Us Congress 2025-2026 Regular Session

Us Congress House Bill HB2528 Compare Versions

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Old	New	Differences
1	1	I
2	2	119THCONGRESS
3	3	1
4	4	STSESSION H. R. 2528
5	5	To amend the Employee Retirement Income Security Act of 1974 to clarify
6	6	the treatment of certain association health plans as employers, and
7	7	for other purposes.
8	8	IN THE HOUSE OF REPRESENTATIVES
9	9	APRIL1, 2025
10	10	Mr. W
11	11	ALBERG(for himself, Mr. ALLEN, Mr. ONDER, Mr. CRENSHAW, Mrs.
12	12	B
13	13	ICE, Mr. KILEYof California, Mr. GROTHMAN, Mr. MACKENZIE, and
14	14	Mr. H
15	15	UIZENGA) introduced the following bill; which was referred to the
16	16	Committee on Education and Workforce
17	17	A BILL
18	18	To amend the Employee Retirement Income Security Act
19	19	of 1974 to clarify the treatment of certain association
20	20	health plans as employers, and for other purposes.
21	21	Be it enacted by the Senate and House of Representa-1
22	22	tives of the United States of America in Congress assembled, 2
23	23	SECTION 1. SHORT TITLE. 3
24	24	This Act may be cited as the ‘‘Association Health 4
25	25	Plans Act’’. 5
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28	28	•HR 2528 IH
29	29	SEC. 2. TREATMENT OF GROUP OR ASSOCIATION OF EM-1
30	30	PLOYERS. 2
31	31	(a) I
32	32	NGENERAL.—Section 3(5) of the Employee Re-3
33	33	tirement Income Security Act of 1974 (29 U.S.C. 4
34	34	1002(5)) is amended— 5
35	35	(1) by striking ‘‘The term’’ and inserting ‘‘(A) 6
36	36	The term’’; and 7
37	37	(2) by adding at the end the following: 8
38	38	‘‘(B) For purposes of subparagraph (A), a group or 9
39	39	association of employers shall be treated as an ‘employer’, 10
40	40	regardless of whether the employers composing such group 11
41	41	or association are in the same industry, trade, or profes-12
42	42	sion, if such group or association— 13
43	43	‘‘(i)(I) has established and maintains an em-14
44	44	ployee welfare benefit plan that is a group health 15
45	45	plan (as defined in section 733(a)(1)); 16
46	46	‘‘(II) provides coverage under such plan to at 17
47	47	least 51 employees after all of the employees em-18
48	48	ployed by all of the employer members of such group 19
49	49	or association have been aggregated and counted to-20
50	50	gether as described in subparagraph (D); 21
51	51	‘‘(III) has been actively in existence for at least 22
52	52	2 years; 23
53	53	‘‘(IV) has been formed and maintained in good 24
54	54	faith for purposes other than providing medical care 25
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57	57	•HR 2528 IH
58	58	(as defined in section 733(a)(2)) through the pur-1
59	59	chase of insurance or otherwise; 2
60	60	‘‘(V) does not condition membership in the 3
61	61	group or association on any health status-related 4
62	62	factor (as described in section 702(a)(1)) relating to 5
63	63	any individual; 6
64	64	‘‘(VI) makes coverage under such plan available 7
65	65	to all employer members of such group or associa-8
66	66	tion regardless of any health status-related factor 9
67	67	(as described in section 702(a)(1)) relating to such 10
68	68	employer members; 11
69	69	‘‘(VII) does not provide coverage under such 12
70	70	plan to any individual other than an employee of an 13
71	71	employer member of such group or association; 14
72	72	‘‘(VIII) has established a governing board with 15
73	73	by-laws or other similar indications of formality to 16
74	74	manage and operate such plan in both form and 17
75	75	substance, of which at least 75 percent of the board 18
76	76	members shall be made up of employer members of 19
77	77	such group or association participating in the plan 20
78	78	that are duly elected by each participating employer 21
79	79	member casting 1 vote during a scheduled election; 22
80	80	‘‘(IX) is not a health insurance issuer (as de-23
81	81	fined in section 733(b)(2)), and is not owned or con-24
82	82	trolled by such a health insurance issuer or by a 25
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85	85	•HR 2528 IH
86	86	subsidiary or affiliate of such a health insurance 1
87	87	issuer, other than to the extent such a health insur-2
88	88	ance issuer may participate in the group or associa-3
89	89	tion as a member; 4
90	90	‘‘(ii) is structured in good faith with any set of 5
91	91	criteria to qualify for such treatment in any advisory 6
92	92	opinion issued prior to the date of enactment of the 7
93	93	Association Health Plans Act; or 8
94	94	‘‘(iii) meets any other set of criteria to qualify 9
95	95	for such treatment that the Secretary by regulation 10
96	96	may provide. 11
97	97	‘‘(C)(i) For purposes of subparagraph (B), a self-em-12
98	98	ployed individual shall be treated as— 13
99	99	‘‘(I) an employer who may become a member of 14
100	100	a group or association of employers; 15
101	101	‘‘(II) an employee who may participate in an 16
102	102	employee welfare benefit plan established and main-17
103	103	tained by such group or association; and 18
104	104	‘‘(III) a participant of such plan subject to the 19
105	105	eligibility determination and monitoring require-20
106	106	ments set forth in clause (iii). 21
107	107	‘‘(ii) For purposes of this subparagraph, the term 22
108	108	‘self-employed individual’ means an individual who— 23
109	109	‘‘(I) does not have any common law employees; 24
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112	112	•HR 2528 IH
113	113	‘‘(II) has a bona fide ownership right in a trade 1
114	114	or business, regardless of whether such trade or 2
115	115	business is incorporated or unincorporated; 3
116	116	‘‘(III) earns wages (as defined in section 4
117	117	3121(a) of the Internal Revenue Code of 1986) or 5
118	118	self-employment income (as defined in section 6
119	119	1402(b) of such Code) from such trade or business; 7
120	120	and 8
121	121	‘‘(IV) works at least 10 hours a week or 40 9
122	122	hours per month providing personal services to such 10
123	123	trade or business. 11
124	124	‘‘(iii) The board of a group or association of employ-12
125	125	ers shall— 13
126	126	‘‘(I) initially determine whether an individual 14
127	127	meets the requirements under clause (ii) to be con-15
128	128	sidered to a self-employed individual for the pur-16
129	129	poses of being treated as an— 17
130	130	‘‘(aa) employer member of such group or 18
131	131	association (in accordance with clause (i)(I)); 19
132	132	and 20
133	133	‘‘(bb) employee who may participate in the 21
134	134	employee welfare benefit plan established and 22
135	135	maintained by such group or association (in ac-23
136	136	cordance with clause (i)(II)); 24
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139	139	•HR 2528 IH
140	140	‘‘(II) through reasonable monitoring proce-1
141	141	dures, periodically determine whether the individual 2
142	142	continues to meet such requirements; and 3
143	143	‘‘(III) if the board determines that an indi-4
144	144	vidual no longer meets such requirements, not make 5
145	145	such plan coverage available to such individual (or 6
146	146	dependents thereof) for any plan year following the 7
147	147	plan year during which the board makes such deter-8
148	148	mination. If, subsequent to a determination that an 9
149	149	individual no longer meets such requirements, such 10
150	150	individual furnishes evidence of satisfying such re-11
151	151	quirements, such individual (and dependents thereof) 12
152	152	shall be eligible to receive plan coverage. 13
153	153	‘‘(D) For purposes of subparagraph (B), all of the 14
154	154	employees (including self-employed individuals) employed 15
155	155	by all of the employer members (including self-employed 16
156	156	individuals) of a group or association of employers shall 17
157	157	be— 18
158	158	‘‘(i) treated as participants in a single plan 19
159	159	multiple employer welfare arrangement; and 20
160	160	‘‘(ii) aggregated and counted together for pur-21
161	161	poses of any regulation of an employee welfare ben-22
162	162	efit plan established and maintained by such group 23
163	163	or association.’’. 24
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166	166	•HR 2528 IH
167	167	(b) DETERMINATION OF EMPLOYER ORJOINTEM-1
168	168	PLOYERSTATUS.—The provision of employee welfare ben-2
169	169	efit plan coverage by a group or association of employers 3
170	170	shall not be construed as evidence for establishing an em-4
171	171	ployer or joint employer relationship under any Federal 5
172	172	or State law. 6
173	173	SEC. 3. RULES APPLICABLE TO EMPLOYEE WELFARE BEN-7
174	174	EFIT PLANS ESTABLISHED AND MAINTAINED 8
175	175	BY A GROUP OR ASSOCIATION OF EMPLOY-9
176	176	ERS. 10
177	177	Part 7 of subtitle B of title I of the Employee Retire-11
178	178	ment Income Security Act of 1974 (29 U.S.C. 1181, et 12
179	179	seq.) is amended by adding at the end the following: 13
180	180	‘‘SEC. 736. RULES APPLICABLE TO EMPLOYEE WELFARE 14
181	181	BENEFIT PLANS ESTABLISHED AND MAIN-15
182	182	TAINED BY A GROUP OR ASSOCIATION OF 16
183	183	EMPLOYERS. 17
184	184	‘‘(a) P
185	185	REMIUMRATES FOR AGROUP ORASSOCIA-18
186	186	TION OFEMPLOYERS.— 19
187	187	‘‘(1)(A) In the case of an employee welfare ben-20
188	188	efit plan established and maintained by a group or 21
189	189	association of employers described in section 22
190	190	3(5)(B), such plan may, to the extent not prohibited 23
191	191	under State law— 24
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194	194	•HR 2528 IH
195	195	‘‘(i) establish base premium rates formed 1
196	196	on an actuarially sound, modified community 2
197	197	rating methodology that considers the pooling 3
198	198	of all plan participant claims; and 4
199	199	‘‘(ii) utilize the specific risk profile of each 5
200	200	employer member of such group or association 6
201	201	to determine contribution rates for each such 7
202	202	employer member’s share of a premium by ac-8
203	203	tuarially adjusting above or below the estab-9
204	204	lished base premium rates. 10
205	205	‘‘(B) For purposes of paragraph (1), the term 11
206	206	‘employer member’ means— 12
207	207	‘‘(i) an employer who is a member of such 13
208	208	group or association of employers and employs 14
209	209	at least 1 common law employee; or 15
210	210	‘‘(ii) a group made up solely of self-em-16
211	211	ployed individuals, within which all of the self- 17
212	212	employed individual members of such group or 18
213	213	association are aggregated together as a single 19
214	214	employer member group, provided the group in-20
215	215	cludes at least 20 self-employed individual 21
216	216	members. 22
217	217	‘‘(2) In the event a group or association is 23
218	218	made up solely of self-employed individuals (and no 24
219	219	employers with at least 1 common law employee are 25
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222	222	•HR 2528 IH
223	223	members of such group or association), the employee 1
224	224	welfare benefit plan established by such group or as-2
225	225	sociation shall— 3
226	226	‘‘(A) treat all self-employed individuals 4
227	227	who are members of such group or association 5
228	228	as a single risk pool; 6
229	229	‘‘(B) pool all plan participant claims; and 7
230	230	‘‘(C) charge each plan participant the 8
231	231	same premium rate. 9
232	232	‘‘(b) D
233	233	ISCRIMINATION AND PRE-EXISTINGCONDI-10
234	234	TIONPROTECTIONS.—An employee welfare benefit plan 11
235	235	established and maintained by a group or association of 12
236	236	employers described in section 3(5)(B) shall be prohibited 13
237	237	from— 14
238	238	‘‘(1) establishing any rule for eligibility (includ-15
239	239	ing continued eligibility) of any individual (including 16
240	240	an employee of an employer member or a self-em-17
241	241	ployed individual, or a dependent of such employee 18
242	242	or self-employed individual) to enroll for benefits 19
243	243	under the terms of the plan that discriminates based 20
244	244	on any health status-related factor that relates to 21
245	245	such individual (consistent with the rules under sec-22
246	246	tion 702(a)(1)); 23
247	247	‘‘(2) requiring an individual (including an em-24
248	248	ployee of an employer member or a self-employed in-25
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251	251	•HR 2528 IH
252	252	dividual, or a dependent of such employee or self- 1
253	253	employed individual), as a condition of enrollment or 2
254	254	continued enrollment under the plan, to pay a pre-3
255	255	mium or contribution that is greater than the pre-4
256	256	mium or contribution for a similarly situated indi-5
257	257	vidual enrolled in the plan based on any health sta-6
258	258	tus-related factor that relates to such individual 7
259	259	(consistent with the rules under section 702(b)(1)); 8
260	260	and 9
261	261	‘‘(3) denying coverage under such plan on the 10
262	262	basis of a pre-existing condition (consistent with the 11
263	263	rules under section 2704 of the Public Health Serv-12
264	264	ice Act).’’. 13
265	265	SEC. 4. RULE OF CONSTRUCTION. 14
266	266	Nothing in this Act shall be construed to exempt a 15
267	267	group health plan which is an employee welfare benefit 16
268	268	plan offered through a group or association of employers 17
269	269	from the requirements of part 7 of subtitle B of title I 18
270	270	of the Employee Retirement Income Security Act of 1974 19
271	271	(29 U.S.C. 1181 et. seq.), including the provisions of part 20
272	272	A of title XXVII of the Public Health Service Act as incor-21
273	273	porated by reference into this Act through section 715. 22
274	274	Æ
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