirement Income Security Act (ERISA) preemption rules. The preemption provision of ERISA generally prohibits states from regulating employee benefit plans. Because of preemption, employee benefit plans are usually required to conform to the same rules across the country regardless of which state the plan is in. ERISA preemption does not apply to state insurance laws. Thus, if the benefits under a MEWA are fully insured, the insurance contracts that provide the benefits will be regulated by state insurance laws, insurance commissioners, and other protections established for individuals covered under insurance policies. If a MEWA is not fully insured, however, a special ERISA rule allows states to regulate the MEWA even though the state is not then regulating “insurance.” In many states, a self-insured MEWA will have to register as an insurer and meet state compliance and reserve requirements if it is to operate legally. Sometimes the complexity of the arrangements invented for programs established by a business association can raise the question of whether a MEWA is fully insured or not. In a recent advisory option, the DOL ruled that a complex arrangement set up for an association of railroad employers did not qualify as fully insured and thus was subject to state regulation as a self-insured MEWA. Any employer participating in or contemplating joining an association of employers in order to jointly purchase health or other welfare benefits is well-advised to make sure the association is meeting all insurance or state self-insurance rules as a MEWA. (DOL Advisory Opinion 2011-OIA)