119-hr2571

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2571 Introduced in House

    (IH) ]

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119th CONGRESS
 1st Session
 H. R. 2571

To amend the Employee Retirement Income Security Act of 1974 to exclude 
 from the definition of health insurance coverage certain medical stop-
loss insurance obtained by certain plan sponsors of group health plans, 
 and for other purposes.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 April 1, 2025

 Mr. Onder 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 exclude 
 from the definition of health insurance coverage certain medical stop-
loss insurance obtained by certain plan sponsors of group health plans, 
 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 ``Self-Insurance Protection Act''.

SEC. 2. FINDINGS.

 Congress finds the following:

    (1) Small and large employers offer health benefit plan 
 coverage to employees in self-funded arrangements using company 
 assets or a fund, or by paying premiums to purchase fully-
 insured coverage from a health insurance company.

    (2) Employers that self-fund health benefit plans will 
 often purchase stop-loss insurance as a financial risk 
 management tool to protect against excess or unexpected 
 catastrophic health plan claims losses that arise above 
 projected costs paid out of company assets.

    (3) Stop-loss coverage insures the employer sponsoring the 
 health benefit plan against unforeseen health plan claims, does 
 not insure the employee health benefit plan itself, and does 
 not pay health care providers for medical services provided to 
 the employees.

    (4) Employer-sponsored health benefit plans are regulated 
 under the Employee Retirement Income Security Act of 1974, 
 however, States regulate the availability and the coverage 
 terms of stop-loss insurance coverage that employers purchase 
 to protect company assets and to protect a fund against excess 
 or unexpected claims losses.

    (5) Both large and small employers that choose to self-fund 
 must also be able to protect company assets or a fund against 
 excess or unexpected claims losses and States must reasonably 
 regulate stop-loss insurance to assure its availability to both 
 large and small employers.

SEC. 3. CERTAIN MEDICAL STOP-LOSS INSURANCE OBTAINED BY CERTAIN PLAN 
 SPONSORS OF GROUP HEALTH PLANS NOT INCLUDED UNDER THE 
 DEFINITION OF HEALTH INSURANCE COVERAGE.

 

Section 733

    (b)

    (1) of the Employee Retirement Income Security Act of 
1974 (29 U.S.C. 1191b

    (b)

    (1) ) is amended by adding at the end the 
following sentence: ``Such term shall not include a stop-loss policy 
obtained by a self-insured group health plan or a plan sponsor of a 
group health plan that self-insures the health risks of its plan 
participants to reimburse the plan or sponsor for losses that the plan 
or sponsor incurs in providing health or medical benefits to such plan 
participants in excess of a predetermined level set forth in the stop-
loss policy obtained by such plan or sponsor.''.

SEC. 4. EFFECT ON OTHER LAWS.

 

Section 514

    (b) of the Employee Retirement Income Security Act of 
1974 (29 U.S.C. 1144

    (b) ) is amended by adding at the end the following:
 ``

    (10) The provisions of this title (including part 7 relating to 
group health plans) shall preempt State laws insofar as they may now or 
hereafter prevent an employee benefit plan that is a group health plan 
from insuring against the risk of excess or unexpected health plan 
claims losses.''.
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