I
119THCONGRESS
1
STSESSION 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
APRIL1, 2025
Mr. O
NDERintroduced 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 insur-
ance coverage certain medical stop-loss insurance ob-
tained by certain plan sponsors of group health plans,
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 ‘‘Self-Insurance Protec-4
tion Act’’. 5
SEC. 2. FINDINGS. 6
Congress finds the following: 7
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(1) Small and large employers offer health ben-1
efit plan coverage to employees in self-funded ar-2
rangements using company assets or a fund, or by 3
paying premiums to purchase fully-insured coverage 4
from a health insurance company. 5
(2) Employers that self-fund health benefit 6
plans will often purchase stop-loss insurance as a fi-7
nancial risk management tool to protect against ex-8
cess or unexpected catastrophic health plan claims 9
losses that arise above projected costs paid out of 10
company assets. 11
(3) Stop-loss coverage insures the employer 12
sponsoring the health benefit plan against unfore-13
seen health plan claims, does not insure the em-14
ployee health benefit plan itself, and does not pay 15
health care providers for medical services provided to 16
the employees. 17
(4) Employer-sponsored health benefit plans are 18
regulated under the Employee Retirement Income 19
Security Act of 1974, however, States regulate the 20
availability and the coverage terms of stop-loss in-21
surance coverage that employers purchase to protect 22
company assets and to protect a fund against excess 23
or unexpected claims losses. 24
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(5) Both large and small employers that choose 1
to self-fund must also be able to protect company as-2
sets or a fund against excess or unexpected claims 3
losses and States must reasonably regulate stop-loss 4
insurance to assure its availability to both large and 5
small employers. 6
SEC. 3. CERTAIN MEDICAL STOP-LOSS INSURANCE OB-7
TAINED BY CERTAIN PLAN SPONSORS OF 8
GROUP HEALTH PLANS NOT INCLUDED 9
UNDER THE DEFINITION OF HEALTH INSUR-10
ANCE COVERAGE. 11
Section 733(b)(1) of the Employee Retirement In-12
come Security Act of 1974 (29 U.S.C. 1191b(b)(1)) is 13
amended by adding at the end the following sentence: 14
‘‘Such term shall not include a stop-loss policy obtained 15
by a self-insured group health plan or a plan sponsor of 16
a group health plan that self-insures the health risks of 17
its plan participants to reimburse the plan or sponsor for 18
losses that the plan or sponsor incurs in providing health 19
or medical benefits to such plan participants in excess of 20
a predetermined level set forth in the stop-loss policy ob-21
tained by such plan or sponsor.’’. 22
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SEC. 4. EFFECT ON OTHER LAWS. 1
Section 514(b) of the Employee Retirement Income 2
Security Act of 1974 (29 U.S.C. 1144(b)) is amended by 3
adding at the end the following: 4
‘‘(10) The provisions of this title (including part 7 5
relating to group health plans) shall preempt State laws 6
insofar as they may now or hereafter prevent an employee 7
benefit plan that is a group health plan from insuring 8
against the risk of excess or unexpected health plan claims 9
losses.’’. 10
Æ
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