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