119-hr2528

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2528 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 2528

To amend the Employee Retirement Income Security Act of 1974 to clarify 
the treatment of certain association health plans as employers, and for 
 other purposes.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 April 1, 2025

 Mr. Walberg (for himself, Mr. Allen, Mr. Onder, Mr. Crenshaw, Mrs. 
 Bice, Mr. Kiley of California, Mr. Grothman, Mr. Mackenzie, and Mr. 
 Huizenga) introduced the following bill; which was referred to the 
 Committee on Education and Workforce

_______________________________________________________________________

 A BILL

To amend the Employee Retirement Income Security Act of 1974 to clarify 
the treatment of certain association health plans as employers, and for 
 other purposes.

 Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

 This Act may be cited as the ``Association Health Plans Act''.

SEC. 2. TREATMENT OF GROUP OR ASSOCIATION OF EMPLOYERS.

    (a) In General.--

Section 3

    (5) of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1002

    (5) ) is amended--

    (1) by striking ``The term'' and inserting ``
        (A) The 
 term''; and

    (2) by adding at the end the following:
 ``
        (B) For purposes of subparagraph
        (A) , a group or association of 
employers shall be treated as an `employer', regardless of whether the 
employers composing such group or association are in the same industry, 
trade, or profession, if such group or association--
 ``
            (i) 
            (I) has established and maintains an employee welfare 
 benefit plan that is a group health plan (as defined in 

section 733

    (a)

    (1) );
 ``
            (II) provides coverage under such plan to at least 51 
 employees after all of the employees employed by all of the 
 employer members of such group or association have been 
 aggregated and counted together as described in subparagraph
            (D) ;
 ``
            (III) has been actively in existence for at least 2 
 years;
 ``
            (IV) has been formed and maintained in good faith for 
 purposes other than providing medical care (as defined in 
 

section 733

    (a)

    (2) ) through the purchase of insurance or 
 otherwise;
 ``
            (V) does not condition membership in the group or 
 association on any health status-related factor (as described 
 in 

section 702

    (a)

    (1) ) relating to any individual;
 ``
            (VI) makes coverage under such plan available to all 
 employer members of such group or association regardless of any 
 health status-related factor (as described in 

section 702

    (a)

    (1) ) relating to such employer members;
 ``
            (VII) does not provide coverage under such plan to any 
 individual other than an employee of an employer member of such 
 group or association;
 ``
            (VIII) has established a governing board with by-laws or 
 other similar indications of formality to manage and operate 
 such plan in both form and substance, of which at least 75 
 percent of the board members shall be made up of employer 
 members of such group or association participating in the plan 
 that are duly elected by each participating employer member 
 casting 1 vote during a scheduled election;
 ``
            (IX) is not a health insurance issuer (as defined in 
 

section 733

    (b)

    (2) ), and is not owned or controlled by such a 
 health insurance issuer or by a subsidiary or affiliate of such 
 a health insurance issuer, other than to the extent such a 
 health insurance issuer may participate in the group or 
 association as a member;
 ``
            (ii) is structured in good faith with any set of criteria 
 to qualify for such treatment in any advisory opinion issued 
 prior to the date of enactment of the Association Health Plans 
 Act; or
 ``
            (iii) meets any other set of criteria to qualify for such 
 treatment that the Secretary by regulation may provide.
 ``
            (C) 
            (i) For purposes of subparagraph
        (B) , a self-employed 
individual shall be treated as--
 ``
            (I) an employer who may become a member of a group or 
 association of employers;
 ``
            (II) an employee who may participate in an employee 
 welfare benefit plan established and maintained by such group 
 or association; and
 ``
            (III) a participant of such plan subject to the 
 eligibility determination and monitoring requirements set forth 
 in clause
            (iii) .
 ``
            (ii) For purposes of this subparagraph, the term `self-employed 
individual' means an individual who--
 ``
            (I) does not have any common law employees;
 ``
            (II) has a bona fide ownership right in a trade or 
 business, regardless of whether such trade or business is 
 incorporated or unincorporated;
 ``
            (III) earns wages (as defined in 

section 3121

    (a) of the 
 Internal Revenue Code of 1986) or self-employment income (as 
 defined in 

section 1402

    (b) of such Code) from such trade or 
 business; and
 ``
            (IV) works at least 10 hours a week or 40 hours per month 
 providing personal services to such trade or business.
 ``
            (iii) The board of a group or association of employers shall--
 ``
            (I) initially determine whether an individual meets the 
 requirements under clause
            (ii) to be considered to a self-
 employed individual for the purposes of being treated as an--
 ``

    (aa) employer member of such group or association 
 (in accordance with clause
            (i) 
            (I) ); and
 ``

    (bb) employee who may participate in the employee 
 welfare benefit plan established and maintained by such 
 group or association (in accordance with clause
            (i) 
            (II) );
 ``
            (II) through reasonable monitoring procedures, 
 periodically determine whether the individual continues to meet 
 such requirements; and
 ``
            (III) if the board determines that an individual no 
 longer meets such requirements, not make such plan coverage 
 available to such individual (or dependents thereof) for any 
 plan year following the plan year during which the board makes 
 such determination. If, subsequent to a determination that an 
 individual no longer meets such requirements, such individual 
 furnishes evidence of satisfying such requirements, such 
 individual (and dependents thereof) shall be eligible to 
 receive plan coverage.
 ``
            (D) For purposes of subparagraph
        (B) , all of the employees 
(including self-employed individuals) employed by all of the employer 
members (including self-employed individuals) of a group or association 
of employers shall be--
 ``
            (i) treated as participants in a single plan multiple 
 employer welfare arrangement; and
 ``
            (ii) aggregated and counted together for purposes of any 
 regulation of an employee welfare benefit plan established and 
 maintained by such group or association.''.

    (b) Determination of Employer or Joint Employer Status.--The 
provision of employee welfare benefit plan coverage by a group or 
association of employers shall not be construed as evidence for 
establishing an employer or joint employer relationship under any 
Federal or State law.

SEC. 3. RULES APPLICABLE TO EMPLOYEE WELFARE BENEFIT PLANS ESTABLISHED 
 AND MAINTAINED BY A GROUP OR ASSOCIATION OF EMPLOYERS.

 Part 7 of subtitle B of title I of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1181, et seq.) is amended by adding at 
the end the following:

``

SEC. 736. RULES APPLICABLE TO EMPLOYEE WELFARE BENEFIT PLANS 
 ESTABLISHED AND MAINTAINED BY A GROUP OR ASSOCIATION OF 
 EMPLOYERS.

 ``

    (a) Premium Rates for a Group or Association of Employers.--
 ``

    (1)
        (A) In the case of an employee welfare benefit plan 
 established and maintained by a group or association of 
 employers described in 

section 3

    (5)
        (B) , such plan may, to the 
 extent not prohibited under State law--
 ``
            (i) establish base premium rates formed on an 
 actuarially sound, modified community rating 
 methodology that considers the pooling of all plan 
 participant claims; and
 ``
            (ii) utilize the specific risk profile of each 
 employer member of such group or association to 
 determine contribution rates for each such employer 
 member's share of a premium by actuarially adjusting 
 above or below the established base premium rates.
 ``
        (B) For purposes of paragraph

    (1) , the term `employer 
 member' means--
 ``
            (i) an employer who is a member of such group or 
 association of employers and employs at least 1 common 
 law employee; or
 ``
            (ii) a group made up solely of self-employed 
 individuals, within which all of the self-employed 
 individual members of such group or association are 
 aggregated together as a single employer member group, 
 provided the group includes at least 20 self-employed 
 individual members.
 ``

    (2) In the event a group or association is made up solely 
 of self-employed individuals (and no employers with at least 1 
 common law employee are members of such group or association), 
 the employee welfare benefit plan established by such group or 
 association shall--
 ``
        (A) treat all self-employed individuals who are 
 members of such group or association as a single risk 
 pool;
 ``
        (B) pool all plan participant claims; and
 ``
            (C) charge each plan participant the same premium 
 rate.
 ``

    (b) Discrimination and Pre-Existing Condition Protections.--An 
employee welfare benefit plan established and maintained by a group or 
association of employers described in 

section 3

    (5)
        (B) shall be 
prohibited from--
 ``

    (1) establishing any rule for eligibility (including 
 continued eligibility) of any individual (including an employee 
 of an employer member or a self-employed individual, or a 
 dependent of such employee or self-employed individual) to 
 enroll for benefits under the terms of the plan that 
 discriminates based on any health status-related factor that 
 relates to such individual (consistent with the rules under 
 

section 702

    (a)

    (1) );
 ``

    (2) requiring an individual (including an employee of an 
 employer member or a self-employed individual, or a dependent 
 of such employee or self-employed individual), as a condition 
 of enrollment or continued enrollment under the plan, to pay a 
 premium or contribution that is greater than the premium or 
 contribution for a similarly situated individual enrolled in 
 the plan based on any health status-related factor that relates 
 to such individual (consistent with the rules under 

section 702

    (b)

    (1) ); and
 ``

    (3) denying coverage under such plan on the basis of a 
 pre-existing condition (consistent with the rules under 

section 2704 of the Public Health Service Act).''.

SEC. 4. RULE OF CONSTRUCTION.

 Nothing in this Act shall be construed to exempt a group health 
plan which is an employee welfare benefit plan offered through a group 
or association of employers from the requirements of part 7 of subtitle 
B of title I of the Employee Retirement Income Security Act of 1974 (29 
U.S.C. 1181 et. seq.), including the provisions of part A of title 
XXVII of the Public Health Service Act as incorporated by reference 
into this Act through 

section 715.
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