I
119THCONGRESS
1
STSESSION 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
APRIL1, 2025
Mr. W
ALBERG(for himself, Mr. ALLEN, Mr. ONDER, Mr. CRENSHAW, Mrs.
B
ICE, Mr. KILEYof California, Mr. GROTHMAN, Mr. MACKENZIE, and
Mr. H
UIZENGA) 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 Representa-1
tives of the United States of America in Congress assembled, 2
SECTION 1. SHORT TITLE. 3
This Act may be cited as the ‘‘Association Health 4
Plans Act’’. 5
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SEC. 2. TREATMENT OF GROUP OR ASSOCIATION OF EM-1
PLOYERS. 2
(a) I
NGENERAL.—Section 3(5) of the Employee Re-3
tirement Income Security Act of 1974 (29 U.S.C. 4
1002(5)) is amended— 5
(1) by striking ‘‘The term’’ and inserting ‘‘(A) 6
The term’’; and 7
(2) by adding at the end the following: 8
‘‘(B) For purposes of subparagraph (A), a group or 9
association of employers shall be treated as an ‘employer’, 10
regardless of whether the employers composing such group 11
or association are in the same industry, trade, or profes-12
sion, if such group or association— 13
‘‘(i)(I) has established and maintains an em-14
ployee welfare benefit plan that is a group health 15
plan (as defined in section 733(a)(1)); 16
‘‘(II) provides coverage under such plan to at 17
least 51 employees after all of the employees em-18
ployed by all of the employer members of such group 19
or association have been aggregated and counted to-20
gether as described in subparagraph (D); 21
‘‘(III) has been actively in existence for at least 22
2 years; 23
‘‘(IV) has been formed and maintained in good 24
faith for purposes other than providing medical care 25
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(as defined in section 733(a)(2)) through the pur-1
chase of insurance or otherwise; 2
‘‘(V) does not condition membership in the 3
group or association on any health status-related 4
factor (as described in section 702(a)(1)) relating to 5
any individual; 6
‘‘(VI) makes coverage under such plan available 7
to all employer members of such group or associa-8
tion regardless of any health status-related factor 9
(as described in section 702(a)(1)) relating to such 10
employer members; 11
‘‘(VII) does not provide coverage under such 12
plan to any individual other than an employee of an 13
employer member of such group or association; 14
‘‘(VIII) has established a governing board with 15
by-laws or other similar indications of formality to 16
manage and operate such plan in both form and 17
substance, of which at least 75 percent of the board 18
members shall be made up of employer members of 19
such group or association participating in the plan 20
that are duly elected by each participating employer 21
member casting 1 vote during a scheduled election; 22
‘‘(IX) is not a health insurance issuer (as de-23
fined in section 733(b)(2)), and is not owned or con-24
trolled by such a health insurance issuer or by a 25
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subsidiary or affiliate of such a health insurance 1
issuer, other than to the extent such a health insur-2
ance issuer may participate in the group or associa-3
tion as a member; 4
‘‘(ii) is structured in good faith with any set of 5
criteria to qualify for such treatment in any advisory 6
opinion issued prior to the date of enactment of the 7
Association Health Plans Act; or 8
‘‘(iii) meets any other set of criteria to qualify 9
for such treatment that the Secretary by regulation 10
may provide. 11
‘‘(C)(i) For purposes of subparagraph (B), a self-em-12
ployed individual shall be treated as— 13
‘‘(I) an employer who may become a member of 14
a group or association of employers; 15
‘‘(II) an employee who may participate in an 16
employee welfare benefit plan established and main-17
tained by such group or association; and 18
‘‘(III) a participant of such plan subject to the 19
eligibility determination and monitoring require-20
ments set forth in clause (iii). 21
‘‘(ii) For purposes of this subparagraph, the term 22
‘self-employed individual’ means an individual who— 23
‘‘(I) does not have any common law employees; 24
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‘‘(II) has a bona fide ownership right in a trade 1
or business, regardless of whether such trade or 2
business is incorporated or unincorporated; 3
‘‘(III) earns wages (as defined in section 4
3121(a) of the Internal Revenue Code of 1986) or 5
self-employment income (as defined in section 6
1402(b) of such Code) from such trade or business; 7
and 8
‘‘(IV) works at least 10 hours a week or 40 9
hours per month providing personal services to such 10
trade or business. 11
‘‘(iii) The board of a group or association of employ-12
ers shall— 13
‘‘(I) initially determine whether an individual 14
meets the requirements under clause (ii) to be con-15
sidered to a self-employed individual for the pur-16
poses of being treated as an— 17
‘‘(aa) employer member of such group or 18
association (in accordance with clause (i)(I)); 19
and 20
‘‘(bb) employee who may participate in the 21
employee welfare benefit plan established and 22
maintained by such group or association (in ac-23
cordance with clause (i)(II)); 24
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‘‘(II) through reasonable monitoring proce-1
dures, periodically determine whether the individual 2
continues to meet such requirements; and 3
‘‘(III) if the board determines that an indi-4
vidual no longer meets such requirements, not make 5
such plan coverage available to such individual (or 6
dependents thereof) for any plan year following the 7
plan year during which the board makes such deter-8
mination. If, subsequent to a determination that an 9
individual no longer meets such requirements, such 10
individual furnishes evidence of satisfying such re-11
quirements, such individual (and dependents thereof) 12
shall be eligible to receive plan coverage. 13
‘‘(D) For purposes of subparagraph (B), all of the 14
employees (including self-employed individuals) employed 15
by all of the employer members (including self-employed 16
individuals) of a group or association of employers shall 17
be— 18
‘‘(i) treated as participants in a single plan 19
multiple employer welfare arrangement; and 20
‘‘(ii) aggregated and counted together for pur-21
poses of any regulation of an employee welfare ben-22
efit plan established and maintained by such group 23
or association.’’. 24
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(b) DETERMINATION OF EMPLOYER ORJOINTEM-1
PLOYERSTATUS.—The provision of employee welfare ben-2
efit plan coverage by a group or association of employers 3
shall not be construed as evidence for establishing an em-4
ployer or joint employer relationship under any Federal 5
or State law. 6
SEC. 3. RULES APPLICABLE TO EMPLOYEE WELFARE BEN-7
EFIT PLANS ESTABLISHED AND MAINTAINED 8
BY A GROUP OR ASSOCIATION OF EMPLOY-9
ERS. 10
Part 7 of subtitle B of title I of the Employee Retire-11
ment Income Security Act of 1974 (29 U.S.C. 1181, et 12
seq.) is amended by adding at the end the following: 13
‘‘SEC. 736. RULES APPLICABLE TO EMPLOYEE WELFARE 14
BENEFIT PLANS ESTABLISHED AND MAIN-15
TAINED BY A GROUP OR ASSOCIATION OF 16
EMPLOYERS. 17
‘‘(a) P
REMIUMRATES FOR AGROUP ORASSOCIA-18
TION OFEMPLOYERS.— 19
‘‘(1)(A) In the case of an employee welfare ben-20
efit plan established and maintained by a group or 21
association of employers described in section 22
3(5)(B), such plan may, to the extent not prohibited 23
under State law— 24
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‘‘(i) establish base premium rates formed 1
on an actuarially sound, modified community 2
rating methodology that considers the pooling 3
of all plan participant claims; and 4
‘‘(ii) utilize the specific risk profile of each 5
employer member of such group or association 6
to determine contribution rates for each such 7
employer member’s share of a premium by ac-8
tuarially adjusting above or below the estab-9
lished base premium rates. 10
‘‘(B) For purposes of paragraph (1), the term 11
‘employer member’ means— 12
‘‘(i) an employer who is a member of such 13
group or association of employers and employs 14
at least 1 common law employee; or 15
‘‘(ii) a group made up solely of self-em-16
ployed individuals, within which all of the self- 17
employed individual members of such group or 18
association are aggregated together as a single 19
employer member group, provided the group in-20
cludes at least 20 self-employed individual 21
members. 22
‘‘(2) In the event a group or association is 23
made up solely of self-employed individuals (and no 24
employers with at least 1 common law employee are 25
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members of such group or association), the employee 1
welfare benefit plan established by such group or as-2
sociation shall— 3
‘‘(A) treat all self-employed individuals 4
who are members of such group or association 5
as a single risk pool; 6
‘‘(B) pool all plan participant claims; and 7
‘‘(C) charge each plan participant the 8
same premium rate. 9
‘‘(b) D
ISCRIMINATION AND PRE-EXISTINGCONDI-10
TIONPROTECTIONS.—An employee welfare benefit plan 11
established and maintained by a group or association of 12
employers described in section 3(5)(B) shall be prohibited 13
from— 14
‘‘(1) establishing any rule for eligibility (includ-15
ing continued eligibility) of any individual (including 16
an employee of an employer member or a self-em-17
ployed individual, or a dependent of such employee 18
or self-employed individual) to enroll for benefits 19
under the terms of the plan that discriminates based 20
on any health status-related factor that relates to 21
such individual (consistent with the rules under sec-22
tion 702(a)(1)); 23
‘‘(2) requiring an individual (including an em-24
ployee of an employer member or a self-employed in-25
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dividual, or a dependent of such employee or self- 1
employed individual), as a condition of enrollment or 2
continued enrollment under the plan, to pay a pre-3
mium or contribution that is greater than the pre-4
mium or contribution for a similarly situated indi-5
vidual enrolled in the plan based on any health sta-6
tus-related factor that relates to such individual 7
(consistent with the rules under section 702(b)(1)); 8
and 9
‘‘(3) denying coverage under such plan on the 10
basis of a pre-existing condition (consistent with the 11
rules under section 2704 of the Public Health Serv-12
ice Act).’’. 13
SEC. 4. RULE OF CONSTRUCTION. 14
Nothing in this Act shall be construed to exempt a 15
group health plan which is an employee welfare benefit 16
plan offered through a group or association of employers 17
from the requirements of part 7 of subtitle B of title I 18
of the Employee Retirement Income Security Act of 1974 19
(29 U.S.C. 1181 et. seq.), including the provisions of part 20
A of title XXVII of the Public Health Service Act as incor-21
porated by reference into this Act through section 715. 22
Æ
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